RIS (PACS) Workflow redesign

RIS (PACS) Workflow redesign

Nick Hollings

Consultant Radiologist

Royal Cornwall Hospital

RIS PACS Workflow redesign

An enormous task! Do NOT underestimate if you wish

your departments to function well afterwards…


Based on redesign for agfa CR, GE PACS, GHG VR and HSS CRIS RIS in Cornwall . 2 acute Trusts & 1 elective hospital

(c.1000 beds)7 community hospitals93 mile distance


Choose your team with care Every PACS Manager needs an

assistant Every Lead Radiologist needs an

assistant

RIS PACS Workflow redesign You need:

Radiologist +1 RIS/PACS Manager +1 (or more) IT project Manager (Imaging business manager) Radiographer leads

• Acute Trust• Community

A&C lead +1 (or more) Supplier Others


How much do you want to change? Don’t re-invent the wheel Visit local trusts with identical

hardware & software design

RIS PACS Workflow redesign Planning Away Day All interested parties present

RIS/PACS Team Super Rads from all modalities GP/primary care medical representative Don’t forget e.g. breast care centre Medical secretaries/p.a.s Health records Make sure you extend invitation to ‘problem’

areas Takes all day!


Need RIS running on p.c. with projector

Need supplier conversant with system Need sec. filling in patient journey

proforma, in real time, on p.c with projector

Keep audience sweet with regular breaks, coffee & biscuits!


Map an imaginary patient through the department for a chest xray

Start with the GP referral, before it arrives in the department

End with the GP receiving the report, in the surgery

RIS PACS Workflow redesign How do you receive your referrals? Do patients walk in or do requests arrive in

the post? Do they phone you or do you phone them? Each scenario needs thinking about Will it be the same for all your departments? Should you centralise your booking office?

RIS PACS Workflow redesign Try to remove all steps with inherent delays

Post (external and internal) Med secs typing up letters Radiologist vetting

Work with your GP rep to facilitate e-referrals if possible (unless order comms already!)

Ditto for in-hospital referrals


Decide if you want to dispense with request cards

Do you have RIS terminals in every room? If no, you may still need cards to check

patient details Labels

Do you really still need them (possible exceptions mammo & N/Med for syringes)?

Will your old printers be able to print them?


Intended radiologist field very important for work-list driven reportingHot, MSK, Neuro, GI etc., as well as

individual consultantsAllows for a/l etc

RIS PACS Workflow redesign How do you avoid double reporting?

Message on PACSText in VR transcription box

Batch printing or individual reports? How do you disseminate reports?

White copyThird party electronic dispersal systemwebPACS


This will take at least 3 hours! Have lunch Extend scenario to other modalities Extend scenario to IPs as well as Ops Don’t forget ‘special’ areas such as

A&E and # clinic

RIS PACS Workflow redesign During the day various issue will arise that

cannot be worked through. If an issue take >5 mins, document it, park it and move on

Beware luddites and ‘the good old days’ ~ change is necessary. A good chairman is vital to keep discussion moving

Try to harmonise working practices across entire HC community. Avoid units doing their own thing


Charge Super Rads with responsibility for completing the proforma for their particular area

That is why they need to be at the away day!

Arrange small group meetings to work through issues parked from away day


The result?Easy to read flow charts/algorithms of

how a patient proceeds through EVERY dept, beginning to end

Walk imaginary patient through each scenario on training system to make sure it works


Give one person overall control of redesign and make sure they hold up to date versions of all documents

RIS PACS Workflow redesign ~ Cut-over plan Cut-over plan – supplementary plan for

week leading up to change over One manager 2 radiologists (inc. CD) 2 senior radiographers from different areas Clerical officer PACS Team RIS trainer

RIS PACS Workflow redesign Decide on priorities, i.e. which modalities

(CT, MR etc) have to be reported. Free up radiologists to get reporting up to date.

Work through each modality, day-by-day, up to changeover, and decide how they will be processed.

Decide when each modality moves over to new system and how long they are temporarily paper based.

RIS PACS Workflow redesign Cancel lists in preceding days if poss

of staff will get overwhelmed Try to change at w/end to avoid busy

clinics Allocate resource to transfer paper

records onto new system once live Ensure support from supplier is

available at changeover, at least by phone, inc. e.g.VR & CR as well.

VR

Not going to discuss merits of DD vs. VR-based reporting

Huge increase in reporting efficiencyIn report turnaround timeNOT radiologist productivity ( 28%)Cost neutralTranscription errors

VR

A simple COTS product (Dragon, Powerscribe etc) will NOT work

Need a specifically designed s/ware product that ‘drives’ reporting, as economically as possible

VR

VR engine merely the transcriptionist MUST have a good trainer and trouble

shooter to help when it goes wrong – always!

e-referrals

Don’t wait for EPR! Discuss with your GP IT lead GPs don’t like having to enter text

twiceOnce onto GP systemAgain on request card (or email)

e-referrals

Generic electronic request card Fields mapped directly from GP

system Request emailed to central address in

X-ray booking office for whole of county

e-request card imported into RIS No more hard to read faxes with tiny

GP labels

RIS (PACS) Workflow redesign

Documents

Transcript of RIS (PACS) Workflow redesign