1. iSite 3.5: Exam Linking

2. Table of Contents Objectives Terminology Introduction
Technologist Worklist
Exam Linking
Exam Unlinking

3. Objectives Understand the purpose of Exam Linking
Understand how to link exams

4. Terminology PACS (Picture Archive and Communications System)
Information Systems designed to manage, store and distribute medical images and related information throughout the healthcare enterprise
HIS (Hospital Information System)
Information Systems designed to manage patient records, including patient registration, billing and order entry
RIS (Radiology Information System)
Information Systems designed to manage exams (orders), including filling orders and scheduling

5. Terminology DICOM (Digital Imaging COmmunication in Medicine)
DICOM is the predominant communication standard between imaging equipment throughout the Healthcare Enterprise
HL7 (Health Level 7)
HL7 is the predominant messaging standard for exchanging key sets of administrative and clinical data in the healthcare enterprise

6. Terminology MRN (Medical Record Number)
A unique patient identifier (also known as Patient ID) used for auditing of billing and scheduling for patients
Accession Number (ACCession Number)
A unique exam identifier (also known as an order number or requisition number) used for auditing of billing and scheduling of scheduled procedures
SUID (Study Instance Unique IDentifier)
A unique study identifier used for auditing of performed imaging service requests

7. Introduction

8. Exam Linking
Linking Exams provides the ability to associate multiple exams (orders) with a single study (image acquisition)
Linking Exams is necessary in an environment where multiple orders and multiple dictation events are created for a single image acquisition sequence
Linking Exams permits the association of a single image acquisition (ex. CT Chest, Abdomen, Pelvis) with multiple exams as demonstrated on the Patient Directory and Patient History Timeline
* Exam Linking is preferably performed prior to image acquisition by the performing Radiologic technologist; however, exam linking may be performed after acquiring images.
Without using the Exam Linking feature, the exams not associated to the study will show on the Patient History Timeline with an ‘X.’ There is no indication to iSite users to look for the images under another exam. Exam Linking solves that problem. Once linked, those exams now have the same image reference.

9. Technologist Worklist

10. Technologist Worklist
In iSuite or iSite Enterprise from the Folder List
Access the Technologist Worklist to find your exams

11. Technologist Worklist
Select an accession number to view images from the Clinical Exam Notes

12. Technologist Worklist
Select the ‘view’ button to view images
Users will not have the option to view images from the Clinical Exam Notes in iSite Enterprise. Images should be viewed from selecting the exam in the Patient Directory.

13. Exam Linking

14. Exam Linking Linking Exams does not link reports
It is not possible to “link” exam notes to linked exams
For example: When CT CHEST, ABDOMEN, PELVIS exams are linked and a user creates an Exam Memo attached to the CHEST exam, the Memo will not show up in the Worklist and canvas page associated with the ABDOMEN and PELVIS exams
Caution: A note might contain information in regards to the linked exams that will be missed by the reading physician or clinician

15. Exam Linking
Exams may be linked by selecting the box next to the patient’s name when there are multiple exam orders associated with a single image acquisition event
Exam linking is performed within the Technologist Worklist. Exam Linking is an essential step of the Technologist Workflow, however it is also a daily management task of the iSite PACS Administration team. The administrators need to make sure exam linking is being performed by the technologists and is being performed properly.

16. Exam Linking The system will not allow linking of multiple patients
Exam linking is performed within the Technologist Worklist. Exam Linking is an essential step of the Technologist Workflow, however it is also a daily management task of the iSite PACS Administration team. The administrators need to make sure exam linking is being performed by the technologists and is being performed properly.

17. Exam Linking
If the exam status is ‘In Progress’ or ‘Scheduled’ select ‘link & begin’
Note: If ‘link & complete’ is selected this may cause the exams to prematurely populate Worklist filters

18. Exam Linking
‘link & complete’ may safely be used after image acquisition and when the exam status is already set to ‘Completed’ by the RIS

19. Unlinking Exams To Unlink: Select the exam(s) you wish to unlink
The Linked Exams dialog will appear automatically

20. Unlinking Exams
To Unlink: Select the exam(s) you wish to unlink and press unlink

21. Unlinking Exams Warning:
Technologists can unlink an image study from an exam in D (Dictated), P (Preliminary), F (Finalized), A (Addended) or R (Revised) status
If a technologist unlinks an image study from an exam with one of these statuses, the radiologist's diagnostic report may be effected because the report was dictated when the images were originally linked to the exam
For example, a report may make reference to or include a diagnosis based upon the image to which it was once linked
If this is the case and the image study is no longer linked to the exam/report, the image reference is lost if not re-linked to the appropriate exam

22. For assistance, please call customer support at 1-877-328-2808 or 1-877-328-2809