1. Picture Archiving and Communications System (PACS) Cerner Millennium: Integration with RIS and PACS UK PACS & Teleradiology Group Newquay, March 30 th 2007 Roger Irish, Maggie Nicholls March 2007

2. Picture Archiving and Communications System (PACS) Contents Introduction Overview of Millennium integration with PACS and RIS Order Communications Project Issues Order Communications in other Clusters Questions

3. Picture Archiving and Communications System (PACS) Introduction Overview of the integration between Cerner Millennium and GE PACS and HSS CRIS in the South Focus is primarily upon Order Communications, but encompasses all integration points Provides an update on the Order Communications Project and its findings Concludes with a brief overview of Order Communications support in other regions

4. Picture Archiving and Communications System (PACS) Interface Overview Basis for Order Communications in the South is the Cerner Millennium interface deployed at Newham & Homerton (East London) Overview focuses primarily on the scope of this interface Overview covers Demographic Changes (via ADT messages) and Orders (Requests) (via the Order Communications interface

5. Picture Archiving and Communications System (PACS) Integration Architecture between CRS and RIS Each entity / Deployment family in CRS communicates to its equivalent entity in RIS Communication is not at the domain level This is true for demographics (ADT) and orders (ORM) There are: –10 CRS domains –7 RIS domains

6. Picture Archiving and Communications System (PACS) Overview of Demographic Propagation Demographic changes are sent from CRS to departmental systems using messages in the ADT interface set Communication is not at the domain level Each entity in CRS communicates to its equivalent entity in RIS

7. Picture Archiving and Communications System (PACS) Order communication data flow Event Event Place request on CRS Request processed on RIS Appointment is scheduled Patient presents Imaging carried out Imaging verified Imaging Reported Report Verified CRS Ordered RIS Complete Accepted Attended Requested Provisional Complete Ordered (Complete)

8. Picture Archiving and Communications System (PACS) Image Viewing in Cerner Millennium R2 The Order Communications results feed from CRIS to Millennium serves a dual purpose: –Passes report in support of the longitudinal patient history held in CRS –Passes a link to the associated imaging in the cluster data store Cerner Millennium Release 2 will include functionality to invoke the Centricity Enterprise Web Viewer from within PowerChart / PowerChart Outreach This will allow the viewing of relevant PACS images from within Millennium

9. Picture Archiving and Communications System (PACS) The Southern Cluster Order Communications Project This was initiated in January 2007 in response to concerns raised by the Southern Cluster RIS/PACS clinicians, that the Order Communications functionality being offered as part of the R0/R1 releases of Cerner Millennium, may not fully meet the clinical and business requirements of Pathology and Radiology departments.

10. Picture Archiving and Communications System (PACS) Summary of Findings Priority for Resolution Clinical Priority High 4524 Medium 421 Low 9-- Yes – Long Term/No workaround required Yes – Short TermNo Acceptable Workaround Available? Issues have not been assessed against requirements to determine if they are defects or change requests Cerner resource enabled several issues to be closed

11. Picture Archiving and Communications System (PACS) Summary of Issue Progression Route RouteNumber of Issues Refer to Requirements Definition Group18 Design Requirements Authority Action7 Refer to R2 Design Groups5 Review by Technical Architects4 Deployment Team Action6 Change Board Action1 Orderables Project Action4 None Required8

12. Picture Archiving and Communications System (PACS) Unsolicited Results Unsolicited Results are required to support: –GP Requests –Paper requests from downtime –Independent Sector requests where results are transcribed into the CRIS, but where the request may not have originated in Cerner Millennium CCN written due to be submitted to Requirements Group 21.03.07 with view to submission to Change Board within next week. (This covers 6 scenarios which require unsolicited results)

13. Picture Archiving and Communications System (PACS) Status Update Required to indicate to the end user that a request has been scheduled inc. date & time of appt (i.e. an update to the request status showing when an appointment has been scheduled in the Radiology System) Raise through Requirements Definition Group for assessment with view to supporting receipt of a status update against a radiology request in Millennium to indicate the request has been 'Scheduled', with the ability to display appointment date & time

14. Picture Archiving and Communications System (PACS) Cancellation of Radiology Appointments Once Radiology requests are submitted by the user (signed) they can only be cancelled via the RIS system Short Term workaround is for users to contact the Radiology Department to request the item be cancelled Could result in unnecessary exposure to radiation if requests are performed before the user can be contacted to cancel There is also no audit trail available by this method to indicate who requested the cancellation Raise through Requirements Definition Group for assessment

15. Picture Archiving and Communications System (PACS) Imaging Request Routing Current thinking regarding interface design does not take into account the level of flexibility needed to route groups of orders to different services within a single trust or between trusts within the same domain This issue has already been raised at the DRA. This issue needs further discussion

16. Picture Archiving and Communications System (PACS) PowerChart Inbox Proxy Settings Requestor is not available to sign off a result Workaround to proxy access to inbox was deemed acceptable short term For the longer term, work is required to ensure future design considers the concept of teams sending notification to all team members and the concept of deferring inbox contents e.g. when on leave Raise for inclusion in future design (R2) to support team working and inbox deferral

17. Picture Archiving and Communications System (PACS) Other Clusters – North West and West Midlands iSoft LE 2.1 and HSS CRIS iSoft i.CM supports all the Order Communications messages that HSS CRIS can process iSoft i.PM supports the patient demographics and admit / discharge messages i.CM Results Reporting supports unsolicited results

18. Picture Archiving and Communications System (PACS) Other Clusters – North East and East Midlands Have same NCRS solution as NWWM, namely iSoft There is no contracted / LSP RIS solution, so trusts are at liberty to choose their own There have been trust implementations of HSS CRIS (standalone) Order Communications functionality is similar to that in the NWWM

19. Picture Archiving and Communications System (PACS) Other Clusters – London Are taking Cerner Millennium, initially based on the Southern Region solution (R0) Have a tactical RIS solution (iSoft RadCentre), no strategic RIS Order Communications functionality is not yet fully agreed

20. Picture Archiving and Communications System (PACS) Questions