1.  
Anant Patel- Radiographer (SCoR Radiographers Informatics Group
CNWL NHS FT- Project Manager, Subject Matter Expert, Test Lead,
Consultancy, Supporting Not for Profit Organisations)
anant.patel@nhs.net

2.  eRequesting (concepts)
 Hospital Information
Systems (HIS)
 Electronic Healthcare
Records (EHR)
ampformatics.co.uk -

3. HEALTH is the GOAL
INFORMATION adds VALUE
TECHNOLOGY use of
TOOLS
ampformatics.co.uk

4.  EHR- Electronic Healthcare Record
 EPR- Electronic Patient Record- Hospital Based
 IRMER- Ionising Radiation (Medical Exposure) Regulations
 PAS- Patient Administration System
 RIS- Radiology Information System
 LIMS- Laboratory Information Management System
 HP- Health Portal- for patients and health services
ampformatics.co.uk

5.  NHS challenged to go paperless by 2018 (GDS 2013) – “to
save billions, improve services and help meet the challenges
of an ageing population”
 Implementing 7 Day working in Imaging Departments:
Good Practice Guidance (DoH 2012)- to utilise the
resources of the NHS and to offer patients a more customer
focussed service
 Principle of safe staffing for radiography leaders (SoR
2015)- having an IT infrastructure which links across
networks- streamlining practice
ampformatics.co.uk

6. Awareness of Diagnostic Imaging
interactions with other systems
Hospital Information Systems
ampformatics.co.uk

8.  Order Communications (Ordercomms) system
 Bi-directional communication/message with a
referrer containing:
Patient information (ID)
Clinical information
Progression of the examination
Image report/addendum
ampformatics.co.uk

9.  Requested
 Justified
 On Hold
 Scheduled
 Attended
 DNA
 Started
 Completed
 Dictated
 Preliminary
 Final
 Addendum
 Report
viewed/acknowledged
ampformatics.co.uk

10.  Hospitals and Clinics
 GP Practices
 Community/Mental/Sexual/District Health
 Private
 eReferral users ( possibly England/Northern
Ireland/Scotland/Wales)
ampformatics.co.uk

11. Track able by all users (status)
Routing to multi-sites/departments
Requests electronically audited (IRMER)
ampformatics.co.uk

12.  Data collected legibly/ready for coding
 Real time demand possible via statistics
 Decision Support (e.g. RCR guidelines- iRefer)
along with could be added or duplicate checks
 Replaces need for scanned diagnostic requests
ampformatics.co.uk

13.  Admin and Clerical- Registration/Scheduling
(enterprise-wide)
 Imaging Manager- Decisions/Activity
 Imaging Redesign- Any interested parties
 Vetting staff- Radiographers/radiologists
 IT Support- PACS/RIS and IT Manager
 RIS supplier- Various companies
 eRequest supplier- Various companies
ampformatics.co.uk

14.  Depends on software/suppliers unless in-
house/bespoke
 Current/Future flows mapped/agreed (work with supplier)
 Order Entry Format (OEF)- align with RIS/national codes
and be flexible:
o Inpatient/outpatient/A&E/GP
o Modality specific
 Decision Support (duplicate/previous similar exam
checks/ MBUR guidelines)
ampformatics.co.uk

15.  Electronic Prescription Service-
o GPs and practice nurses - to send prescriptions electronically to a
dispenser (such as a pharmacy) of the patient's choice.
o This makes the prescribing and dispensing process more efficient
and convenient for patients and staff
 Cardiology- similar to imaging
 Pathology x10 as many requests as imaging
o Hence pathology driven/collaboration
o IRMER not to be forgotten
 Roll out to other specialities, e.g. endoscopy
ampformatics.co.uk

16.  Electronic Patient Record (Hospitals only)- not directly
talking to external systems
 Electronic Healthcare Record (Cradle to the Grave)-
Linked up with external systems, but may not be fully
integrated

18.  Imaging- PAS/PACS/RIS (minimum)
 Imaging- PAS/PACS/RIS/VNA
 Order Entry- PAS/Ordercomms/PACS/RIS/VNA
 EPR- PAS/PACS/RIS/VNA +
Labs/Pharmacy/Scheduling
 EHR (almost)- EPR + Ext systems (Portals-Clinical
& Patient/ HIE/GP
Systems including Ordercomms)

19.  Clinical Systems need to talk to each other
o Pathology services- Collaboration the main one
o Cardiology/other diagnostics- Relatively easy to add on
o IRMER- Blocker when Imaging is
added onto the other systems

20.  (1) PACS/RIS Suppliers
o ‘Try’ to integrate (full System Integration Testing)
o Though will end up with workarounds to achieve integration
o Suppliers getting better- need clinical & A&C input
 (2) EPR/EHR Suppliers
o Try to sell their whole solution or components
o PACS/RIS suppliers may have better imaging solutions/integration
but does it benefit the EHR?
 (3) VNA- Any differences?

21.  Integration Engines (using messaging)
o Can join Clinical Information Systems (best of breeds)
o Future Proof
• Trust (preferably imaging) must retain some control rather than the supplier or IT
department
 NOT JUST IMAGING
o Consider integrating with other systems (Labs/External/Patient)
o Data for activity
o NHS England- Open Source- “NHS England is drawing up plans to commit
millions, possibly tens of millions, of pounds from the £260m technology
fund to funding open source software, potentially including an NHS version
of VistA”, Digital Health (2015)

22. ampformatics.co.uk

23.  Department of Health (2012).Implementing 7 Day Working in Imaging Departments: Good Practice
Guidance.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213707/dh_132083.pdf
[Accessed 23rd June 2015]
 Government Digital Service (2013). NHS Challenged to go Paperless by 2018.
https://www.gov.uk/government/news/jeremy-hunt-challenges-nhs-to-go-paperless-by-2018--2 [Accessed
: 22nd June 2015}
 Nawanan T (2012). IT in Hospitals. [Online] Available from http://www.slideshare.net/nawanan/it-in-
hospitals?from_action=save [Accessed : 19th June 2015]
 RCR (2014). A Practical Guide to Implementing Ordercomms and electronic remote requesting
http://www.rcr.ac.uk/docs/radiology/pdf/BFCR(14)1_Order_FINAL.pdf [Accessed : 22nd June 2015}
 Society of Radiographers (2015). Principles of safe staffing for radiography leaders.
https://www.sor.org/learning/document-library/principles-safe-staffing-radiography-leaders [Accessed
23rd June 2015]
ampformatics.co.uk

24.  Belgium Museum of Radiology (2015). Wartime Advances
Image.
http://www.flanderstoday.eu/sites/default/files/webimages/ft34
3-p15-agenda_opener_0.jpg [Accessed 23rd June 2015]
 Digital Health (2015). Open eyes to NHS open source.
http://www.digitalhealth.net/insight/analysis/1122/open-
eyes-to-nhs-open-source/ [Accessed 25th June 2015]
ampformatics.co.uk