Download Inpatient or Care areas: Expected workflow with RIS and PACS

MUHC INPATIENT- EXPECTED IMAGING WORKFLOWS with RIS and PACS
Authorized Care area personnel accesses common MUHC Order entry interface
to connect to RIS and initiate Radiology or Nuclear Medicine exam request.
General
exam/procedure
requested?
No
Yes
Specialized exams/procedures, urgent or not must be booked
by Radiology. Interventions, angiography and NM (i.e.
Procedures necessitating a review of the clinical history by
the radiologist to determine appropriate course of action)
must be confirmed by Radiology or Nuclear Medicine. For
CT, MRI, clinical history must first be reviewed for
determination of appropriate protocol by radiologist.
General radiographic exams, GI, GU are booked
directly in Radiology Information System (RIS).
Pertinent information (i.e. clinical indications,
responsible ordering physician, allergies and other
precautionary information are inputted by the Care
area. If already inputted, automatically entered from
HIS patient profile.
Yes
No
Contraindications
identified during input
or review of Pt info?
Technical coordinator and, if indicated, radiologist reviews significance of contraindications. Exam/procedure may be
confirmed, modified (including rebooked and substitution of exam) or cancelled.
No
Yes
No
Specialized
exam/procedure
confirmed or
modified?
Yes
General
exam/procedure
confirmed or
modified?
Exam/procedure
cancelled
Yes
No
Request
urgent?
Urgent, stat requests
from Care areas are
manually prioritized by
Radiology based on
human and/or
equipment resources
available at the time of
the request. A priority
in booking is alloced to
urgent request.
Booking confirmed for angiographic,
interventional or NM exam/procedure.
Radiologist assigns appropriate protocols to CT
or MRI exam. RIS and PACS informed of
booking. Preparation sheets, if indicated, are
available for review or print and pre-fetching
algorithm is triggered.
Yes
No
Bedside
exam?
Pager of technologist assigned to bedside
exams is triggered by input of bedside
request. Name and location of patient are
electronically forwarded to pager.
Technologist contacts Radiology and
provides approximate time of examination.
Care area is confirmed through RIS of
exam time. PACS is informed that fetching
of previous pertinent exams must be done
with priority and modality worklist is
updated. Technologist(s) performs exam
and brings CR plates to CR unit on Care
area for digitalization and review of images.
Once accepted, images are routed to
PACS.
New exam images are auto-directed to the
Urgent Results Diagnostic Workstation.
Radiologist reads exam in priority and
results are dictated via voice to text and
validated by the radiologist with his
electronic signature.
Upon confirmation of exam time and
location of exam by Radiology
through RIS, the Care area is
informed that the RIS has
communicated to Transport Service
the coordinates of the patient to be
transported urgently to Radiology.
Exam is performed. PACS
informs the RIS that examination
is completed and : images are
routed to the PACS core system
for reading.
Yes
For General exams, the Care area select from
available time slots, the most appropriate
time/date for the patient. Preparation sheets,
if indicated, are available for review or print.
RIS and PACS informed of booking, modality
worklists updated and pre-fetching algorithm
is triggered for previous pertinent images on
the eve of the exam.
On date of examination, Personnel in the Modality exam
room contacts (or information is provided electronically
to) Transport Service ahead of time for transportation of
patient to Radiology or Nuclear Medicine. Note Care
areas can at any time consult the Patient Tracking
module of the RIS to determine the location of the
patient while in Radiology or Nuclear Medicine. Certain
exams in Nuclear Medicine might require mote than one
examination session.
Patient is identified on worklist, if any previous images
are available, they are consulted by the technologist as
well as indications for exam. Selection of Pt’s name from
the Worklist informs the RIS Patient tracking module that
exam has started. Patient is explained the procedure by
the technologist. Pre-injection of sedatives or other
drugs is done for angiographic and interventional
procedures after consent is explained to and signed by
the patient. Infusion of contrast agent is initiated for CT
and MRI exam, if indicated. NB: Signed consent is
digitized and linked to patient’s record.
No
Need for
urgent
results?
Radiologist logs in the workstation and its reading worklist is
automatically retrieved for case selection. Radiologist reads
exam, dictates results, validate and apply electronic signature
to results.
Results and images are then available for review on any Web RIS/PACS workstations anywhere within the MUHC
by the responsible physician and authorized personnel. As well, exam location, date/ time or confirmed bedside
exam info can also be consulted and/or printed at any time and from any site by authorized personnel.
AH/CL Oct 9, 01 v5