Transcript TRN-0035-14 iSite 3.5: Exceptions Handler (RIS)

iSite 3.5: Exceptions Handling (RIS Version)
Table of Contents
•
Objectives
•
Terminology
•
Exception Definition
•
Exceptions Handler
•
Resolve Exception
•
Verify Resolution
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Learning Objectives
• Understand the purpose and performance of:
– Exception Occurrence
– Exceptions Handler
– Building Exceptions List
– Resolving Exceptions
– Verifying Exceptions
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Terminology
• PACS (Picture Archive and Communications System)
– Information Systems designed to manage, store and distribute
medical images and related information throughout the healthcare
enterprise
• HIS (Hospital Information System)
– Information Systems designed to manage patient records, including
patient registration, billing and order entry
• RIS (Radiology Information System)
– Information Systems designed to manage exams (orders), including
filling orders and scheduling
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Terminology
• MRN (Medical Record Number)
– A unique patient identifier (also known as Patient ID) used for
auditing of billing and scheduling for patients
• Accession Number (ACCession Number)
– A unique exam identifier (also known as an order number or
requisition number) used for auditing of billing and scheduling of
scheduled procedures
• SUID (Study Instance Unique IDentifier)
– A unique study identifier used for auditing of performed imaging
service requests
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Terminology
• DICOM (Digital Imaging COmmunication in Medicine)
– DICOM is the predominant communication standard between
imaging equipment throughout the Healthcare Enterprise
• HL7 (Health Level 7)
– HL7 is the predominant messaging standard for exchanging key
sets of administrative and clinical data in the healthcare enterprise
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Exception Resolution
1. Identify Exception
1. Worklist Module
2. Exceptions Handler Option
2. View Exception Images
1. Click on ID hyperlink
2. Click View
3. iSite will present matches based on MRN and Accession Number or
the user may enter a known ACC (from RIS) and apply
1. Additional searches may be performed by clicking find pt/exam button
2. Click on the radio button next to patient’s record
4. Locate the Exam
1. Click on the MRN hyperlink
2. Verify Exam information and apply
5. Verify Resolution of Exception
1. Check patient folder
2. Check inactive/active lists
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“Gold Standard” Patient Record
• In a RIS integrated environment, the iSite database is populated with
patient records and exams by HL7 messages
• The record from the RIS is the record that iSite will consider the Gold
Standard
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Definition of an Exception
• An exception is a study that contains patient or exam information from
the modality which does not match patient demographic information
residing within the iSite database for this patient or exam
• DICOM Metadata, including MRN and/or Accession number, do not
match the iSite database Gold Standard
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Image Validation
• All studies from modalities need to be validated prior to registration into
the iSite database
• Exceptions are studies that fail the automatic validation process and are
identified with (!) an exclamation point in the Patient Directory
• Exception studies require a MANUAL process to validate them into the
database
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Image Validation
• iSite uses an interface (ConnectR) to automatically validate studies into
the database
• ConnectR looks at DICOM Metadata for images and validates the
images with the corresponding exam ordered by the RIS
HL7 Order
ACC
Study (DICOM Metadata)
…
SUID
iSite Database
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Image Header Information
• The Image DICOM Metadata information that ConnectR uses for
validation in a RIS integrated environment are:
• Medical Record Number
• Accession Number
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Image Header Information
Modality
(scanner)
NAME
MRN
ACC #
NAME
MRN
ACC #
Diagnostic
viewing
workstation
iSite Server
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Exception Occurrence in RIS Environment
• DMWL (Dicom Modality Work List) was not used for some reason
– HIS/RIS was down
•
•
•
•
Network or Connectivity Issue
Power Outage
System Reset
Periodic System Maintenance
– Lack of full DICOM support at the modalities
• Technologists must manually enter patient information
• ACC not entered or entered incorrectly
• Modality allows manual entry of MRN or ACC number, but it does not
insert it into the DICOM Metadata
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Exception Occurrence in RIS Environment
• DMWL (Dicom Modality Work List) was not used for some reason
– ER
• Did not have time to order exam in RIS
• No ACC number assigned when exam started
– Workflow Error
• ACC or Exam was cancelled while exam was in progress
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Identifying Exceptions
• In iSite Enterprise
– Patient Directory (identify exceptions with an ‘!’ next to the
patient’s name)
– Worklist Filters
– Exceptions Handler Folder
• In iSuite
– Exceptions Handler tab within the Worklist tab
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Exceptions Handler
• In iSuite or iSite Enterprise from the Folder List
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Exceptions List
• Select an Exceptions List
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Exceptions List
• A New Exceptions Worklist may be built
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Exceptions List
• Active or Inactive Status
• Reason (e.g. ACC not found)
• Patient Sex
• Performing Resources
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Exceptions List “Best Practices”
• 2 Days is recommended for
Date Range
• ACQ and FIND are
recommended for Type
• Modality is recommended in
most instances
• To select a modality click the
(…) button
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Exceptions List
• Select the modality from
the pop-up Equipment
Dictionary
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Identifying Exceptions
• An Additional Search may be made using Patient Name or Accession
Number as well as other identifiers
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Resolve Exceptions
• An Exception may be resolved by selecting the ID hyperlink
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Resolve Exceptions
• View the image by selecting the ‘View’ button
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Resolve Exceptions
• Images of poor quality may be removed by selecting the
‘remove’ button
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Resolve Exceptions
• iSuite conducts a Database search for a matching MRN (Patient ID)
and ACC (Accession Number)
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Resolve Exceptions
• Locate the Patient’s Record/Exam
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Resolve Exceptions
• Select the correct Accession Number to which the images belong
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Resolve Exceptions
• If ACC number is known it may be entered in the field
• ACC number entered must represent a valid exam that the RIS ordered or it
will be rejected
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Resolve Exceptions
• ‘find pt/exam’ may be used to perform additional searches
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Resolve Exceptions
• iSuite conducts a Database search for a Name, although additional
searches may be made
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Resolve Exceptions
• Select the ‘apply’ button
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Resolve Exceptions
• Resolve the Exception by confirming the selection
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Exception Resolution Verification
• Verify the Exception is now in the ‘Inactive’ Exception List and no longer
in the ‘Active’ Exception List
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Exception Resolution Verification
In iSite Enterprise verify:
• Exception with the “!” is no longer there
• Exception’s Images or study are now part of the patient’s original folder
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Exception Resolution
1. Identify Exception
1. Worklist Module
2. Exceptions Handler Option
2. View Exception Images
1. Click on ID hyperlink
2. Click View
3. iSite will present matches based on MRN and Accession Number or
the user may enter a known ACC (from RIS) and apply
1. Additional searches may be performed by clicking find pt/exam button
2. Click on the radio button next to patient’s record
4. Locate the Exam
1. Click on the MRN hyperlink
2. Verify Exam information and apply
5. Verify Resolution of Exception
1. Check patient folder
2. Check inactive/active lists
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For assistance, please call customer support at
1-877-328-2808 or 1-877-328-2809
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