ISAI_REVIEWER.pdf

WORKFLOW IN RADIOLOGY Workflow is the way you do things. Workflow is generally and scientifically composed of different processes; it’s just not a simple stage; there are processes. In every process, there are tasks and subtasks. This...

WORKFLOW IN RADIOLOGY Workflow is the way you do things. Workflow is generally and scientifically composed of different processes; it’s just not a simple stage; there are processes. In every process, there are tasks and subtasks. This particular workflow is applicable to many different kinds of organizations, one of those that really benefit to the workflow is organizations that performs services in the same manner everyday. If you do the same manner everyday and if you do the same thing everyday, it would be so beneficial to have a workflow process, especially when you are in the position when you do the same thing everyday For example in radiology, there is shifting because the radiology department functions 24 hours a day. Workflow is just a simple way of doing things right and doing things the way it should be done, everytime it is done. So when you have an outcome that is set forth for an organization, that outcome is being achieved When you have a workflow it doesn’t matter who does it,the important thing is the outcome. There are certain levels of efficiency and quality that is acomplished when you have a workflow. NOTE: For imaging centers and radiology departments, radiology workflow optimization matters as it affects the quality level of service delivery and is key in decreasing operational costs. Considering these points, it doesn’t hurt to do a radiology workflow analysis to review how your practice is currently operating to ensure optimal performance. RADIOLOGY WORKFLOW - Radiological processes consist of numerous well-defined activities which are performed by different people or systems, in different locations and at different points in time. In a digital department, most of these activities are supported by computerized application systems and appropriate software components within these systems. Key steps in Radiology Workflow 1. Patient registration: This step involves capturing and verifying the patient's demographic and insurance information, as well as obtaining consent if necessary. 2. Scheduling: The scheduling step ensures that the patient is assigned a time slot for their imaging examination. This step also includes coordinating any necessary preparations, such as fasting or contrast administration.  3. Imaging: During this step, the technologist performs the imaging procedure, which may involve X-rays, CT scans, MRIs, or other modalities. The technologist ensures patient safety, positioning the patient correctly, and operating the imaging equipment. 4. Image interpretation: After the imaging is complete, the radiologist reviews the images to identify any abnormalities or conditions. This step requires expertise in image interpretation and the ability to correlate findings with the patient's clinical history. 5. Reporting: The radiologist generates a detailed report summarizing the findings from the image interpretation. The report is then sent to the referring healthcare provider, who will use it to guide further diagnosis or treatment. 6. Follow-up: In some cases, the radiologist may request additional imaging or follow-up with the patient to monitor the progress of a particular condition or to ensure the effectiveness of a treatment plan. PACS - PACS Systems (picture archiving and communication system) are a medical imaging technology which provides economical storage, retrieval, management, distribution and presentation of medical images. Electronic images and reports are transmitted digitally via PACS systems. This eliminates the need to manually file, retrieve, or transport film jackets. It allows a healthcare organization (such as a hospital) to capture, store, view and share all types of images both internally and externally. GENERIC PACS WORKFLOW 1. Changes in the order entry are on the horizon, but for now, the order-entry process is the same as in film-based departments. The technologist needs a requisition to verify the patient ID and to take a patient history. 2. The order is input into the Radiology Information System (RIS), and the RIS sends a message to the PACS to find all historic images and put them on the short-term archive. This eliminates waiting for the file room to retrieve a film jacket from the off-site storage location 3. The technologist prepares the room, retrieves the patient, and performs the patient history. The history is recorded on the paper requisition or input electronically into the patient’s computerized medical record. 4. The technologist performs the examination, and depending on the type of image acquisition device, the images are processed and repeated as necessary and sent to the appropriate PACS device. The patient images have been tagged with information from the RIS so that historic image reports are available at the PACS when the new images are sent. If the patient’s physician does not have access to the electronic images, a compact disk (CD) or digital versatile disk (DVD) can be made that contains the images in digital format. 5. The requisition is either taken to the radiologist, or the radiologist may pull the images from an electronic work list. The radiologist also pulls up historic images and reports and compares the previous images with the current images 6. The radiologist dictates a report and has it transcribed, or voice recognition software may be used. If the radiologist uses voice recognition software, he or she can review the report right after dictation, make corrections, and sign the report, making It final PACS format The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine). DICOM permits PACSs, Radiology Information Systems (RIS) and more medical imaging systems to connect with and pass data to systems at other healthcare facilities. Most PACSs handle images from various medical imaging instruments, including ultrasound (US), magnetic resonance (MR), nuclear medicine imaging, positron emission tomography (PET), computed tomography (CT), endoscopy (ES), mammograms (MG), digital radiography (DR), computed radiography (CR), histopathology, ophthalmology, etc. Additional types of image formats are always being added. Clinical areas beyond radiology such as cardiology, oncology,orthopedics, and even the laboratory are creating medical images that can be incorporated into PACS DICOM - DICOM® is the international standard to transmit, store, retrieve, print, process, and display medical imaging information. - DICOM® — Digital Imaging and Communications in Medicine — is the international standard for medical images and related information. It defines the formats for medical images that can be exchanged with the data and quality necessary for clinical use.  Picture Archiving and Communication System (PACS) Workflow - PACS > consists of digital acquisition, display workstations, and storage devices interconnected through an intricate network. A display workstation is any computer that a health care worker uses to view a digital image, and it is the most interactive part of a PACS. Four major components: PACS 1. The imaging modalities 2. A secured network for the transmission of patient information; 3. Workstations for interpreting and reviewing images; 4. And archives for the storage and retrieval of images and reports. Combined with available and emerging web technology, PACS has the ability to deliver timely and efficient access to images, interpretations and related data. It breaks down the physical and time barriers associated with traditional film-based image retrieval, distribution, and display. The common sequential steps of a Technologist Workflow related to Radiology PACS Workflow 1. Patient identification and verification: The technologist confirms the patient's identity and verifies that the correct patient information is associated with the images. 2. Image acquisition and quality control: The technologist performs the imaging procedure, ensuring that the images are of acceptable quality and meet the necessary standards for interpretation. 3. Image transfer and storage: Once the images are acquired, the technologist transfers them to the Picture Archiving and Communication System (PACS), where they are securely stored for future access and retrieval. 4. Image processing and manipulation: The technologist may need to perform image processing tasks, such as adjusting brightness or contrast, to optimize the images for interpretation. 5. Image distribution and sharing: The technologist may need to share the images with other healthcare providers involved in the patient's care, either through the PACS system or by generating CDs or other media. 6. Equipment maintenance and troubleshooting: The technologist is responsible for ensuring that the imaging equipment is functioning properly and addressing any technical issues that may arise during the workflow. The common sequential steps of a Radiologist Workflow related to Radiology PACS Workflow - Image access and retrieval: The radiologist accesses the PACS system to retrieve the patient's images for interpretation. This step involves searching for the correct patient, accessing the relevant imaging studies, and displaying them on a workstation. - Image interpretation and analysis: The radiologist carefully reviews the images, analyzing them for abnormalities, anatomical structures, and any relevant findings. This step requires expertise in image interpretation and the ability to correlate the findings with the patient's clinical history. - Report generation: Once the interpretation is complete, the radiologist generates a detailed report summarizing their findings. This report includes a description of the imaging findings, any relevant measurements, and an overall assessment of the patient's condition. - Report distribution: The radiologist ensures that the report is properly distributed to the referring healthcare provider, who will use it to guide further diagnosis or treatment. This may involve electronically sending the report through the PACS system or printing a hard copy for delivery. - Communication and consultation: In some cases, the radiologist may need to communicate directly with the referring healthcare provider to discuss the findings, provide additional information, or answer any questions that may arise. - Follow-up and documentation: The radiologist may need to document any additional recommendations for further evaluation or treatment. This step ensures that the patient's imaging findings are properly documented and integrated into their medical records. Integrating the HealthCare Enterprise Workflow Model The IHE (Integrating the Healthcare Enterprise) initiative was started in November 1998 by the Radiological Society of North America (RSNA) in conjunction with the Hospital Information and Management Systems Society (HIMSS). Integrating the Healthcare Enterprise (IHE) is a multinational healthcare initiative that develops and publishes domain -based (for example, radiology, laboratory, etc.) The aim of the initiative was to devise a technically viable specification for improving communication between the various healthcare systems and medical devices IHE improves the way health care systems communicate with one another and accelerates the adoption of EHRs. Hospital Information System and Electronic Medical Record - A medical imaging study begins with a patient-physician encounter that generates an order or prescription. From within a healthcare enterprise, patient demographic and medical data are collected and distributed by a HIS, which may or may not be completely computerized and paperless. An EMR is such a data system that is completely paperless. - In an EMR environment, the imaging study can be ordered by clinicians via computer. Such a computerized physician order entry carries the potential advantages of providing relevant patient history and providing point-of-need decision support, such as image exam appropriateness criteria. Radiology Information Systems - Regardless of the method of study order, radiology study orders must be communicated to a RIS. A RIS is a computer application that manages patient demographic data and scheduling and tracks associated images and reporting results. Once an imaging study order is entered into a RIS, the study is associated with a unique identifier code such as an accession number. The accession number and medical record number allow unambiguous association of the image dataset with the correct patient demographics; this also allows coordination of the patient’s scheduling and imaging encounter at the imaging modality. This system enables a patient study to be accessed at any site of a radiology department network for acquisition and communication of results and images back to the HIS/EMR. In addition, many of the business/operational analytics (scorecards, dashboards, and reports) necessary to monitor operational quality/efficiency are generated by the RIS or depend on RIS data. Radiology Information Systems: Picture Archiving and Communication Systems Integration - There is clearly a need for RIS and PACS to communicate efficiently. Some vendors offer hybrid products comprising both RIS and PACS; however, that is not always the case. In scenarios where health networks work with different vendors, the radiologists’ workflow is derived by either the RIS or the PACS as the primary source of truth. A RIS-driven workflow seems intuitive based on having patient and study information and being the primary tool for schedulers and technologists. However, a PACS-driven workflow would use the imaging studies themselves to drive a worklist and would be within the software workspace that radiologists mainly use, acquiring additional data from the RIS via the accession number or other identifier. Regardless of the method used, optimized and localized integration of RIS- PACS to offer efficient workflows for both radiologists and technologists is vital for a reliable and accurate department system. Technical Standards - For the various components of a healthcare system to communicate effectively, there are technical standards that enable the interoperability of different systems, both within radiology and throughout the enterprise. Standards are maintained and updated by corresponding associations and are continually evolving to improve efficient communication. Health Level 7 - Healthcare networks have many components in an information system, including the EMR, RIS, order entry systems, laboratory information systems, etc. Health Level 7 (HL7) is the computer standard governing the communication of these various information systems within and between healthcare networks. HL7 is responsible for communicating with a RIS and sharing information with an EMR. In imaging, this encompasses study ordering,  registration, and results communication. HL7 characterizes each interaction as an event and can disseminate the associated message electronically to other systems. - Although HL7 is the standard spanning the breadth of healthcare, Digital Imaging and Communications in Medicine (DICOM) is the technical standard for display, storage, and transmission of medical images. DICOM began as a collaborative effort by the American College of Radiology (ACR) and National Electrical Manufacturers Association in the early 1980s and was renamed DICOM in 1993. Now it has become the universal standard data format for images and communications among all medical imaging devices and software applications. A DICOM image also contains information regulated by the standard: media display, security profiles, data storage, and data encoding and exchange. DICOM - DICOM has been the critical enabler for interoperability of hardware and software spanning all aspects of radiology workflow (image acquisition modalities, PACS servers, workstations, networks). DICOM also allows image databases to be shared as PACSs develop and expand and maintain communication with other information systems. - DICOM does not have a centralized body to certify or enforce implementation of the standard. It is up to various vendors to conform to the standard. Although the standard can be followed, the mechanisms of use are not specified. Vendors almost universally provide DICOM conformance statements that explicitly state how a specific vendor’s offering supports DICOM. Also, vendors may opt to carry additional proprietary technical parameters, which may impact interoperability. Integration, Standards, and Interoperability Workflow - Integration, Standards, and Interoperability Workflow integration and interoperability is at present hampered by a number of serious obstacles. Many of these are related to the mismatch between the DICOM standard for digital image communication in medicine, and the HL7 standard for health information systems. - The structure of the DICOM standard is divided into parts 1-21. - HL7, compared to DICOM, is much less formally structured (thus allowing tremendous flexibility, but also creating the need to redefine almost every implementation explicitly). - a development in the HL7 community is a new standard called Fast Health Interoperability Resources (FHIR—pronounced “fire”) and based on modern web services and RESTful interfaces approach that uses APIs and openstandard file formats such as XML or JSON (JavaScript Object Notation) to store and exchange data. FHIR can fill the needs of the previous HL7 standards (V2, V3, CDA) and provides additional benefits in the ease of interoperability, interfaces, and access to data.  PARTS OF THE DICOM STANDARD Part 1: Introduction and Overview Part 2: Conformance Part 3: Information Object Definitions Part 4: Service Class Specifications Part 5: Data Structures and Encoding Part 6: Data Dictionary Part 7: Message Exchange Part 8: Network Communication Support for Message Exchange Part 10: Media Storage and File Format for Media Interchange Part 11: Media Storage Application Profiles Part 12: Media Formats and Physical Media for Media Interchange Part 14: Grayscale Standard Display Function Part 15: Security and System Management Profiles Part 16: Content Mapping Resource Part 17: Explanatory Information Part 18: Web Services Part 19: Application Hosting Part 20: Imaging Reports using HL7 Clinical Document Architecture Part 21: Transformations between DICOM and other Representation Top Information Technology Standards 1. ISO 20000 is the specific standard for the IT sector that emphasizes guidelines and best practices for service providers of all types and sizes to maintain consistency and security of their services. 2. ISO 27001 helps at ensuring the security of your information assets and sensitive data.  3. CMMC or Cybersecurity Maturity Model Certification is also an information security standard but is strictly for the organizations that operate as a part of the Defense Industrial Base (DIB). 5 Popular Best Practices to Adopt for Information Technology Standards 1. Protection of Data: create definite policies for protecting information, IT devices, intellectual property assets, and all other data-based systems. Those policies must be widely promoted across the organization and followed by every department and employee. 2. Strong Password and Authentication: This is a must-have practice for preventing any outsiders or cyber criminals to access your organization’s confidential information. It includes setting up complex passwords, changing passwords on regular basis, and 2 factor/multifactor authentications for user access. 3. Advanced Security Systems: Investing in state-of-the-art security systems is essential to protect your organization’s information from new emerging threats as well as to deal common security issues. 4. Installing Latest Software and Updates: Running frequent updates and installing the latest software for virus and malware protection is a necessary practice too. They are required to safeguard everything from various threats, starting from your IT devices to business applications, operating systems to web browsers, cloud storage systems to external hard drives. 5. Data Back-Up: This must be a regular practice for your organization to ensure that none of your vital data and information assets are lost permanently. Even if they are destructed accidentally or get misplaced, back up helps to immediately retrieve them. Benefits of Radiology Workflow Optimization 1. Faster Turnaround - Eliminating or automating processes that drain time means patients receive their results even faster. 2. Patient Satisfaction - When patients receive fast turnaround for results and consistent communication, it boosts their overall satisfaction. 3. Increased Referrals - Improving radiology workflow to allow physicians to request orders on the spot, for example, eliminates manual or paper-based actions. Simplifying this order request process paves the way for increased referrals. 4. Reduced Operational Costs - Eliminating or automating redundant processes means your staff has more time for more important tasks.