Transcript NPfIT_RIS_Coding update - UK Imaging Informatics Group

Terminology for
representation of
Diagnostic Imaging
Procedures - Update
Dr Keith Foord
Consultant Radiologist, East Sussex Hospitals
A national system of RIS coding
and descriptors ?
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Relates to needs of request/entry systems within ICRS – preRIS - SNOMED match to record request to Spine
Consistency and uniqueness in requesting terminology – preRIS and within RIS
Consistency in activity measurement - RIS
Consistency in clinical coding of events – RIS - SNOMED match
But must be as intuitive and easy to use as possible
Should have national acceptance
For accurate communication of results data between hospitals –
post RIS results reporting, cluster stores and national spine SNOMED match to ‘performed examination code’ to Spine
For ‘Payment by results’ – accurate records of same patient
activity – national tariffs - SNOMED match / accurate HRGs
DICOM Structured Reporting
NHS Costings Code Book
Descriptors
Descriptors need to be UNIQUE in NCRS
FOOT LEFT not unique
When a user searches all of the examinations available for ‘Foot Left’
the search may return:
FOOT LEFT, FOOT LEFT Swab, FOOT LEFT Physiotherapy,
FOOT LEFT Dressing,
etc., etc.
But XR FOOT LEFT is unique
Unique codes for requestor, reporter, Trust,
ward and unique ‘Accession numbers’
related to examination modality.
Requestor and reporter ? National code or
GMC/GDC/SR no. or cross match to this via look up table.
May not be a doctor.
Trust ? 3 character codes eg RPX
Ward ? 3 character prefix eg RPXBaird
Accession No. ? 3 character prefix RPX123456.
Needed as same model machines might generate
identical numbers and no process between manufacturers
to coordinate these.
Radiology Short Codes
Used in RIS as shortcuts
For bookings
For internal communications within Radiology
To help group procedures
For internal management / audit / activity
For common use need a structure, ideally
short (max. 6 letters/digits) and logical
Radiological Short Codes
1 2 3 4 5 6
Modality
X – X-ray
F – Fluoro
I – Interventional/
Fluoro
C – CT
M – MRI
U – U’sound
N – Radionuclide
Imaging
P – PET
E- Endoscopy
Z- Image
analysis or
review
Three or four letter body part
/ function code
4th letter reserved
for R, L, B or W
if procedure R or L lateralisable,
Both or Whole body,
otherwise can be used for any
letter or number
Postqualifier
(Extra or subdescriptor)
Format for a midline or non lateralising structure, no
post qualifier
ABCDE
Format for a lateralisable or whole body structure, no
post qualifier
ABCDF
Format for a midline or non lateralising structure,
with a post qualifier
ABCDEG
Format for a lateralisable or whole body structure,
with a post qualifier
ABCDF G
Extra qualifiers (6th letter/number = G)
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A
B
D
E
I
J
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M
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O
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P
R
S
T
X
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1
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Ablation
Biopsy (Core or FNA)
Drainage or Aspiration of fluid
Embolisation
Insertion of device
inJection - as an objective of the procedure, not as part of the preliminary to this
objective
Mobile - for any modality, but particularly for 'portable' plain films and use of mobile
image intensifiers
tOmography in its wider sense. O may be added to any plain film examination to
define planar tomography - or postcoordinated
Plasty - as in angioPlasty or dacrocystoPlasty - ie balloon dilatation
for Radiotherapy planning
Stent
Use of intraThecal contrast
eXtraction - eg in retrieval of intravascular foreign bodies or removal of temporary IVC
filter
First part of study
Second part of study
Third part of study
Fourth visit etc. – 5,6,7,8,9 – 10th = 0
Eg CT guided PELVic Biopsy
CPEL VB
Eg Interventional (Fluoroscopic) Right SFA Angioplasty
I ASF RP
Pre and Post Co-ordination (1)
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In order to group procedures many RIS systems lack
the ability to post co-ordinate procedures together
under one accession number.
Particular examples are for 'both' plain film exams eg
'both ankles' and in CT where examinations often
combine e.g. CT Chest, Abdomen, Pelvis.
Pre co-ordination or grouping of these procedures is
therefore required in advance.
Pre co-ordination should not be used in RIS-PACS
systems capable of full post co-ordination as with
these individual procedure codes will be automatically
or manually grouped prior to archiving and reporting
Eg CT guided PELVic Biopsy
CPEL VB
This is pre-coordinated with the whole
process described in the code
Pre and Post Co-ordination (2)
In modern RIS systems post co-ordination can be
applied to group related procedures together. All RIS
systems supplied via LSPs should do this.
 Some procedure codes such as 'U/S biopsy' by
themselves do not define precisely what has
happened although it would define the activity of
“Performing a biopsy under ultrasound control and the
consumables/activity associated with this.”
 Such codes need post co-ordinating with the relevant
body part to fully inform activity statistics
 Similarly separate CT body part examinations can be
post co-ordinated together to enable the multiple
examinations to be reported together as one report.
 The advantage is a more sophisticated approach to
audit, activity measurement and stocktaking
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Eg CT guided PELVis Biopsy
CPEL VB
CPEL V
PLUS
CB I OP B
Are POST coordinated and describe both processes which are
then reported as one. CT biopsy cost structures do not need to be
built into multiple codes
Eg PET/CT for Chest
CCHES
PLUS
P GE NW
Are POST coordinated and describe both processes which are
then reported as one.
Full list of
RIS Codes &
Descriptors
+ Synonyms
SNOMED CT
Descriptors
and Codes
NACS
Location &
People
codes
Post
Coordinating
RIS single
descriptors
HL7
RIS
SNOMED CT
Descriptors
and Codes
HL7
NCRS
‘Order’
Entry
List of
Orderable
Procedures
SNOMED CT
Descriptors
and Codes
NCRS
‘Reporting’
Module
SNOMED CT
SPINE
Sub-Descriptors / Codes
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REQUESTING Layer
(1st order)
Right Oblique
QR
Left Oblique
QL
Right Lateral
LR
Left Lateral
LL
Weight Bearing WB
Standing
ST
Axial
AX
AP20o
20
Judet’s
JU
Stryker’s
SY
Etc…
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IN RADIOLOGY (RIS)
Layer
(2nd order)
 Same list +
 Supine
SU
 Prone
PR
 Decubitus
DE
 Complex Oblique QC
 Angled Oblique
22,30,45
 Frog laterals
FR
 May need to combine
together or with 1st
order list eg DELR
NPfIT and Descriptors/Codes
Southern Cluster – IDX – GE PACS- Kodak CR - HSS CRIS
 London Cluster-IDX- Philips PACS-Philips(Fuji)CR-? RIS
 NE Cluster- iSOFT- Agfa PACS-Agfa CR-? RIS
 EEM Cluster- iSOFT- Agfa PACS -Agfa CR -? RIS
 NWWM Cluster- iSOFT- ComMedica PACS –Kodak CRKodak RIS
 Has RCR endorsement
 SNOMED CT can be integrated-matched
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SNOMED CT
NCRS provides support for clinical coding using the
SNOMED CT nomenclature for diagnosis and procedure
codes.
SNOMED CT codes will be applied to the patients record
through manual selection by users, as well as an integrated
bi-product of clinical processes (i.e. orders, assessments).
SNOMED CT clinical coding is supported for inpatient and
outpatient encounters.
SNOMED CT
At the end of an episode / encounter of care, SNOMED CT
codes are recorded in NCRS via the Discharge Summary /
Encounter diagnosis and procedure codes.
The SNOMED codes recorded in NCRS are sent to the 3M
clinical encoder where clinical coding is completed in
SNOMED CT, ICD10, Read, and OPCS4.
Codes will be transferred back to NCRS and will update,
not replace, the patient diagnosis and procedure codes.
A full audit trail is available.
SNOMED CT
Within NCRS P1R2, users will have the ability to manually
record SNOMED CT codes within the following areas:
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Discharge Summary / Encounter
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Problems / Provisional Diagnoses
Within NCRS P1R2, SNOMED CT codes will be recorded
against the patients record, as a bi-product of clinical
processes, in the following clinical areas:
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Assessments
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Findings / Flowsheets
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Orders (viz. the code for the request)
Results (viz. the code for the procedure(s)
performed, not the radiological diagnosis or report which will
be transferred via HL7 messaging)
Orders and Results
in Radiology
SNOMED CT Order codes can be derived from Order/Entry
systems, but will be MUCH MORE ACCURATE if derived from
the accepted and if required modified final RIS procedure
entry with SNOMED CT matching.
SNOMED CT Results codes from Radiology are a dilemma.
This does not apply to ‘Procedure performed’ , but to a
provisional radiological diagnosis which may be a list of
differential diagnoses which could be entered by a reporter (ie
manually). Unlikely to happen given pressures of work!
The use of DICOM structured reporting may give the possibility
of automatically constructing radiological diagnosis codes from
the structured report
Structured reporting
DICOM SR – is an ‘envelope’, but within this useful structure is available.
User decides how much structure to use and controls with templates the type of
content, if it is mandatory or optional and modes of expression
Incorporated into the report are captured
images of key findings (which can be exploded
to full screen presentation), structured
diagnosis information, recorded audio, the
ability to sort findings by anatomy or priority, to
view prior findings associated with the
corresponding patient and hyperlinks to related
information.
Structured reporting
Link Features to Description
New nodule
superimposed
with right
fourth rib
10% Pneumothorax
Cavitation
Free air
David Clunie
Development Director, Imaging Products
ComView Corporation – Paper at SPIE, 2001
Structured reporting
David Clunie
Development Director, Imaging Products
ComView Corporation – Paper at SPIE, 2001
Structured reporting