Scottish Radiology Transformation Programme · Author: Workflow Managers Contact:...

Author: Workflow Managers Contact: [email protected] Date: 9th Sept 2019 Version: 1.3 of 43

Guidance

Document

Scottish Radiology

Transformation Programme

Workflow Manual for the

Scottish National Radiology

Reporting Service (SNRRS)


Contents

Background .............................................................................................................. 4

Introduction .............................................................................................................. 5

What is The Safe Working Framework? .......................................................... 5

What else is required? ..................................................................................... 5

HEALTH BOARD GUIDANCE FOR SNRRS REPORTERS ..................................... 6

National Reporting System REGISTRATION PROCESS ....................................... 7

User Requirements .......................................................................................... 7

Reporter’s Base Site Technical Requirements ................................................ 8

NEW USER SET UP IN THE SNRRS ........................................................................ 9

SITE SYSTEM ADMINISTRATION.......................................................................... 10

Reference Files - Mapping ............................................................................ 10

List of General Data Fields ................................................................. 10

List of Core Data Fields ...................................................................... 10

ASSIGNING AND UN-ASSIGNING EXAMINATIONS IN THE SNRRS .................. 11

Assigning Examinations ................................................................................ 11

Un-Assigning Examinations from the SNRRS ............................................... 12

REPORTING ON THE SCOTTISH NATIONAL RADIOLOGY REPORTING

SYSTEM .................................................................................................................. 14

Work lists ....................................................................................................... 14

Reporting Order ............................................................................................. 15

Multiple Examinations .................................................................................... 15

Linking and Un-Linking Examinations ............................................................ 15

Reported Prior Examinations ......................................................................... 16

Un-Reported Prior Examinations ................................................................... 16

Report Authorisation ...................................................................................... 16

Report Template ............................................................................................ 17

Notes ............................................................................................................. 17

Missing Clinical Information ........................................................................... 18

Critical / Significant Findings.......................................................................... 18

Save / Save for Review / Park / Messaging Function .................................... 20

Save.................................................................................................... 20


Save for Review .................................................................................. 21

Park .................................................................................................... 22

Messages ........................................................................................... 23

Oops Function ............................................................................................... 23

Adding an Addendum .................................................................................... 24

Completed Reports ........................................................................................ 25

LEARNING FROM EXPERIENCE (DISCREPANCIES) .......................................... 26

Donating Board Finds SNRRS Discrepancy ....................................... 26

SNRRS reporter finds donating Board discrepancy ............................ 26

REPORTING TURNAROUND TIMES / BREACHES .............................................. 27

QUALITY ASSURANCE AND AUDIT ..................................................................... 28

SNRRS Performance Reports ............................................................................... 30

DTI and PASSWORD MANAGEMENT ................................................................... 31

Desktop Integration (DTI) Between Share+ and Local PACS ........................ 31

HSS RIS sites ................................................................................................ 31

CSH 10.1 RIS sites ........................................................................................ 31

Soliton Reporting+ sites ................................................................................. 31

CSH Vue Reporting sites ............................................................................... 32

Password Management Share+ .................................................................... 33

For HSS sites ...................................................................................... 33

For CSH 10.1 sites ............................................................................. 33

For Soliton Reporting+ sites................................................................ 34

For CSH Vue Reporting sites ........................................................................ 34

Change Password Share+ ............................................................................. 35

Forgotten Passwords ..................................................................................... 35

NATIONAL REPORTING SYSTEM – TECHNICAL FAULT REPORTING

PROCESS ................................................................................................................ 36

NATIONAL REPORTING SYSTEM APPLICATION / SYSTEM FAULT REPORTING

PROCESS ................................................................................................................ 37

APPENDIX 1 SNRRS REPORTING TEMPLATE .................................................... 38

APPENDIX 2 SNRRS LEARNING FROM DISCREPENCY FORM ......................... 39

APPENDIX 4 SNRRS AUDIT REVIEW LOG BOOK ............................................... 40


Background

After the successful Business Case submission to the NHS Chief Executives in

August 2017, the Scottish Radiology Transformation Programme (SRTP) was

established. The SRTP remit is to implement the recommendations of the Business

Case which involves a substantial transformational change programme for Radiology

services in Scotland. This includes an Information Technology (IT) solution linking

the Radiology Information Systems (RIS) in Scotland to enable reporting of images

across traditional NHS Board boundaries. The SRTP have been working to introduce

the building blocks towards a sustainable method of delivering a Scottish National

Radiology Reporting Service (SNRRS). By working in this way Scottish Radiology

departments can:

- make the most of the existing reporting capacity across the country,

- provide retired staff with a mechanism to contribute to cross boundary work

- explore different ways of working to utilise subspecialty skill sets

Soliton Share+ Reporting system has been chosen to provide the IT Connectivity

required for a Scottish National Radiology Reporting Service (SNRRS). By July 2019

most radiology departments in Scotland will be connected to the Share+ National

Reporting System and will have the ability to send their examinations to it for

reporting. Reporters will be able to report examinations sent to the National

Reporting System from March 2019.

Until all Boards are fully connected to the Share+ system access to the National

Reporting System for Reporters is achieved through a remote Desk Top Client. Such

a client can be easily set up on any workstation which meets the required standard

and is agreed through the SRTP.

This Workflow Manual is intended to form part of a Safe Working Framework to

support the SNRRS. It is essential in the context of shared cross boundary reporting

that there are consistent processes in place to ensure that the service is safe and

also delivered to a high standard across the country.


Introduction

What is The Safe Working Framework?

The Safe Working Framework informs Health Boards of the governance procedures

that NHS National Services Scotland (NSS) have put in place to ensure that

examinations are reported in a safe and secure environment.

The SWF is a suite of documents covering the following areas:

Safe Working Framework introduction

Workflow manual (this document)

o Audit and Quality Assurance (included in this document)

CLO Legal statement

Adverse Events

Information Governance

System Training

Service Management & System and IT Support

Resilience and Disaster recovery

What else is required?

Local business rules are required to underpin this framework.

For example, there needs to be local arrangements in place to receive and act on

the findings and instructions from a report completed as part of the SNRRS. These

rules may be different in each Board dependent on local arrangements and

agreements, however overall they must provide a consistent method of underpinning

this framework.

In parallel with ongoing deployment of Share+, the NSS I.T Connectivity team and

Workflow Managers (WFM) will work closely with site staff to establish local

workflows which are compatible with the processes outlined in this document. Sign

off will take place between both SNRRS and local sites to ensure a consistent

approach. SNRRS reporters will be briefed on the workflows contained within this

framework at the time of their training on the system to enable them to work safely

when reporting for other Health Boards.


HEALTH BOARD GUIDANCE FOR SNRRS REPORTERS For the purposes of this document the word ‘Reporter’ will be used to describe either

a Radiologist or a Reporting Radiographer.

Any Radiologist currently employed by an NHS Health board will be eligible to apply

to report for the SNRRS.

The SNRRS needs to work in tandem with existing working practises and across

Scotland, therefore the employing Health Board has absolute right of veto on any

individual reporter within the employing board being initially granted access to the

National Reporting System.

Should there be evidence to suggest that a reporter is not meeting the expectations

and agreements made as part of working on the National Reporting System; the

Employing Health Board has absolute right of cessation of involvement in cross

boundary reporting activity, for any individual reporter within the employing Board.

The employing Health Board must, in the latter case, ensure the SNRRS Medical

Director is informed, as well as the WFMs to ensure that cross-boundary reporting

access is technically disabled.

For the purposes of Health Board indemnity; as this activity is being provided under

existing NHS employment as a regulated Health Professional, the expectation is that

it should be managed under the same terms as other additional Clinical Activities.


National Reporting System REGISTRATION PROCESS

User Requirements

The following process and flowchart outlines the initial process to follow for a

reporter who wishes to work for the SNRRS.

Before the New User Request form is completed, it is expected that the reporter will

contact the Workflow Manager to enquire about the possibility of reporting for the

SNRRS.

*The Starter Pack will contain the following:

A welcome letter

Useful Contacts List

Scope of Practice (SOP) o Must be completed and signed off by the employing Board Medical

Director. The specialities contained within the SOP document should be consistent with the Scope of Practice that the Reporter reports within their existing job plan.

o Once agreed by the employing Board, the SOP must be signed off by the SNRRS

Safe Working Framework

Timesheet

New User Form

Reporter expresses

an interest to the

WFM’s to report on

the National

Reporting System

WFM issues *starter pack

to the Reporter

Reporter

completes the

Scope of Practice

Form

Scope of Practice

is reviewed and

signed off by Board

Medical Director

Reporter returns

approved Scope of

Practice back the

to WFM’s

Scope of Practice is

actioned by WFM’s

and New User

process can begin


Reporter’s Base Site Technical Requirements

There are a number of technical pre-requisites / requirements that need to be carried

by the WFMs, NSS, Local IT and external Suppliers before any reporting can be

undertaken on the National Reporting System from a designated workstation.

SWAN form must be completed by site and actioned by the Supplier

Firewalls need to be “opened” by site

Desktop Integration (DTI) Situational Background Assessment

Recommendation (SBAR) must be reviewed and signed off by Health Board

Client install instructions need to be issued by the Supplier and deployed on

designated workstation by the employing Health Board

VR Licence allocated to Reporter by WFM


NEW USER SET UP IN THE SNRRS Once the reporter / Site Admin have completed the New User Request form, the

WFM will issue a voice recognition licence (reporters only) and create login details.

Once access to the system is in place, training will be provided by either the WFM or

a Key User.

Training documentation is provided in the starter pack.

No

YES

New User Request

form issued by the

WFM

Reporter / Site Admin

completes form,

receives approval from

line manager and

returns to WFM

User account is

created by

WFM

Workstation

require Client

install?

Local IT client install on

designated workstation

Carry out

Speech Magic

and system

user training

WFM and Reporter /

Site Admin sign off

training checklist

Start reporting on /

assigning to the

National Reporting

System


SITE SYSTEM ADMINISTRATION

Reference Files - Mapping

Once the system has been populated with local RIS reference data (for example,

examination codes, referrer codes etc.), these will need to be maintained and

updated if any changes are made locally.

If the general data fields are not mapped correctly or are missing then the

examination will not display correctly in the National Reporting System until mapped.

List of General Data Fields

Visit Type

Referring Consultant

Referring Clinician

Referring Department

Exam Type

Priorities

Gender

Sites

Specialities

Users

If the “core” data field, is not mapped correctly then this will result in the examination

not sending to the National Reporting System. If changes to local RIS codes are

made, the local RIS Manager must inform the SNRRS of the change by emailing the

WFM’s mailbox [email protected] with details of the change. Once the

change has been confirmed by the RIS manager, the information should be emailed

to the WFM’s mailbox with 48 hours. An email will be sent to the Site Admin

confirming that the new information has been added to the National Reporting

System platform.

List of Core Data Fields

Examination Code

mailto:[email protected]


ASSIGNING AND UN-ASSIGNING EXAMINATIONS IN THE NATIONAL REPORTING SYSTEM

All Health Boards will have access to the National Reporting System and the amount

of reporting possible will be dependent on:

- Reporter availability at that point

- Donating Boards reporting requirements

- Turnaround times required by donating Boards

This will be a dynamic situation with the WFM managing capacity and activity

through the National Reporting System on a daily basis, ensuring timescales are met

and working closely with Service Managers and reporters across Scotland.

Each donating Health Board will be responsible for assigning work to the National

Reporting System from within their Local RIS system. Each donating Health Board is

responsible for ensuring that only appropriate work is assigned to the National

Reporting System.

WFM’s should be provided with the contact details of staff responsible for the

assigning process by each donating Health Board. The process for assigning

examinations will be developed as donating boards are connected to the SNRRS.

Local site staff will follow their local procedure for assigning the agreed type and

number of examinations from their RIS System to the National Reporting System.

They should then email the WFM mailbox when this is completed, documenting how

many and what type of examinations have been sent. Once the email is received,

the WFM will reply, confirming receipt.

For audit purposes, the WFM’s will record all communication transactions relating to

patients and workflow.

Assigning Examinations

The process to assign examinations to the National Reporting System will differ

depending on the donating Board RIS supplier. The process outlining the steps to

follow for each system will be documented as they are agreed by donating sites.

The diagram below explains in simple steps how examinations will be received and

managed once they have been assigned to the National Reporting System.


The management of urgent examinations will be agreed between both parties on

request. Sites requesting urgent examinations to be reported must confirm with the

WFM that there is capacity available to report these examinations with a timescale

confirmed for completion.

Assigning Deceased Patients

Any patients known to be deceased should not be assigned to the SNRRS for

national Reporting.

Un-Assigning Examinations from the National Reporting System

Donating Health Boards require a local process to un-assign examinations that

require urgent reports

If a donating board requires the report to be completed locally then they MUST

advise the WFM before the examination is un-assigned from the National Reporting

System. If not it will result in the examination being double reported by a Local and

National reporter.

Although there is the ability to report in some sites without un-assigning, it is strongly

recommended that the examination is un-assigned first because if not, then the

examination will remain on National Reporting System to be reported nationally.

The local site will contact the WFM (either by telephone or email depending on

urgency) stating that the examination requires to be returned to local site for

reporting, providing name, date of examination and patient CHI number.

For URGENT

examinations, the WFM receives an email followed up with a phone call from the local site advising work has

been assigned

For ROUTINE

examinations, the WFM receives an

email from the local site advising work has been assigned

Examinations

are assigned

to work lists

Examinations are

assigned to

National Reporting

System from Local

RIS

Examination is

available to report

WFM applies the relevant

urgency flag to the

examination so they are

assigned to the correct work list


The WFM will check the status of the examination to ensure that reporting is not

currently being undertaken.

If reporting is not in progress in the National Reporting System, the Local site will un-

assign the examination from their local RIS. This will immediately remove the

examination from National Reporting System, ensuring it is no longer available for

reporting nationally.

N.B. Local sites have the ability to un-assign examinations from the National

Reporting System for local reporting at any time.

The following diagrams explains in simple steps how all examinations will be un-

assigned

Contact WFM to

establish status of

examination(s) to

ensure report is not

underway

WFM checks status of

examination(s) in question

For CSH RIS Sites:

Box is unchecked in the local RIS, which

will remove the examination from the

National Reporting System

For the HSS RIS Sites:

Right click on the examination in RIS,

select External Reporting, select Soliton,

and select Un-Assign

Examination is unassigned and

removed from the work list within the



REPORTING ON THE NATIONAL REPORTING SYSTEM

An example of the National Report Template can be found in Appendix 1

The flowchart below explains the high level steps the reporter should follow to

complete the report:

Work lists

A reporter will report from the work lists that have been established depending on

their scope of practice.

Examinations will be distributed into work lists according to modality / specialty /

urgency.

When reporting on the National Reporting System, the first work list a reporter will

see will be titled “My Saved Work list”.

There will be no ability for a reporter to create their own work lists so, if there is a

requirement to be added or removed from an existing work list or to create a new

Reporter logs in to

the National

Reporting System

and is taken straight

to a “My Saved

Work” list

Reporter then checks

what examinations have

been assigned to them by

other reporters and any

previous saved

examinations.

Reporter

should then

go to their

Assigned

work lists

Reporter

selects the

first patient

at the top of

the list

Reporter

completes the

report, filling in all

the required fields

then Authorises

report

The National

Reporting System

will automatically

take the reporter to

the next available

report


one, this must be done through the WFM’s by emailing them

[email protected].

With each work list, unauthorised examinations show up in grey, and Saved for

Review examinations show up in yellow.

Reporting Order

When a report is authorised, the system is pre-set to take the reporter to the next

available examination. This can be changed by the reporter during an active session

but it will default back to the pre-set status when the reporter logs in the next time.

Reporters will always report examinations in order of urgency. For the purposes of

SNRRS this is dictated by the examination acquisition date. This will ensure that

examinations are reported in date order.

Reporting of Deceased Patients

National Reporters should not report any *known deceased patients on the SNRRS.

Any deceased patients should be assigned to the WFM by the Reporter. The WFM’s

will then arrange with the Donating Board to un-assign these types of patients.

*deceased patients are identified with a flag at the top of the SNRRS reporting page

Multiple Examinations

All multiple examinations under the one attendance will require to be reported as a

single report on the National Reporting System.

Each examination under the one attendance will be displayed as a separate header

within the National Reporting System reporting template. Each examination heading

should be populated with the clinical findings.

Linking and Un-Linking Examinations

If a patient has multiple examinations that are done under the same accession

number on the same modality, they will come through to the National Reporting

System as linked. The reporter must not unlink these examinations as they will not

propagate back to the local RIS correctly.



If a patient has multiple examinations that are done under separate attendances, the

reporter must not link these examinations as the reports will not be sent back correctly

to the local RIS.

Reported Prior Examinations

When an examination is assigned to the National Reporting System for reporting, the

system will fetch reports from the last 2 years from the local RIS. With the Desktop

Integration (DTI) in place, all previous images beyond the 2 years will be viewable on

PACS.

The previous 2 year report history relating to the patient is shown in the bottom right-

hand corner of the report page screen.

Un-Reported Prior Examinations

If a patient has had previous unreported examinations that have not been assigned,

these will not be seen on the National Reporting System but the images will be

viewable on PACS. The Reporter should report the current examination but if they

believe that the unreported examinations should be linked to this report then they

should advise the WFM via the National Reporting System messaging service, who

will in turn contact the referring department.

PLEASE ENSURE THE CORRECT IMAGES ARE DISPLAYED FOR THE

EXAMINATION YOU ARE ABOUT TO DICTATE.

Report Authorisation

Once an examination has been reported and authorised within the National Reporting

System it will automatically be returned to the local RIS. It will be the responsibility of

each site to ensure that all sent examinations have been returned.

There is a 2 minutes delay (oops function) set in the National Reporting System to

allow the reporter time to amend any errors after authorising the report. If an

amendment is made and re-authorised, the 2 minute delay restarts.


Report Template

A standard report template has been agreed by SNRRS in conjunction with clinical

colleagues and Health Board representatives in order to ensure parity across the

country when reporters are issuing reports for use in other Health Boards.

The template can found in Appendix 1. Each of the following mandatory fields will

either be pre-populated or required to be completed by the reporter:

Clinical Indications If request was made via Order Comms, this will be auto-populated by the National Reporting System If request was made via scanned document, the reporter will be required to populate this field

Examination Type Auto-populated in the National Reporting System

Findings Must be filled in by the reporter

Verified by Auto-populated in the National Reporting System

HSS RIS Boards When a National Reporting System report is authorised the main body of the text report will be returned to the local CRIS system. The Header shown within the National Reporting System will be the SNRRS Header

and be visible only within the National Reporting System. This will be replaced with

local site CRIS Header and Footer when examination is returned to local RIS.

Carestream RIS Boards

The mechanism for SNRRS reports returning to Carestream RIS is still being

developed and will be shared in due course.

Notes

Any Radiographer comments scanned in relation to that examination are available in

the tab located beside the clinical history at the top right-hand corner of the report

page.


Missing Clinical Information

There may be the occasion when clinical information is missing, resulting in the

reporter being unable to complete the report, for example, no scanned request card,

history not retrieved, or missing images. The reporter should indicate why the exam

cannot be reported in the Notes field, assign the report to the WFM using the ‘assign

to’ function and then ‘skip’ the examination. WFM will receive the notification and

contact the donating Board advise of any such examinations who will then take the

appropriate action.

Critical / Significant Findings

Reporters using the National Reporting System will be required to highlight reports

with Critical / Significant Findings and examinations that need followed up. This can

be done by selecting the appropriate Alerts & Flag option. The categories below

describe the various options for a reporter when selecting an alert. The action required

by the reporter is also detailed.

SIGNIFICANT / CRITICAL FINDING TYPE

REMEDIAL ACTION REQUIRED

MECHANISM TO COMPLETE GOVERNANCE

Critical Finding (should only be used in the event of a life threatening abnormality) Contact site with Findings

Reporter contacts donating site by phone using the agreed contact procedure and information available within the National Reporting System

Apply Alert to the report Apply appropriate flag Annotate report with description of remedial action

Urgent Finding – Action Required

None


Urgent Finding - Cancer Suspected

None


Follow Up – Examination Requires Follow Up

None



When the National Reporting System is configured, the ‘edit alert/flags’ function will

list the available categories for a reporter to select, as listed in the table above. Once

this section is completed by the reporter they will then click the ‘alert referrer’ icon.

This button activates an email to the donating Health Board’s specified contacts who

will receive the email and action the findings. The Board’s contact details will be

configured prior the Board going live on the National Reporting System. The Board

contact details will include a phone number for urgent findings and out of hour’s

contacts. It will be the responsibility of the donating site to ensure contact details are

kept up to date.

As a failsafe the WFM mailbox will be copied in to all the email alerts applied to

examinations. The email alert to the donating Board will require a read receipt which

will be sent to the WFM mailbox. This will ensure that the donating Boards have

received the email and will action the findings. The WFM mailbox will be checked

daily to ensure that all email alerts have been received by the relevant Board. If a

read receipt has not been received within 24 hours the WFM will contact the admin

team at the donating Health Board to enquire about the status of the examination

findings.

Once the Edit Alerts / Flag and Alert Referrer process has been followed, it is important

that the reporter dictates the alert into report as a failsafe to ensure the critical /

significant finding is visible to the referring site.


As the table above outlines, all critical findings will be communicated at the time of

reporting by the reporter to the relevant party that has been identified by the donating

Board. These details are held within the reporting system.

The following flowchart explains how to apply a Flag and Alert the Referrer:

The WFM will produce monthly stats on the number and type of significant / clinical

findings that have been generated and keep related records to ensure sound

governance.

Save / Save for Review / Park / Messaging Function

Save

This function would be used when a report requires to be saved by reporters for verification at a later time. The saved report will appear in the reporters “My Saved Work” work list as an “Unauthorised” status. Saved reports can be searched, viewed, edited and verified by other reporters. If another reporter does verify the report, it will disappear from the “My Saved Work” work list. It is recommended that any saved reports are verified during the current session.

Reporter

selects the

“Edit Alerts /

Flag” Button

Option Menu

displayed with

the 4 categories

Reporter selects the relevant category.

The recipient bar can be populated but it

doesn’t have to be as each category will

generate an email that will be sent to a

pre-defined distribution list. The WFM will

be copied in to all emails

Reporter

checks the

“Alert Referrer”

button

Reporter

Authorises

report

Once the message

is delivered, a read

receipt will be sent.

WFM monitors all Flags / Alerts

daily to ensure they are delivered and actioned by

the referring Board

Reporter starts

the report

Report requires

to be saved for

verification at a

later time within

current session

Reporter

selects “Saved”

button

Report is saved

in the “My

Saved Work”

work list


Save for Review

This function would be used when a reporter wants to assign an incomplete report to another reporter or a pool of reporters for a second opinion. The consensus opinion is then signed off by both parties with joint responsibility. When this function is chosen, the report can be searched, viewed, edited and verified by other reporters. The save for review report will appear in the reporters “My Saved Work” work list as a “For Review” status.

There is a max of 3 reporters per report. If this function is selected, the reporter has to select the Authorise button before it will be published. If a reporter has been assigned, they will appear as an author on that report.

Reporter starts

the report

Reporter

completes

Assigned to field

to send the report

to Reviewer(s)

Reporter

selects “Save

for Review”

button

Report appears

on Reporters

and Reviewers

“My Saved

Work” work list

Reviewer: Reviews Amends (if necessary) Verifies

Reviewer: Reviews Amends (if necessary) Saves for Review Assigns back to originating Reporter

Report is verified

and returned to

RIS with both

Reporters name on

report

Originating

Reporter

verifies report


Park

This enables the Reporter, if interrupted to PARK the report for a period of time that has been started and delays sending the speech files back to the server. If parked, the report content is not viewable by anyone using the National Reporting System, including the Workflow Managers. Any exam that is parked in the National Reporting System for longer than the reporter

is logged on, the WFM will contact the reporter to find out when the report will be

completed. If the Reporter is on leave or away from the National Reporting System for

a period longer than a week then the parked report will be deleted and the exam will

be required to be reported again. This is to prevent unnecessary delays to reporting.

If a report is parked and the WFM un-parks it for it to be reported again, the originating

reporter will not be paid for any effort put in to the first report.


Messages

Would be used when the reporter wants to consult with or seek advice from another reporter on a report and ask for informal feedback. The reporter is able to send a link to another reporter or the WFM’s and communicate via a secure messaging service.

Oops Function

When a report is authorised, there is a 5 minutes delay set on the delivery of the

reporter back to the donating Board’s RIS. This gives the Reporter the ability to

amend a report without having to add an addendum.

The Oops functions can be activated multiple times, each time it is selected the 5

minute delay will restart.

Please note that voice recognition (VR) cannot be used when amending a report

during the Oops function period.

Reporter

opens the

report they

require

consultation

on

Whilst in the

report, reporter

selects the

message button

Reporter sends

message to either

an individual or

group

Message is

sent to the

individual or

group with a

link to the

report

Report is either

then Saved or

Saved for

Review (refer to

relevant

workflow

diagrams)


Adding an Addendum

Reporters can add and an addendum to a report created in the National Reporting

System but must be aware of the risks when adding an addendum during a

subsequent active session. If a Reporter logs off from the system and is required to

addend a report the next day, for example, there is a risk that the report may have

already been addended locally. If the SNRRS reporter adds an addendum in the

system, it will overwrite the locally created report.

Because of this risk, the safe time to add an addendum is ONLY during the current

active session.

If a report is required to be addended outwith the Reporters session then they must check the PACS system first to check if there has been an addendum added locally. If it has:

Not been addended locally – then the report can be addended. The reporter must contact the WFM’s, who will inform the donating Board.

Been addended locally - the Reporter must contact the WFM’s with

details of the addendum to be added, who will ensure this is completed

locally. Once action is taken, the SNRRS reporter will be notified of this.

**Please note: If a future exam is assigned to the NRS, the previous locally addended

NRS report will be locked in the NRS and no further addendum can be added.

DURING

REPORTERS

ACTIVE

SESSION

Reporter

opens the

report

requiring an

addendum

Reporter

checks PACS

to ensure there

has been no

addendum

added locally to

the same report

Addendum

template appears

as a separate tab

in the report

Reporter

completes all

mandatory fields

in the template

Addendum now

saved as a

separate tab in

the report

Reporter selects

the addendum tab


Completed Reports

As an examination has been verified by an SNRRS Reporter it will automatically be

sent to the referring RIS system and any other downstream applications. It will be the

responsibility of each site to ensure that all sent examinations have been returned.


LEARNING FROM EXPERIENCE (DISCREPANCIES)

There are 2 types of discrepancies that can be found in the National Reporting

System:

Referring Board finds discrepancy on National Reporting System

generated report

Reporter finds discrepancy on a previous donating Board report

The Adverse Events process details the responsibilities of each party in the event of

a discrepancy leading to an adverse event.

Donating Board Finds National Reporting System Discrepancy

SNRRS reporter finds donating Board discrepancy

Donating

Board finds

discrepancy

Local site

reporter

addends the

report

Local site

contact WFM

advising of

discrepancy

WFM will conduct

an investigation

and record

discrepancy

SNRRS Reporter finds

discrepancy. Using

Share+ messaging they

will pass to WFM

WFM will contact

donating Board for

investigation

Local site will

addend report and

follow local process

to alert referrer


REPORTING TURNAROUND TIMES / BREACHES

In general terms the National Reporting System will report examinations in order

based on the date of acquisition and clinical urgency, for example, referral source,

cancer pathways, and paediatric patients

WFM will monitor the National Reporting System daily to ensure that all reports are

being completed in accordance with the date of acquisition and clinical urgency,

unless informed otherwise by donating Board.

The SNRRS will develop Service Level Agreement’s (SLA) with the donating Boards

based on the above principles.

WFM’s will monitor turnaround times on a regular basis and the results will be sent

back to the Boards for review.


QUALITY ASSURANCE AND AUDIT For audit purposes, all reporters working within the SNRRS will individually have 5% of their reports audited for accuracy and quality on a monthly basis for review.

Each report to be audited will

be messaged by the WFM to

the designated auditor by the

WFM using the NRS

messaging service

ADDENDUM REQUIRED NO ADDENDUM REQUIRED

The Auditor will clearly state there

is an addendum required in the

body of the NRS message,

copying in the originating

Reporter.

WFM’s will complete the first part

of the Learning from Experience

form and issue to the Reporter as

soon as the message is received.

The Reporter will be asked to

review the feedback and will either:

Agree with the Auditors

feedback and **addend the

report within 48 HOURS of

receiving the completed form

Disagree with the Auditor and

complete the feedback section

in the Learning from

Experience from

Once the addendum has been

added, the Reporter should notify

the WFM, who will inform the

Donating Board that an

addendum has been added to the

report.

The Learning from Experience

form with Reporter comments will

be sent to the Auditor for further

comment. If no agreement can be

reached, the case will be

escalated to the SNRRS Medical

Director for arbitration

WFM’s will notify each Reporter

via email 1 week after an audit

has taken place and advise them

of the outcome (with the

exception of addendums, which

will be actioned immediately)

**To add an addendum the report must

follow the workflow detailed in section:

Adding an Addendum


Each report that is audited must contain the following, in line with Royal College of Radiologists (RCR) document Standards for the Reporting and Interpretation of Imaging Investigations (updated 2015):

A clinical indication identifying the referral history from the referral form

The findings in main body of the report

An opinion / action plan / recommendation

A name block which identifies o The reporter’s name and designation o The reporter’s GMC or HCPC number o The Employing Board o The reporter’s e-mail address and telephone number

https://www.rcr.ac.uk/sites/default/files/bfcr061_standardsforreporting.pdf

https://www.rcr.ac.uk/sites/default/files/bfcr061_standardsforreporting.pdf


SNRRS Performance Reports The WFM’s will produce monthly performance reports. Some examples of the reports that can be produced are:

Reporters hours worked

Reports completed

Discrepancies

Reporters payments


DTI and PASSWORD MANAGEMENT

Desktop Integration (DTI) Between Share+ and Local PACS

In order for the correct images to be presented on the PACS when an exam is selected

for reporting, desktop integration must be in place between the Share+ and the local

PACS.

Desktop integration currently exists on reporting workstations for local reporting and it

is important that the following guidelines are followed when using the Share+ client on

your local workstation for reporting, in order to ensure the correct patient images are

always presented.

HSS RIS sites

In HSS RIS sites, the local reporting integration is setup that when the reporter logs

into RIS, the PACS username and password for this user is stored in the background

of the RIS and the PACS application will launch, integrating both systems.

For reporting on Share+ in these sites the user should log into Share+ using their

PACS username and password. This information will then be passed via the DTI

adapter and launch the PACS application, thus integrating both systems.

It is important that the local RIS is not open when Share+ is being used locally or vice

versa. Having more than one application open could lead to the incorrect patient being

reported.

CSH 10.1 RIS sites

In CSH 10.1 RIS sites, the local reporting integration is setup that when the reporter

logs into PACS, the RIS username and password for this user is stored in the

background of the PACS and the RIS application will launch, integrating both systems.




It is important that the local RIS is not open when Share+ is being used locally or vice


reported.

Soliton Reporting+ sites

In Soliton Reporting+ sites, the local reporting integration is setup that the reporter

logs into Reporting+, using their PACS username and password. This information will

then be passed via the DTI adapter and the PACS application will launch.





It is important that Reporting+ is not open when Share+ is being used locally or vice


reported.

CSH Vue Reporting sites

In Vue Reporting sites, there is no local integration and only the PACS application is

required for reporting.




It is important that PACS reporting is not carried out when Share+ is being used locally

or vice versa. Having more than one application open could lead to the incorrect

patient being reported.


HSS RIS Sites log into

Password Management Share+

Password Management will vary depending on local sites reporting platform. This is

due to the complexity of requiring Desktop integration to work for reporters for both

their local reporting platforms and for Share+ and their local PACS. If the local

integration means that the password must stay the same then it is recommended a

strong password be used.

For HSS sites

Local Reporting

Share+ Reporting

For CSH 10.1 sites

Local Reporting

HSS Local RIS

Password

changes every 90

days. PACS

username and

password stored

in background of

RIS

P

Local CSH PACS

Password never

changes

HSS RIS Sites log into

Which launches

PACS

SHARE+

Uses PACS

username and

password for log-

in

Password never

changes

Local CSH PACS

Password never

changes

Which launches

PACS

CSH Local RIS

Password

never changes

Local CSH PACS

Password

changes every 90

days. RIS

username and

password stored

in background of

PACS

CSH 10.1 RIS Sites log

into

Which launches

RIS


CSH 10.1 RIS Sites log

into

Soliton Reporting+ Sites

log into

Share+ Reporting

For Soliton Reporting+ sites

Local Reporting

Share+ Reporting

For CSH Vue Reporting sites

Local Reporting

SHARE+

Uses PACS

username and

password for log-

in

Password will be

changed every 90

days with PACS

password

Local CSH PACS

Password

changes every 90

days

Which launches

PACS

Reporting+

Uses PACS

username and

password for log-

in

Password will be

changed every 90

days with PACS

password

Local CSH PACS

Password

changes every 90

days

Soliton Reporting+ Sites

log into

Which launches

PACS

SHARE+

Uses PACS

username and

password for log-

in

Password will be

changed every 90

days with PACS

password

Local CSH PACS

Password

changes every 90

days

Which launches

PACS

Local CSH PACS

Password

changes every 90

days

CSH Vue Reporting Sites

log into


CSH Vue Reporting Sites

log into

Share+ Reporting

Change Password Share+

As above, the requirement to change password will be governed by the local PACS

password change policy in order to ensure that DTI is maintained for the user.

If a user’s PACS password expires and they are asked to change it, this will mean

that the users Share+ password and PACS password are out of sync, so the next

time the user logs into the Share+ the DTI will not launch.

Users will need to log into application using existing password and then click on

config icon.

Within config they will be offered option to Change password.

Users should change their Share+ password and save and then log out of the

application and back in again to reconnect their DTI link with the PACS system.

Forgotten Passwords

If a user forgets their username or password they need to contact the Workflow

managers of the Share+ system to get password reset. Following first login after

password reset the user will be asked to change their password. They should

change it to match their current PACS password.

Users will be given 3 options to enter their Share+ password before the system locks

them out. In order to unlock their password, users will need to contact a workflow

manager.

SHARE+

Uses PACS

username and

password for log-

in

Password will be

changed every 90

days with PACS

password

Local CSH PACS

Password

changes every 90

days

Which launches

PACS


NATIONAL REPORTING SYSTEM – TECHNICAL FAULT REPORTING PROCESS

Reporter / Assigner logs technical

fault with PACS Manager

Is the issue relating to the


(Share+)?

PACS Manager triages call and transfers by email or phone call to Workflow

Manager (WFM)

YES

Relevant details are passed to the WFM such as:

User name

Contact number

Workstation ID

Technical fault is managed

through to resolution between

WFM, user (or PACS

Manager) and supplier

WFM investigates call and

logs with supplier if required

NO

PACS Manager

handles call locally as

normal

Types of

incidents:

Application

won’t launch

Application is

running slow

PACS

integration won’t

launch

Share+ is a 9am to

5pm service. Any calls

logged after 5pm

won’t be picked up

until the next working

day


NATIONAL REPORTING SYSTEM APPLICATION / SYSTEM FAULT REPORTING PROCESS

Reporter / Assigner logs issue

direct with WFM via email or

phone call

Types of Issues:

Adding a new user Password related queries

Change Management Application issues

Relevant details are passed to the WFM such as:

User name

Contact number

Workstation ID

WFM investigates call and

logs with supplier if required

Share+ is a 9am to 5pm

service. Any calls logged after

5pm won’t be picked up until

the next working day

Technical fault is managed

through to resolution between

WFM, user (or PACS

Manager) and supplier


APPENDIX 1 NATIONAL REPORTING SYSTEM REPORTING TEMPLATE

The standard SNRRS report template is as outlined below:

THIS REPORT WAS COMPLETED AS PART OF THE SCOTTISH

NATIONAL RADIOLOGY REPORTING SERVICE

Clinical Indications

Examination

Findings (examination should be dictated by reporter in this section)

Verified by

Dr First name Surname GMC 123456

Designation

(Health board)

Reporter email......................

Local Dept Tel:

Please contact the local Imaging department if you have any queries.


APPENDIX 2 SNRRS LEARNING FROM EXPERIENCE FORM

Name:

DOB: Click here to enter a date.

Accession No.:

Imaging Modality:

Date of Study: Click here to enter a date.

Date of Report Click here to enter a date.

Clinical Information provided at the time of

request:

Auditors Comments

Reporters Comments

Addendum Completed (Date)

Donating Board Notified

Author: Workflow Managers Contact: [email protected] Date: 17th May 2019 Version: v1.2 NSS Programme Management Services (PgMS)

APPENDIX 4 SNRRS AUDIT REVIEW LOG BOOK

Reporter Name:

Date Patient IDAgree with

Report

Disagree

with Report (if yes,

discrepancy

form must be

completed)

Any Other

FeedbackFeedback to Reporter

AUDIT REVIEW LOGBOOK


Key Information

Title Workflow Manual for the Scottish National Radiology Reporting Service (SNRRS)

Date Published / Issued 8th March 2019

Date Effective From 15th March 2019

Version / Issue Number V1.2

Document Type Governance / Operational

Document Status Draft

Author Reporting Radiology Workflow Managers

Owner Jim Cannon, SRTP Director

Approver Dr Hamish McRitchie, SRTP Medical Director

Approved by and Date Dr Lorna Ramsay, NSS Medical Director – 8th March 2019

Contact [email protected]

File Location X:\02 Implementation Phase\Projects\Safe Wrkng Gvrnce\Framework\SWF\WF Manual\SNRRS Workflow Manual v1.0.docx

Revision History

Version Date Summary of Changes Name

v0.2 24/10/2018 draft changes Workflow Managers












v0.12 07/12/2018 reviewed with SRTP team and Dr Raj Burgul Workflow Managers

v0.14 22/01/2019 Changed name of document to Workflow manual and added more detail

Workflow Managers

v0.15 31/01/19 Review and amended Workflow Manager

v0.16 04/02/19 Review with Jim Cannon and Dr Hamish McRitchie

Workflow Manager

V0.17 08/02/19 Programme Team Workflow Manager

V0.18 06/03/2019 Acronyms updated Workflow Manager

V0.19 08/03/2019 Reformatted and standardised wording Hazel Stewart

V1.0 08/03/2019 Updated version Hazel Stewart

V1.1 29/04/2019 Updating sections following review with RR’s Rachel Marshall

V1.2 17/05/2019 Corrected SNRRS references Rachel Marshall

Distribution

This document has been distributed to:

Version Date of Issue Name Role / Area

v0.12 09/01/19 SRTP Programme Team

v0.14 30/01/19 Clinical Advisory Group n/a

V0.17 08/02/19 SRTP Programme Team

V0.18 06/03/2019 Dr Lorna Ramsay NSS Medical Director

V1.0 08/03/2019

Dr Sanjay Pillai Clinical Director, NHS Tayside

Mike Conroy Diagnostic Imaging Manager, NHS Tayside

Tejinder Chima Clinical Service Manager, NHS Tayside

Anne Sermon Programme Manager, NHS Tayside

Deb Jones Regional Executive Lead (North region)

Helen Marshall Reporting Radiographer, GJNH


Craig Maguire Reporting Radiographer, GJNH

Patrizia Herdsman Reporting Radiographer, NHS FV

Valerie Petrie Reporting Radiographer, NHS Tayside

Margaret Diamond Consultant Reporting Radiographer, NHS Fife

Dr Simon McGurk Consultant Radiologist, NHS Borders

Jennifer Gilchrist Service Manager, GJNH

Sandra Robertson Service Manager, NHS FV

Jeanette Burdock Radiology Service Manager, NHS Fife

Scottish Radiology Transformation Programme · Author: Workflow Managers Contact:...

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