ConnectR Training

Table of Contents Introduction: What is ConnectR? The Big Picture: Data Flow Diagram Access: How to Log In Server and System Status System Pairs: What are the interfaces? Message Logs: How to Read Messages Error Worklist: How to Re-File an Error

Objectives Ability to monitor server/system status Understand the various interfaces and their associated functions Ability to read various types of messages Ability to monitor the error worklist Ability to re-file errors appropriately Ability to perform basic trouble shooting with DICOM Modality worklist issues

Introduction: What is ConnectR? ConnectR is an interface engine. It is capable of interpreting and translating DICOM and HL7 messages into a format which is compatible and understandable within the iSite® Server Database. Once the DICOM and HL7 messages are translated and updated inside the iSite Database, then the data is available for viewing in the end-user applications namely iSite® Enterprise, iSite® Radiology, and iSuite.

ConnectR – HL7 Inbound Interface The Big Picture ConnectR – HL7 Inbound Interface 1. New order -- status “S” ORMNW New Order RIS iSite DB

Data Flow: 2 RIS RI iSite DB MODALITY New order -- status “S” ConnectR – HL7 Inbound Interface New order -- status “S” DMWL Query Request ORMNW New Order HL7 RIS RI iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target MODALITY Merge Toolkit Merge Toolkit DICOM DATA SP CALL

Data Flow: 3 RIS iSite DB MODALITY New order -- status “S” Merge Toolkit ConnectR – HL7 Inbound Interface RIS ConnectR – DMWL Interface MODALITY ORMNW New Order New order -- status “S” DMWL Query Request DMWL Query Response C-FIND-RQ HL7 DICOM Source Target DATA SP CALL iSite DB C-FIND-RSP ACK

Data Flow: 4 RIS iSite DB MODALITY New order -- status “S” ConnectR – HL7 Inbound Interface RIS ORMNW New Order New order -- status “S” DMWL Query Request DMWL Query Response Modality sends images – order status “I” HL7 iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

Data Flow: 5 RIS iSite DB MODALITY New order -- status “S” ConnectR – HL7 Inbound Interface RIS ORMNW New Order ORMSC Update Order New order -- status “S” DMWL Query Request DMWL Query Response Modality sends images – order status “I” Update order – status “C” HL7 iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

Data Flow: 6 RIS iSite DB MODALITY New order -- status “S” ConnectR – HL7 Inbound Interface RIS ORMNW New Order New order -- status “S” DMWL Query Request DMWL Query Response Modality sends images – order status “I” Update order – status “C” Order preliminary report – status “P” ORMSC Update Order ORU Preliminary Report HL7 iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

Data Flow: 7 RIS iSite DB MODALITY New order -- status “S” ConnectR – HL7 Inbound Interface ORMNW New Order ORMSC Update Order RIS ORU Preliminary Report New order -- status “S” DMWL Query Request DMWL Query Response Modality sends images – order status “I” Update order – status “C” Order preliminary report – status “P” Order final report – status “F” HL7 ORU Final Report HL7 iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

Access In the address box, type in the IP address of your Stentor Server followed by “/idxconnectr/launch.asp” Select “ConnectR” for Data Source

Status Page To access the Status Page: Click on the “Monitor” bar Click on the “Status” bar

Monitor Status Within ConnectR, there are numerous system pairs that handle different types of data coming into the system by converting the data to a format that the iSite database can understand. The server status as well as the status of each of these system pairs can be monitored.

System Pairs DICOM PAIR HL7 PAIR Internal Communication Pair DMWL PAIR

Source Systems Source Systems designate the first point of data entry from an outside source (i.e. Modalities for the DICOM PAIR and RIS for the HL7 pair) into ConnectR. The Source Systems pass the data to their associated Target System.

Target Systems The Target Systems then process the data and update the iSite Database with the information that the data messages contained.

Last Message The Last Message column displays the date and time stamp of the last message that came through that associated system.

QSize The QSize column displays the number of messages waiting in the queue to be processed. A “0” value indicates that the interface is processing messages in an expedient manner. Take note or contact Customer Care if Queue is in the hundreds or thousands.

DICOM Pair Source System – receives studies from the modalities and passes the messages to the target system for processing. Target System – processes and registers the messages from the modality into the database.

DICOM Flowchart RIS iSite DB MODALITY Merge Toolkit Merge Toolkit ConnectR – HL7 Inbound Interface ORMNW New Order ORMSC Update Order RIS ORU Preliminary Report HL7 ORU Final Report HL7 iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

HL7 Pair Source system - receives HL7 data messages (ADTs, ORMs ORUs). Target system - processes HL7 data messages (ADTs, ORMs, and ORUs) and updates the database.

HL7 Flowchart RIS iSite DB MODALITY Merge Toolkit Merge Toolkit ConnectR – HL7 Inbound Interface ORMNW New Order ORMSC Update Order RIS ORU Preliminary Report HL7 ORU Final Report HL7 iSite DB ConnectR – DMWL Interface C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

Internal Pair Target system – receives updates from iSuite and passes the messages to the source system for processing. Source system – processes the updates and forwards the updates to iSite.

DMWL Source Source system – Receives the query or request from the Modality to perform a (DICOM C-Find) Sends the translated data back to DICOM modality.

DMWL Target Target system – Processes the query (DICOM C-Find to iSyntax) and queries the iSuite database for patient exam data with exams in either “S” – Scheduled or “I” – In Progress Send result back to the Source System

DMWL Flowchart RIS iSite DB MODALITY Merge Toolkit Merge Toolkit ConnectR – HL7 Inbound Interface ORMNW New Order ORMSC Update Order RIS ORU Preliminary Report HL7 ORU Final Report HL7 ConnectR – DMWL Interface iSite DB C-FIND-RQ Source Target Merge Toolkit Merge Toolkit DICOM DATA SP CALL C-FIND-RSP Source MODALITY DICOM ACK iSite Processing Module MSMQ - iSuitenorm C-STORE SERIESREG MSMQ DICOM ConnectR – Stentor -> IDX Interface

Message Log Page To access the Status Page: Click on the “Monitor”. Click on the “Message Log.” Select a system on the drop down arrow to view the original data messages that came into that system and how the data messages look as they leave that system.

Stentor to IDX Source Step 1 Step 2 This Source system is the receiving bucket for DICOM Series Registration messages. ‘Raw’ DICOM message is first received in the source system before being passed onto the corresponding target system for processing. Step 1: Click on the down arrow to open up the drop down list and select Stentor to IDX Source. Step 2: Select a date by clicking on the Calendar icon. The dates highlighted in black are the only dates which have messages.

Date / Time Stamp This Source system will display the native DICOM messages from the Modalities as well as Heartbeat Messages. Date and Time stamp of the DICOM message that is displayed in the Source and Target message boxes. The displayed message is the 12th message out of a total of 6977 messages received for that day.

String Filter Use the String Filter field to type in any patient identifier for ConnectR to search through all messages and locate only those DICOM message (study series) for the patient.

DICOM Source / Target The Source Box indicates what that DICOM message looked like as it entered into the system. The Target Box indicates what that DICOM message looked like as it left this system. For this system Source and Target messages will look exactly the same.

Play Buttons The arrow buttons: 1 2 3 4 The arrow buttons: Move you to the very beginning of the message log (message number 1 out of a total of 6977) Move you back one message at a time Move you forward one message at a time Move you to the very end of the message log (message number 6977 of 6977)

Grid Buttons Click on the grid button in either the Target Message pane or the Source Message pane to view the ‘raw’ DICOM study message in an easy-to-read column format.

Grid Page The Grid page will display the data messages in a tree-like format that makes it easier to look up individual field names and its associate value.

Message ID Message ID: is a unique identifier that ConnectR assigns to each data message. These numbers aide in isolating a problem data message for trouble-shooting procedure calls (translations of the raw data message) in the Target systems.

Stentor to IDX Target The Target system receives DICOM Series Registration messages from the corresponding Source system. The Target system processes the messages by using procedure calls. A procedure call is a set of instructions that translate the actual data message into recognizable fields in the database. Step 1 Step 2 Step 1: Click on the down arrow to open up the drop down list and select Stentor to IDX Target. Step 2: Select a date by clicking on the Calendar icon. The dates highlighted in black are the only dates which have messages.

DICOM Source / Target The Source message box displays the ‘raw’ DICOM study message that is undergoing translation. The Target message box displays the translations and any errors if present. The Source and Target messages will look different when translation of the original DICOM message has occurred.

DICOM Target Grid The Grid page for the Target message will display the translated data messages in a tree-like format that is easier to look up individual field names and its associate value.

HL7 Source This Source system is the receiving bucket for HL7 messages before being passed on to the Target system for processing. As a requirement of the HL7 standard, every ‘raw’ HL7 message received is followed by an ACK (acknowledgement) message sent back to the RIS/HIS to indicate we have received the message.

Hl7 Target The Target system receives HL7 messages from the corresponding Source system. The Target system processes the messages by using procedure calls. A procedure call is a set of instructions that translate the actual data message into recognizable fields in the database.

HL7 Target Grid This grid page will display how ConnectR has converted the HL7 message into data fields that the iSite Database can understand and recognize.

HL7 Source Grid This Grid will display the “raw” HL7 message in a easy to read table per HL7 field name and the value.

HL7 Overview What is HL7? “Health Level Seven develops specifications, the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.” What is a “Message?” A message is a basic communication unit containing information that models a real world event. How does one read a Message? A message is structured like an organizational chart. Message Segment Fields component Common HL7 Message Types, Segments, and Fields based on HL7 Standards http://www.hl7.org

Message Types DEFINITIONS ADT is an (A)dmit, (D)ischarge, and (T)ransfer message that is generated when a “Trigger Event” happens like a patient gets admitted, discharged, or transferred to another facility. ORM is an (Or)der (M)essage which includes new orders, order status changes, and order cancels. ORU is a Report/Result Message. These values are sent in the Message Header (MSH) of an ADT, ORM, or ORU message and are considered message types. Example: <11>MSH|^~\&|IMAGING|PSJMC|TDSresults|PSJMC|20030926000401||ORM^O01|783744|P|2.3<13> Common HL7 Message Types, Segments, and Fields based on HL7 Standards http://www.hl7.org

HL7 Segments Example: <11>MSH|^~\&|IMAGING|PSJMD|TDS|PSJMD|20030926133719||ORM^O01|785465|P|2.3<13> PID||01000083270000160771229|555-55-555^^^PSJ||ESCARDA^NARVARO||19000606|M|||1234 SOMEWHERE AVE^^^CA^90001-0000||213-456-7890|312-987-6543||||60771229|55555555<13> PV1||I|4S^S460|||||FEB^SINATRA^FRANK^E^^^MD^8888||||||||||IP||||||||||||||||||||||||||200102240414<13> ORC|SN||100A-01011800||IP|N|1^^^200102241201^^S||200309261015|^INTERFACE^HIS||FEB^SINATRA^FRANK^E^^^MD^8888<13> OBR|||100A-01011800|9025^CT PELVIS 72193^MWA||| 200102241201||||||--..|||FEB^SINATRA^FRANK^E^^^MD^8888||58944|||| 200102240414||CT|||1^^^200102240414^^S|ST1^TAPAIN^STEVEN^^^^MD^0275~SLP^POLISH^JOSEPH^L^^^MD^9828<13> NTE|1||CT UROGRAM ,PT GOING TO OR 1230 TODAY<13> <28><13> PID is a Patient Identifier Segment PV1 is a Patient Visit Segment ORC is the top level Order Information Segment OBR is the Order Detail Segment NTE is the Notes and Comments Segment OBX is the Report/Result Segment in an ORU Message

HL7 Fields Field Positions and Names ADT, ORM, and ORUs ORM/ORUs ORUs PID-02 MPI Number PID-03 MRN PID-05 Patient Name PID-07 DOB PID-08 Sex PID-18 Patient Account Number PID-19 SSN PV1-07 Attending MD PV1-17 Admitting MD ORM/ORUs ORC-02 or OBR-02 Order Number ORC-03 or OBR-03 Accession Number ORC-12 Ordering MD OBR-04 Exam Code and Exam Description OBR-07 Order Date and Time OBR-24 Resource Name OBR-25 Order/Exam Status ORUs OBX-05 Result Text

Data Flow: 3 RIS iSite DB MODALITY New order -- status “S” Merge Toolkit ConnectR – HL7 Inbound Interface RIS ConnectR – DMWL Interface MODALITY ORMNW New Order New order -- status “S” DMWL Query Request DMWL Query Response C-FIND-RQ HL7 DICOM Source Target DATA SP CALL iSite DB C-FIND-RSP ACK

Troubleshooting DMWL Take the following steps if you use DMWL and there is no response: Use iSite’s Modality Worklist to query the exam you are expecting. If the exam is not there, then Look at DMWL Source and Target Systems in ConnectR to see if the query and results were returned. To look up exams in Modality Worklist, Select “Yes” in this prompt Select the resources (or modalities) that you want the exams for by clicking on the Next use the Primary Filters to select other matching criteria.

DMWL Source The Source system receives the query or request from the modality. The Source system then passes the query to the Target system for processing. The query is logged as a Data Message.

DMWL Target The Target system receives query from the Source system and translates the request into a procedure call (SP Call). This procedure call queries the Stentor database for relevant exams and passes the patient list back to the Source system. Message Type is “SP” Call

DMWL Source The Source system sends the patient list back to the modality as an Ack Message. Message Type is “Ack Message”

Other Reasons to look into ConnectR Study sent but is not present in iSite Enterprise Search for the study by either the accession number, MRN, or patient name in the corresponding study interface target system Verify that the study exists in the interface with the correct patient values Verify if there are any errors logged with this study Order Exam and/or Report sent but is not present for the corresponding study in iSite Enterprise Search for the order and/or report in the HL7 interface target system by either the accession number, MRN, or patient name Verify that the order and/or report exists in the interface with the correct patient values Verify if there are any errors logged with this order and/or report

Error Worklist: 1 Any HL7 errors can be viewed in the Error Worklist by selecting the HL7 Target System.

Error Worklist: 2 There are various types of errors, but begin by just Step 1 Step 2 Step 3 There are various types of errors, but begin by just looking at the “Patient or Exam Locked by Another User” errors. Select Date Range Type in “locked” in String Filter. Click on

Exam Status OBR-25 “S” for Scheduled Exams “I” for In-progress Exams Exams Scheduled by the RIS. “I” for In-progress Exams Internal iSite Status to designate that iSite is actively receiving images for an Exam. “C” for Completed Exams Designation by the RIS that a Study (image acquisition) has been completed. Completed Status always comes from RIS. “D” for Dictated Exams Exams which Radiologists have dictated reports but not yet transcribed. “P” for Preliminary Exams Exams have Preliminary Reports, but not signed off yet by Radiologists. “F” for Final Exams Exams with Finalized Reports that have been signed off by Radiologists Most of these “locked” errors are trying to update the status of an exam. Therefore, let’s look at the logical progression of the life of an exam.

Re-Filing Errors It is very important to check whether errors should be re-filed prior to re-filing. For example, there may be an error message that is trying to complete an exam to the ‘C’ – Completed Status. At a later time another message filed successfully and updated the exam with a report to a ‘F’ – Final Status. So the current status of this exam in iSuite is “F”. In this example, if the error message is re-filed, than the ‘F’ – Final Status will be overwritten back to a ‘C’ status for this exam which is undesirable.

Re-Filing Errors: Step 1 Steps to Check Errors before re-filing: Double left clicking on the error will open up the message log.

Re-Filing Errors: Step 2 Click on to view messages Step 2

Re-Filing Errors: Step 3 Use the play buttons to scroll through the Target messages until you find the error. Tip: Start from the very end then scroll forward one message at a time until you have come to the error. Go back one more.

Re-Filing Errors: Step 4 This message is the actual error. Grid this to find the Accession number of the exam and the status that this message was trying to update this exam to.

Re-Filing Errors: Step 5 Step 5: Verify Exam Status Value prior to Re-filing message Log in to iSuite Go to the Pt Record Tab Go to Exam Tab Enter ACC Look at Exam Status. If exam status is further down the chain of progression for an exam then DO NOT re-file error.

Re-Filing Errors: Step 6 To remove an Error, click To re-file an error, click Step 6

Stentor Customer CARE If your trouble-shooting requires additional assistance please call Stentor Customer Support (CARE) at 1-877-328-2808 or 1-877-328-2809.