This document discusses electronic requesting (eRequesting) in healthcare systems. It describes how eRequesting can enable bidirectional communication between referrers and imaging departments regarding patient exams. The document outlines the key benefits of eRequesting such as improved workflow, real-time demand monitoring, and alignment with regulations. It also discusses the interactions between eRequesting systems and other hospital information systems like RIS, EHR, and the challenges and considerations for integration.

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
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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
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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
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6. Awareness of Diagnostic Imaging
interactions with other systems
Hospital Information Systems
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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
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9.  Requested
 Justified
 On Hold
 Scheduled
 Attended
 DNA
 Started
 Completed
 Dictated
 Preliminary
 Final
 Addendum
 Report
viewed/acknowledged
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10.  Hospitals and Clinics
 GP Practices
 Community/Mental/Sexual/District Health
 Private
 eReferral users ( possibly England/Northern
Ireland/Scotland/Wales)
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11. Track able by all users (status)
Routing to multi-sites/departments
Requests electronically audited (IRMER)
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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
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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
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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)
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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
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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