eRequesting and the EHRAnant Patel- Radiographer (SCoR Radiographers Informatics Group
CNWL NHS FT- Project Manager, Subject Matter Expert, Test Lead,
Consultancy, Supporting Not for Profit Organisations)
ampformatics.co.uk -
The Brief
eRequesting (concepts)
Hospital Information Systems (HIS)
Electronic Healthcare Records (EHR)
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What is Health Information (Informatics) Technology?
HEALTH is the GOAL INFORMATION adds VALUE TECHNOLOGY use of TOOLS
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Terminology 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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Drivers- Paperless by 2018 and 7 Day Working
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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Not just eRequesting
Awareness of Diagnostic Imaging interactions with other systems Hospital Information Systems
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Current understanding of eRequesting
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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Status Changes Requested Justified On Hold Scheduled Attended DNA Started
Completed Dictated Preliminary Final Addendum Report
viewed/acknowledged
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Diagnostic Requestors Hospitals and Clinics GP Practices Community/Mental/Sexual/District Health Private eReferral users ( possibly England/Northern
Ireland/Scotland/Wales)
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Benefits (1)
Track able by all users (status)
Routing to multi-sites/departments
Requests electronically audited (IRMER)
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Benefits (2)
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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Imaging User Considerations
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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eRequesting Design Decisions 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/GPo Modality specific
Decision Support (duplicate/previous similar exam checks/ MBUR guidelines)
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eRequesting Not Just For Imaging 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/collaborationo IRMER not to be forgotten
Roll out to other specialities, e.g. endoscopy
Clinical Systems talking to each other
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
Levels of Current State (majority paper-light)
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)
Integration (EPR)
Clinical Systems need to talk to each othero Pathology services- Collaboration the main oneo Cardiology/other diagnostics- Relatively easy to add ono IRMER- Blocker when Imaging is
added onto the other systems
Remember Suppliers Offer Products
(1) PACS/RIS Supplierso ‘Try’ to integrate (full System Integration Testing)o Though will end up with workarounds to achieve integrationo Suppliers getting better- need clinical & A&C input
(2) EPR/EHR Supplierso Try to sell their whole solution or componentso PACS/RIS suppliers may have better imaging solutions/integration but
does it benefit the EHR? (3) VNA- Any differences?
Trusts don’t have to be tied into suppliers
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 IMAGINGo Consider integrating with other systems (Labs/External/Patient)o Data for activityo 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)
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References 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]
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References
Belgium Museum of Radiology (2015). Wartime Advances Image. http://www.flanderstoday.eu/sites/default/files/webimages/ft343-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]
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