Ordercomms Part of bigger picture EPR/RIS/PACS

Transcription

1 Ordercomms Part of bigger picture EPR/RIS/PACS Dr Neelam Dugar Chairman of The UK PACS & Teleradiology Group

2 1 Clinical Episode=3 Docs REQUEST DOC ORDERCOMMS IMAGE DOC PACS REPORT DOC RIS

3 STATUS END-POINT Status Sync OCS/RIS/PACS Requested/Ordered Scheduled/Appointment given Arrived/Attended Exam Performed Verified Report Report Acknowledged Review Requested Cancelled Request Held Request Vetted DNA Report amended Dictated Unauthorised Exam not performed

4 Requesting Workflow 1. Create a Requesting Doc request card 2. Send the request card to scheduling systems (RIS/Path etc) OR CROSS ENTERPRISE DOCUMENT SHARING Of IHE Document based Referral Request profile of IHE Store request card in a electronic document folder and notify the scheduling systems of location of doc.

5 Create Request Doc Log-in---Single sign-on Search for patient Request -- exam from dept Check previous exams----(automatic DTI with PACS) Sign off

6 Active and Passive IT Systems Active IT System Support workflows Generate Orders/Schedule exams /Create images or documents Produce Status changes Passive IT System Do Not Support Workflows Storage and display of Images/Documents Display status changes E.g: PACS, XDS-EPR E.g: Ordercomms, RIS, pathology system, x-ray modalities etc

7 PAS/MPI/ADT Demographics ADT Messages Ordercomms Scheduling Info Document Registry Metadata Departmental Systems Eg. RIS/Path XDS Registry with EPR viewer

8 Requesting vs. Current Input from Ordercomms Requesting Location Requesting Responsible Consultant Requesting Department Synchronized with PAS Current Location Current Responsible Consultant Current Department

9 Patient Safety Clinical IT fundamentals All departmental systems MUST have real time synchronisation of demographics with PAS All demographics change MUST happen on PAS ALL Clinical systems MUST display Current location Current department Current Responsible consultant

10 PAS ADT synchronization Correct patient PATIENT SAFETY Correct Information about ---current location /Current Department / Current Responsible consultant---improves patient safety

11 Data Input 4 sources PAS/ADT/MPI Login Details Ordercomms Clinical Information Misc. portering, renal fuction, pharmacy etc.

12 A. PAS/ADT data input Demographics 1. Patient demographic Name, DOB, Sex, Address 2. Unique identifiers (NHS no., local PAS no.) ADT Messages Current location Current responsible consultant Current Department/Specialty 3. GP details

13 B. Data input from log-in details Name of requester Grade of requester Referrer contact details Date of request

14 C. Clinical data input Department Radiology/Pathology Modality Examination code (synchronised with RIS exam codes) Clinical History (free text)

15 D. Misc data input Portering information (bed/chair/walking from Portering system) Renal function (from Pathology system) Metformin information (from Pharmacy system)

16 Data Output Create a Request Doc like the request card (XDS concept) Store doc in a folder Notify doc location --scheduling systems (RIS, Path, etc) HL7 scheduling Messages to RIS/path SCHEDULED WORKFLOW OF IHE CROSS ENTERPRISE DOCUMENT SHARING DOCUMENT BASED REQUEST REFERAL Status Synchronization with scheduling systems

17 PAS/MPI/ADT Demographics PATIENT INFORMATION RECONCILIATION ADT Messages Departmental Systems Eg. RIS/Path SCHEDULED WORKFLOW OF IHE Scheduling Info Ordercomms DOCUMENT BASED REQUEST REFERAL Document Registry Metadata CROSS ENTERPRISE DOCUMENT SHARING XDS Registry with EPR viewer

18 No man can live as an island -A Hymn

19 Integrated Health Record Patient Centric Care (use XDS)

20 Multiple departmental IT systems feed Hospital EPR Radiology PACS Local Store RIS Local Store Ordercomms Local Store Maternity System Local Store Ophthalmology PACS Local Store Hospital XDS Registry Indexing Laboratory System Local Store Cardiology PACS Local Store Pathology System Local Store

21 XDS Metadata Registry Who Patient Name, DOB, Address, Unique ID Who Author Name, Grade What Document-Type (Request Card), Document sub-type (radiology request), format (pdf, CDA etc), Where Department/Speciality, Institution When date and time of document creation

22 Ordercomms and XDS Who, Who, what, where, when ---Metadata information is already available on the Ordercomms Ordercomms--- create a document (pdf, CDA, word doc format) Request document (analogy with paper request card) Index the metadata to XDS Registry Via the XDS registry this will be available for view along with the rest of the XDS based EPR

23 XDS EPR Viewer (Patient :Joe Bloggs) 1. Ordercomms 2. Endoscopy 3. Blood Results 4. Histology 5. Cardiology 6. Audiology 7. Radiology images 8. Clinical Letters/ Discharge Summaries

24 Context Synchronization Front-end integration between IT systems Radiology request, image and report --- common identifier no. (context sharing)--?? Accession no. 2 types of Context Synchronization Automatic Ordercomms, RIS and PACS Manual Ordercomms / Results Acknowledgement Systems with EPR

25 Requesting Workflow Automatic Context Synchronization Ordercomms JOE BLOGGSDOB: 1/1/01 Request: CXRClinical HistoryShortness of Breath PACS- Radiology Local Imaging History Chest X-Ray-1/2/01 Chest CT- 16/2/01 MRI Spine PET CT Dr Harry Potter Ordercomms EPR

26 Requesting Workflow Manual Context Synchronisation Ordercomms EPR- XDS Based Registry JOE BLOGGS DOB: 1/1/01 Request: CXR Clinical History Shortness of Breath Dr Harry Potter 1. ECG 2. Endoscopy 3. Blood Results 4. Radiology Ordercomms EPR

27 Reporting Workflow Context Synchronization PACS PACS RIS RIS Reporting Worklist URGENT 1. Joe Bloggs-MAU MAU-Chest X-RayX 2. Bob Wilson-SAU SAU-Abdomen Abdomen X-RayX 3. Sarah Jenkins-Ward 12- Hand X-RayX NON-URGENT 1. Hannah -Floris-GP- Foot X-RayX 2. Joanne Hampson-OPD OPD- Pelvis X-RayX 3. James Bond Gun X-RayX RIS TITLE OF PACS SUBJECT PACS

28 Reporting Workflow: Automatic Context Synchronization with OCS/RIS/PACS PACS- Current Chest X-RayX PACS- Previous Chest X-RayX Reporting Workflow Ordercomms DOC Chest X-rayX Clinical History: Shortness of breath Local Imaging History Chest X-Ray X Chest CT MRI Reporting Workflow RIS DD/VR Local Imaging History 1. Chest X-Ray 2. Chest CT 3. MRI Current TITLE OF Chest SUBJECT X-ray Local Imaging History 1. Chest X-Ray 2. Chest CT 3. MRI Previous Chest X-ray

29 Future --Access to Hospital EPR (Manual Context Sync) PACS- Current Chest X-RayX EPR- XDS Registry Reporting Workflow Ordercomms DOC Chest X-rayX Clinical History: Shortness of breath Local Imaging History Chest X-Ray X Chest CT MRI RIS DD/VR Local Imaging History 1. Chest X-Ray 2. Chest CT 3. MRI 1. ECG 2. Endoscopy 3. Blood Results 4. Histology Reporting Workflow TITLE EPROF SUBJECT PACS PACS EPR

30 Results Acknowledgement Workflow Results Acknowledgement Sy... WORKLIST FOR AB(CONSULTANT ORTHOPAEDIC SURGEON) Urgent 1. Joe Bloggs-MAU MAU-Chest X-rayX Bob Wilson-SAU SAU-Abdomen Abdomen X-rayX Sarah Smith-Ward 12- Hand X-rayX Non-Urgent Hannah Floris-GP GP- Foot X-rayX Joanne Hampson-OPD OPD- Pelvis X-rayX James Bond Gun X-rayX Results Acknowledgement S...

31 Results Acknowledgement Workflow (Automatic context synchronization) Results Acknowledgement Sy... PACS Joe Bloggs Chest X-rayX There are bilateral lung metastasis. I note that the patient is known to have kidney tumour. Acknowledge and File Away Show EPR PACS Results Acknowledgement S...

32 Results Acknowledgement Workflow (Manual Context Synchronization) Results Acknowledgement Sy... Joe Bloggs Chest X-rayX There are bilateral lung metastasis. I note that the patient is known to have kidney tumour. EPR- XDS Based Registry 1. ECG 2. Endoscopy 3. Blood Results Acknowledge and File Away Show PACS 4. Radiology PACS Results Acknowledgement S...

33 Access to EPR Improves patient SAFETY

34 Cardiology Workflow Cardiology PACS EPR- National XDS Registry Cardiology Workflow Cardiology Information System 1. ECG 2. Endoscopy 3. Blood Results DD/VR National Cardiology History 1. Cardiac Angiogram 2.ECG 3.Echocardiogram 4. Histology Cardiology Workflow TITLE EPR OF SUBJECT PACS PACS EPR

35 Opthalmology Workflow Ophthalmology PACS EPR- National XDS Registry Ophthalmology Information System 1. ECG Ophthalmology Information System 2. Endoscopy 3. Blood Results 4. Radiology DD/VR Ophthalmology Informati... TITLE EPR OF SUBJECT PACS PACS EPR

36 Discharge Summaries Workflow Discharge Summaries System EPR- XDS Based Registry Discharge Summaries System 1. ECG 2. Endoscopy 3. Blood Results DD/VR 4. Radiology Discharge Summaries System EPR

37 Clinical Letters Workflow Clinical Letters System EPR- XDS Based Registry Clinical Letters System 1. ECG 2. Endoscopy 3. Blood Results DD/VR 4. Radiology Clinical Letters System EPR

38 Theatres Workflow Theatres System EPR- XDS Based Registry Theatres System 1. ECG 2. Endoscopy 3. Blood Results DD/VR 4. Radiology Theatres System EPR

39 GP Workflow GP System EPR- XDS Based Registry GP System 1. ECG 2. Endoscopy 3. Blood Results DD/VR 4. Radiology GP System EPR

40 XDS Scalabilty SHA Hospital H Local XDS Registry Hospital A Local XDS Registry Hospital B Local XDS Registry Hospital G Local XDS Registry SHA Registry Indexing Hospital C Local XDS Registry Hospital F Local XDS Registry Hospital E Local XDS Registry Hospital D Local XDS Registry

41 XDS Scalabilty National Hospital H Local XDS Registry Hospital A Local XDS Registry Hospital B Local XDS Registry Hospital G Local XDS Registry Hospital F Local XDS Registry National NHS Registry Indexing Hospital E Local XDS Registry Hospital C Local XDS Registry Hospital D Local XDS Registry

42 Existing Clinical IT systems Context Synchronisation Integrated Health Record XDS/XDS-I Standard SWF, PIR and DRR Standards of IHE