iSite 3.5: Exceptions Handling (RIS Version)

CONFIDENTIAL 2TRN-0035-14 Rev 06/23/06

Table of Contents

• Objectives

• Terminology

• Exception Definition

• Exceptions Handler

• Resolve Exception

• Verify Resolution


Learning Objectives

• Understand the purpose and performance of:

– Exception Occurrence

– Exceptions Handler

– Building Exceptions List

– Resolving Exceptions

– Verifying Exceptions


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


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


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


Exception Resolution

1. Identify Exception1. Worklist Module2. Exceptions Handler Option

2. View Exception Images1. Click on ID hyperlink2. Click View

3. iSite will present matches based on MRN and Accession Number or the user may enter a known ACC (from RIS) and apply1. Additional searches may be performed by clicking find pt/exam button2. Click on the radio button next to patient’s record

4. Locate the Exam1. Click on the MRN hyperlink 2. Verify Exam information and apply

5. Verify Resolution of Exception1. Check patient folder2. Check inactive/active lists


“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


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


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


ACC … SUID

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 Study (DICOM Metadata)

iSite Database


Image Header Information

• The Image DICOM Metadata information that ConnectR uses for validation in a RIS integrated environment are:

• Medical Record Number• Accession Number


Image Header Information

Modality (scanner)

Diagnostic viewing

workstation

iSite Server

NAMEMRNACC #

NAMEMRNACC #


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


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


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


• In iSuite or iSite Enterprise from the Folder List

Exceptions Handler


Exceptions List• Select an Exceptions List


Exceptions List• A New Exceptions Worklist may be built


Exceptions List

• Active or Inactive Status

• Reason (e.g. ACC not found)

• Patient Sex

• Performing Resources


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


Exceptions List

• Select the modality from the pop-up Equipment Dictionary


Identifying Exceptions• An Additional Search may be made using Patient Name or Accession

Number as well as other identifiers


Resolve Exceptions• An Exception may be resolved by selecting the ID hyperlink


Resolve Exceptions• View the image by selecting the ‘View’ button


Resolve Exceptions• Images of poor quality may be removed by selecting the

‘remove’ button


Resolve Exceptions• iSuite conducts a Database search for a matching MRN (Patient ID)

and ACC (Accession Number)


Resolve Exceptions• Locate the Patient’s Record/Exam


Resolve Exceptions• Select the correct Accession Number to which the images belong


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


Resolve Exceptions• ‘find pt/exam’ may be used to perform additional searches


Resolve Exceptions• iSuite conducts a Database search for a Name, although additional

searches may be made


Resolve Exceptions• Select the ‘apply’ button


Resolve Exceptions• Resolve the Exception by confirming the selection


Exception Resolution Verification

• Verify the Exception is now in the ‘Inactive’ Exception List and no longer in the ‘Active’ Exception List


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

Exception Resolution Verification


Exception Resolution

1. Identify Exception1. Worklist Module2. Exceptions Handler Option

2. View Exception Images1. Click on ID hyperlink2. Click View

3. iSite will present matches based on MRN and Accession Number or the user may enter a known ACC (from RIS) and apply1. Additional searches may be performed by clicking find pt/exam button2. Click on the radio button next to patient’s record

4. Locate the Exam1. Click on the MRN hyperlink 2. Verify Exam information and apply

5. Verify Resolution of Exception1. Check patient folder2. Check inactive/active lists


For assistance, please call customer support at

1-877-328-2808 or 1-877-328-2809

iSite 3.5: Exceptions Handling (RIS Version)

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