Teleradiology Management System. User Guide Technologist Supplement

Transcription

1 Teleradiology Management System User Guide Technologist Supplement

2 User Guide Technologist Supplement Table of Contents 1. Life Cycle of an Exam Login Worklist Tech Workflow...6 I. Perform an Add-On...6 II. Create the Visit...10 III. Complete the Exam...10 IV. Scan Paperwork...11 V. Uploading Images...13 VI. Completing the Visit Burn Patient CD

3 User Guide - Technologist Supplement Life Cycle of an Exam in SixPACS The life cycle of an Exam in SixPACS follows a path through many different statuses. Depending on the user s role, they will be able to see exams at some or all of these stages. Received Once a call has been received and the exam detail has been entered, the exam is moved to the Received status and is ready to be assigned to a Tech. Assigned Exams are Assigned when they have been dispatched to a tech. They are either assigned directly to the Tech by a Dispatcher, or they are automatically assigned when the Tech receives a page through their Blackberry device. The exam records will remain in the Assigned status until the Tech adds them to a visit. In Progress The In Progress status is used by the Tech to compile and send all the information necessary to complete a visit. A visit is defined as a single trip to a facility. A visit can contain a single patient, or multiple patients. Keeping track of visits and the number of patients seen in a visit helps to facilitate the billing process. Completed Once the Tech has completed the information necessary for a visit, the visit is marked Complete. The exam record of the order then changes to a different status, depending on the order type. Typically, x-ray, ultrasound and cardio (EKGs and Pacer Checks) are given a status of Completed, to be reviewed by the Radiologist/Cardiologist. To Be Transcribed After a Radiologist has viewed the images associated with an exam and dictated the results and impression, it is marked and moved to the status of To Be Transcribed. To Be Faxed Once a report is created, the exam status is changed to To Be Faxed. From here, the report is faxed to the facility. To Be Called When a positive report is faxed, is the given a status of To Be Called. The Dispatcher then calls the facility to verify that they received the report. The exam record is then manually marked Called, and moves to To Be Billed To Be Billed Once the exam reaches this status, the exam is ready to be billed. Billed This status is the end of the exam cycle. Canceled If an exam is canceled for any reason, it is flagged as Canceled. In SixPACS, the role of the Tech has been expanded to include the ability to add patients and exams. This allows Techs to dispatch themselves in order to perform exams after-hours or anytime that a Dispatcher is not available. The process for adding patients and exams and the new process for uploading images is outlined below. Login Each Tech will be able to login from any computer with a suitable web browser. At the login screen, enter your username and password

4 User Guide Technologist Supplement Worklist After logging in, the Tech Worklist will be displayed. This shows all exams assigned to the Tech that is currently logged in to the system (Fig. 1). Fig 1 Tech Worklist The worklist consists of a series of tabs. The first four tabs represent a status of the order. The last two tabs display a list of orders that do not have face sheets or EKGs scanned into the system. The tabs also show the number of orders that are currently within each tab. The currently active tab will be displayed in bold text. Each order is initially displayed in a collapsed manner in order to make the entire list more readable. The information shown includes whether the order is a stat, the type of order, facility name, patient name, SSN, and date of birth. Clicking on an individual row will expand the results to show the entire order (Fig. 2). The buttons shown in the detail will change, depending on the type of order, which status it is in, as well as how much information has been attached to it. The description of each button is shown in Table A. Fig 2 Tech Worklist with detail shown - 4 -

5 User Guide - Technologist Supplement Button Description Table A Order Detail Buttons Closes the order detail Adds the order to the current visit Removed the order from the current visit Edit the order Escalate the order to management Burn a CD of the patient s exams Assign a radiologist to the order Refreshes the current order View Patient history Tag a Physician to the patient Scan the face sheet No face sheet has been scanned Face sheet has been scanned (click to view) Add an exam to the current order Create a task for the current patient Cancel a single exam Log a repeat of an exam Scan EKG (shown only for EKGs and Pacer Checks) Scan paper ultrasound study (used only with ultrasound equipment that prints on paper) No images exist for exam (X-Ray and Ultrasound) (4) Images present, number indicates total images (click to view) No EKG has been scanned (EKG and Pacer Checks) EKG has been scanned (click to view) - 5 -

6 User Guide Technologist Supplement Tech Workflow When processing an exam, the tech will follow the workflow as shown in Fig. 3 below. Depending on the situation, the tech will complete one or all of the steps shown. I. Add-On II. Create Visit III. Complete Order IV. Scan Paperwork V. Send Images VI. Complete Visit Fig. 3 Tech Workflow I. Perform an Add-on (if an exam is already assigned, skip to Section II) If a dispatcher is unavailable or the Tech performs an Add-On exam, a Tech may add a patient and/or an exam to their own Worklist. From the Tech Worklist, click Add-on Patient. This takes you to the search page (Fig. 4). Enter the patient s last four numbers from their Social Security Number (or NONE if not available), along with the first three letters of the last name. Then click Find Patient. Any patient meeting the search criteria will be displayed in the list below the search boxes. Select the proper patient from the list by clicking on their SSN or click Add new Patient in the lower left corner if the patient is not displayed in the list. Fig. 4 Patient Search If the patient does not appear in the list after performing the search, click Add new Patient in the lower left corner

7 User Guide - Technologist Supplement After choosing a patient, the new exam window is displayed. Enter the facility name and the name of the person requesting the order. This is usually a staff member at the facility. Click Next. If you chose an existing patient, verify the patient information is correct. If this is a new patient, complete the required information. Click Next. Enter/verify the patient s insurance information. Click Next

8 User Guide Technologist Supplement Enter the room number of the patient, the location to fax the report and the ordering physician. Click Next. Choose the exams requested. Note that multiple exams can be added, as well as different types of exams (x-ray, us, cardio, etc.). Click Next. Select the date of service for this order. If this is a stat order, or it is for an employee, choose the correct checkboxes. Click Next

9 User Guide - Technologist Supplement Enter any comments. Click Next. Review the information that was gathered. Click on Finish to create the order. The order will be automatically assigned to you, and the patient will appear on the worklist under the Assigned status

10 User Guide Technologist Supplement II. Create the Visit Once an exam has been assigned, it is available to be completed by the tech. This involves creating a visit, updating the exam record with time of the exam, and the proper exam types performed, (i.e. HAND LT 2V, WRIST LT 2V, etc.). After the order record is updated, the appropriate paperwork is scanned, and the images can then be sent to the server, using the Exam ID as the accession number of the study. The first step in the process is to create a visit. A visit is created for each physical visit to a facility. The purpose of creating a visit is to track the number of patients seen for billing purposes. It is also used to track whether the visit was done while the Tech was on call, to help with calculating call pay. To create a Visit, click on the New Visit button, at the top of the worklist. The New Visit dialog box will display, as shown in Fig. 5. The facility dropdown box only shows the facilities associated with the exams assigned to the Tech. Select a facility, and the appropriate choice for call, and click OK. Fig. 5 Create Visit The current visit will now be displayed at the top of the worklist. If it is a call visit, the words On Call will also be displayed. The New Visit button will now be replaced with a button marked Complete Visit. III. Complete the Exam Fig. 6 Current Visit Displayed Once an exam has been assigned, it is available to be completed by the tech. This involves updating the exam record with the proper exam types performed, (i.e. HAND LT 2V, WRIST LT 2V, etc.). After the exam record is updated, the images can be sent through the telerad station, using the Exam ID as the accession number of the study. Once the visit has been created, the Tech can add patient orders to the visit. This is accomplished by selecting the patients displayed in the Assigned tab, and clicking on the Add To Visit button. The orders that are added to the current visit are shown in the In Progress tab. Updating the Exam Record To update the exam record, click on the order from the In Progress tab in the Worklist. This will bring up the order detail. Click on the Edit Order button. The Edit Order dialog box will appear, as shown in Fig 7. Verify that the patient

11 User Guide - Technologist Supplement information is correct, and then select the correct procedure from each dropdown list next to the exams that have been performed. Enter the time of the exam. Click on the Save button to update the order record. If you fail to enter all the required information, an alert will be shown, indicating what is required. Fig. 7 Updating the Exam Record Once the order is updated and all information is entered, the Exam ID for each procedure will be displayed (Fig 8.). Pay special attention to enter the correct Exam ID that corresponds to the study when it is entered into the image software (CR, DR, etc.). IV. Scan Paperwork Once the exam record is updated with the exams performed, you must scan the appropriate paperwork. On X-Ray and ultrasound exams, the paperwork required is the face sheet. In the case of EKGs, the printed EKG is scanned separately from the face sheet. To scan a face sheet, click on the Scan Facesheet button. This will bring up the Scan Facesheet dialog, as shown in Fig. 8. The description of each button is shown in Table B. Click on the Acquire Image button. This will bring up the scanner interface. If you need to scan multiple sheets, scan each one individually, then click on done in the interface. If you close the interface, and open it again, any previous scans will be replaced. Once you have scanned all the pages, click on the Send button. Close the dialog when finished. To scan an EKG, click on the Scan EKG button. Follow the instructions for scanning a facesheet above. Please Note: failure to scan a facesheet or EKG on an exam that requires one will result in a reminder dialog to display on the worklist stating that there are facesheets/ekgs missing. Clicking on the Facesheets Required or EKGs Required tabs (shown in Fig. 1) will display the patient records that need a sheet scanned

12 User Guide Technologist Supplement Figure 8 Scan Facesheet Dialog Button Acquire Image Send Rotate 90 Zoom Tool Zoom In Zoom Out Prev Page Next Page Delete page Delete All Table B Scan Dialog Buttons Description Some computers have more than one device for scanning images. If you have an issue with the paper scanner, click this button to make sure that the scanner is listed. If it is not in the list, try unplugging the scanner from the computer and plugging back in. Also make sure that the cable is securely attached at both ends. Opens the scanner interface to scan a document. Sends the scanned image to the server. Rotates the currently displayed image 90 degrees clockwise. Zooms into the current image. Zooms into the current image. Zooms out of the current image. Displays the previous page (multiple page scan) Displays the next page (multiple page scan) Deletes the currently displayed scanned page. Deletes all scanned pages

13 User Guide - Technologist Supplement V. Uploading Images Once the order record is updated with the required information, you are ready to upload the images to the server. Again, take note of the Exam ID for each exam listed in the order. This number is used as the accession number, and ties the images to the exam record. The process of uploading images is dependent on whether the type of acquisition software and hardware is used. All images that are uploaded are now tied to the exam record within SIXPACS and the Tech must add the exam ID to the upload. For example, in Kodak software, this is added in the Accession Number field (Fig. 9). In XScan, the exam ID is added to the DICOM Acc No field (Fig. 10). Once the images have been sent to the server, the order detail will display a magnifying glass and will show the number of images for each exam. Thumbnails of each image will also display under the exam. Click on the Refresh button to update the information in the order detail. Figure 9 Kodak Accession Number Field (highlighted) Figure 10 XScan Dicom Acc No (highlighted) VI. Completing the Visit The process of completing orders, scanning paperwork and sending images is repeated for each order in the current visit. The orders listed in the In Progress tab include an icon that indicates whether the order has enough information for the visit to be completed. An example of this behavior is shown in Figure 11. The first order shown is missing information required for the order to be complete (i.e. facesheet, time of exam, images, etc.). This is shown by the alert symbol (yellow triangle with exclamation mark). The second order contains all the information required. The complete symbol is shown. The complete symbol must be shown for each order before completing the visit. If any order is not ready to be completed, you will not be able to complete the visit. NOTE: There may be circumstances where you cannot complete the visit (equipment failure, transmission errors, wrong information entered into acquisition software, etc.). To continue to process more orders, the Tech will need to escalate the order to management for them to assist with resolving the issue (see Escalate an Order to Management below)

14 User Guide Technologist Supplement Click on the Complete Visit button. The current visit will change to NONE, and the status of the orders will change to Completed. Fig. 11 Order Completion Status Assign Radiologists/Cardiologists The last step in the process is to assign a radiologist/cardiologist to the completed studies. As soon as images are present for each exam in the order, the Assign Rad button will be displayed. Click on the Assign Rad button. The Assign Radiologist Dialog will be displayed as shown in Figure 12. Select a radiologist and click Assign. The radiologist will be shown on the worklist, to the right of the patient s date of birth (Fig. 13). Figure 12 Assign Radiologist Dialog

15 User Guide - Technologist Supplement Figure 13 Radiologist Assigned to Order Escalate an Order to Management Circumstances may arise where an order cannot be completed by the Tech. These circumstances include image transfer issues, where the wrong accession number was entered into the system, incorrect images attached to exams, etc.. When this occurs, the tech must escalate the order, so that management can take the appropriate actions to have the exam read. To escalate an order, click on the Escalate Order button. Enter an appropriate comment in the dialog box that appears, and click on OK. An will be sent to management with the order information and the comments that you have entered. The order will change to an Escalated status, and the visit can then be successfully completed. Burn Patient CD The following instructions illustrate how to burn patient images to a CD from SixPACS. From the worklist, select a patient order. Click on the Burn CD button. The Burn Patient CD dialog will be displayed, as shown in Fig. 14. Figure 14 - Burn Patient CD Dialog Select the desired exams by clicking on the checkboxes next to the corresponding row in the dialog box. Click on OK to continue

16 User Guide Technologist Supplement The RemotEye viewer will load and display the images. Click on the Save/Export button, and select Burn Current Patient, under the Burn CD/DVD locally menu. If the following dialog box appears, follow the instructions under Installing CD/DVD Burning Support. Once the software is installed, continue with the next step

17 User Guide - Technologist Supplement The Burn DICOM CD/DVD dialog window will be displayed. Make sure that there is a blank CD in the drive and click on the Burn CD/DVD button. If you get a Query Error dialog, just click on OK. The CD will continue to be written. When the CD burning is complete, the CD will be ejected, and a dialog will show that it has been written successfully. Installing CD/DVD Burning Support Follow these instructions, if the following dialog box is displayed when trying to burn a CD If the above dialog box appears, click on Yes. A web page with the following information will be displayed. Click on Download Installer for Windows

18 User Guide Technologist Supplement If a bar appears at the top of the browser window, click on the bar and select Download File. If the following dialog appears, click on Run. If the following dialog appears, click on Run When the program runs, click on the Next Button

19 User Guide - Technologist Supplement Click Install The installation will download a copy of the viewer. This process takes approximately 30 minutes to complete. When the installation is complete, click Done. Close the browser window for the Installer. To continue burning a CD, follow Step #4 from Instructions for Burning a CD from the PACS