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ADHB's Solution for Radiology Order Entry and Results Signoff


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Dr Charles Bradfield
Auckland District Health Board
(P35, 1/10/09, Works Room, 11.13)

Published in: Health & Medicine
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ADHB's Solution for Radiology Order Entry and Results Signoff

  1. 1. ADHB’s Solution for Radiology Order Entry and Results Signoff Dr Charles Bradfield
  2. 2. Why bother with Order Entry <ul><li>Physicians don’t actually like it </li></ul><ul><li>It certainly doesn’t speed things up </li></ul><ul><li>So why bother ?… </li></ul>
  3. 4. In 2007 ADHB Clinical Board <ul><li>Priority should be given to a Radiology Order Entry system that: </li></ul><ul><ul><li>Integrates with the Clinical Workstation </li></ul></ul><ul><ul><li>Ensures sign off by the responsible clinician </li></ul></ul><ul><ul><li>Allows reconciliation of Radiology orders with Radiology Results </li></ul></ul><ul><ul><li>Has some form of escalation of unsigned or unaccepted radiology results </li></ul></ul>
  4. 5. We chose the Sysmex Solution <ul><li>Integrated </li></ul><ul><li>Got most of the stuff </li></ul><ul><li>Less development needed </li></ul><ul><li>Familiar </li></ul><ul><li>Local support </li></ul><ul><li>Regional alignment </li></ul><ul><ul><li>CMDH – Lab order module </li></ul></ul><ul><li>Potential to have Labs + Rads – in a single workflow </li></ul>
  5. 6. Objectives and Benefits <ul><li>Improve patient care by: </li></ul><ul><ul><li>Making sure the damn doctors sign off their results </li></ul></ul>
  6. 7. Objectives and Benefits <ul><li>Improve patient care by: </li></ul><ul><ul><li>Making sure busy clinicians are prompted to sign off their results </li></ul></ul><ul><ul><li>Every order should have a report (reconciliation) </li></ul></ul><ul><ul><li>Every report to be routed to the right clinician </li></ul></ul><ul><ul><li>In case of problems the report should be escalated to the next responsible person automatically </li></ul></ul>
  7. 8. Measures of Success <ul><li>We don’t end up with anymore bad press and reprimands from the HDC </li></ul><ul><li>Reconciliation of orders vs reports is 100% </li></ul><ul><li>If the CMO doesn’t get stuff in his email then everyone is doing their job </li></ul>
  8. 9. Considerations <ul><li>All you have to do is tell your clinicians: </li></ul><ul><li>“ If you order it, then you are responsible for checking it!” </li></ul>
  9. 10. Considerations <ul><li>“ If you order it then you are responsible for checking it!” (the result) </li></ul><ul><ul><li>Fine if you are in a solo or small practice </li></ul></ul><ul><ul><li>Completely impractical when: </li></ul></ul><ul><ul><ul><li>People do shift work </li></ul></ul></ul><ul><ul><ul><li>Locums </li></ul></ul></ul><ul><ul><ul><li>Rotations to other Departments, DHB’s or countries </li></ul></ul></ul>
  10. 11. Considerations <ul><li>We have used whole range of fuzzy logic solutions in the past to assist the routing of lab results to the intended recipients: </li></ul><ul><ul><li>This has been a dismal failure if we look at the high number of unaccepted and un-viewed results in our organisation </li></ul></ul><ul><li>The person making the order is in the most likely position to know where the results should go ! </li></ul>
  11. 12. Considerations <ul><li>Essential Data to Collect apart from the obvious: </li></ul><ul><ul><li>Who is making the order? </li></ul></ul><ul><ul><li>On whose instruction? </li></ul></ul><ul><ul><li>Who is clinically responsible for the patient? </li></ul></ul><ul><ul><li>Who is going to sign of the result? </li></ul></ul>
  12. 13. Considerations <ul><li>Who then is going to sign off the report? </li></ul><ul><ul><li>87 departments </li></ul></ul><ul><ul><li>Differences between inpatient activities and outpatients activities </li></ul></ul><ul><ul><li>Doctors who have different roles depending on where they are working. </li></ul></ul>
  13. 14. Considerations <ul><li>Sign off can be routed to: </li></ul><ul><ul><li>A single individual </li></ul></ul><ul><ul><li>A team </li></ul></ul><ul><ul><li>A department or service </li></ul></ul><ul><ul><li>A role </li></ul></ul><ul><li>Should a result erroneously end up in your inbox, you should be able reroute it. </li></ul>
  14. 15. Considerations <ul><li>How does Escalation work? </li></ul><ul><ul><li>There is a well defined clinical governance model in any hospital </li></ul></ul><ul><ul><li>Any single clinician who works in a hospital has a line of governance to the CMO </li></ul></ul><ul><ul><li>We determined that a 4 level process would cover all situations in the hospital </li></ul></ul><ul><ul><li>Rerouting of results should not defeat the process of escalation </li></ul></ul>
  15. 16. Exceptions: <ul><li>Some investigations are requested for Private Practitioners </li></ul><ul><li>Not all inpatients have hospital employed clinicians ordering investigations </li></ul><ul><li>Not all x-rays are reported on </li></ul><ul><li>Not all reports are welcomed by the requesters of Radiology investigations </li></ul>
  16. 17. Lessons Learnt <ul><li>Beware the complex environment </li></ul><ul><li>Top down – change management </li></ul><ul><li>87 departments – can satisfy….. </li></ul><ul><li>Clinicians will try and break it. </li></ul><ul><li>There are always exceptions </li></ul><ul><li>We think there is merit in trying to start order entry with Radiology </li></ul>
  17. 18. New Radiology totals on the Concerto Homepage
  18. 19. Select the Create Order icon in the Concerto context bar to bring up the Encounter Selection screen – the first order entry screen.
  19. 20. Enter radiology request information - Responsible person = case manager
  20. 21. Enter radiology request information – Responsible person = Team
  21. 22. Enter radiology request information – Responsible person = Role.
  22. 23. Enter each requested procedure’s details.
  23. 24. Preview order before sending request details to Radiology Information System.
  24. 25. View order status and appointment date/time from the Éclair Document Tree
  25. 26. View radiology reports from the Éclair Document Tree