Connecting clinical workflows with Advanced Visualization Rick Gouse

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Where is Workflow in Enterprise Imaging? Radiologist Specialized Department Connected Enterprise Open Community Dynamic Multi-ology information Viewer Clinical Archive Infrastructure Leverage Investments & Optimize Costs Unify Web Viewing & Smart Apps Visualization & Accessibility Optimize Workflows and Reporting Workflow & Collaboration Connect Care pathways & Information Connectivity & Analytics Sharing

The Evolution of “RIS” Intake and Management of Relevant Data Pre-exam Tasks Intra-exam Procedures Post Exam Directives Follow-up Tracking

The breakdown of workflow Workflow Application Areas Intake and Management of Relevant data Patient Registration Order Placement and appropriateness Referring Physician Notifications / worklist Pre Exam Workflows Order and Schedule Refinement Patient and exam clinical data mgt. Exam exactness and protocoling Intra Exam Workflows Patient arrival and pre-exam tasks Intra-exam tasks Exam QC and Image Mgmt Nursing Care Charge Capture Post Exam Workflows Interpretation and report creation Report review, approval and signature Post-exam and follow-up directives MDT and other reviews

Customer Defined Workflow Controls Workflow control framework providing: Unlimited Exam specific tasks and task groups Tasks supported by Rich Content and User Control Ability to build fine-grain workflow scenarios from order to exam results distribution and post-exam follow-up Tracking tasks execution with timing, duration and delays. Workflow control hub embedded to Imaging Desktop for basic Tech Workflows: begin, complete, QC exam Workflow control features available for RIS-IC user via legacy UI Trigger Step N Worklist Task Data Result / Status Action Done

Intake and Management of Relevant Data Pre-exam Tasks Intra-exam Procedures Post Exam Directives Follow-up Tracking Role Activity Referrer CT Enterography exam ordered on a patient with ongoing abdominal pain Scheduler History and indications obtained Allergies recorded Exam scheduled Patient education performed If patient is allergic to IV contrast, an MRI may be done instead (Gadolinium used as contrast in MRI may be better tolerated)

Intake and Management of Relevant Data Pre-Exam Tasks Intake and Management of Relevant Data Pre-exam Tasks Intra-exam Procedures Post Exam Directives Follow-up Tracking Role Activity Billing clerk Pre-authorization documented Radiologist Review of all relevant forms/labs/data Exam protocoled Nurse/Tech GFR calculated and reviewed Patient education performed IV started Volumen given w/instructions A GFR greater than 60 is desired; between 60 and 40, the patient is asked to orally hydrate for a couple days post injection; and lower than 40, the patient needs to be hydrated with IV fluids before and after the exam, and be monitored by a nurse during the exam timeframe.

Intake and Management of Relevant Data Intra-exam Procedures Pre-exam Tasks Intra-exam Procedures Post Exam Directives Follow-up Tracking Role Activity Nurse/Tech Document contrast Patient education performed Start IV contrast Tech Perform imaging study Monitor IV Perform exam tracking steps Monitor the patient’s vital signs If any extravasation of IV contrast occurs during the exam, an “Extravasation Report” needs to be filed and proper nursing care for the patient performed.

Intake and Management of Relevant Data Intra-exam Procedures Post-Exam Directives Intake and Management of Relevant Data Pre-exam Tasks Intra-exam Procedures Post Exam Directives Follow-up Tracking Role Activity Nurse/Tech Remove IV Monitor the patient’s vital signs Tech Complete exam tracking steps Radiologist Review imaging for completeness Provide and document post-exam instructions Interpret the study and Record recommended imaging or clinical follow-up Coordinate care with other specialties, as needed (for example, if the patient is recommended to have a small bowel biopsy based on the results of imaging).

Intake and Management of Relevant Data Intra-exam Procedures Follow-up Tracking Intake and Management of Relevant Data Pre-exam Tasks Intra-exam Procedures Post Exam Directives Follow-up Tracking Role Activity Care Coordinator Document recommended imaging or clinical follow-up Nurse/Care Coordinator 1-day post-exam patient call to check IV site/general condition Radiologist Review pathology if biopsy was ordered QA Monitor Document compliance with PQRS and Centers of Excellence measures Monitor compliance with recommended imaging or clinical follow-up Full documentation of all events in the care continuum allows establishment of “models of care”, supports audit reports of documented events for accrediting bodies and for P4P, and provides care-specific marketing analytics.