1. Orders in Radiology a physician’s view Iain Keeping MD FRCP Patient safety lead Filetek UK for Meditech

2. Scope Usability Patient safety Orders in OPD and on the ward

3. Credentials NHS respiratory specialist, Chester 25yrs Procurement of integrated system 1995 - 1999 Implementation 1999 - 2007 Radiology first module to be implemented Inpatient and outpatient ordering 2000

4. Paper based ordering Time consuming multiplicity of forms duplicity of information + biochemistry + haematology + procedures + consent = fraught physician!

5. Paper based ordering Illegible Light on clinical information Inaccurate Easily lost BUT anyone else can do it for you!

6. Electronic ordering Easy search for patient record Single ordering process for everything Easy location of test Order sets? Intuitive names of tests Prevention of duplicate orders Ideally

7. Electronic ordering Legibility – not much impact Clinical information – forced to give it Accuracy – patient demographics, location Will not be lost Advantages (physician’s view) Definitely faster Order remains part of the EPR for all to see BUT few can do it for you

8. The Big Issues Juniors are no problem “Big bang” is best Early clinical ownership Destroy ALL paper request forms overnight Lock away down-time request paper forms Getting doctors to use it

9. The Big Issues Barcode readers – limited value, better in OPD Define dictionaries to suit the requester Decide on order sets in advance Role of nurses? Make access simple

10. The Big Issues Loathed by ordering doctors Beloved of radiographers Resolved in Chester to: “Could the patient be pregnant?” The LMP question

11. The Big Issues No irrelevant questions Complex questions are justifiable eg CTPA Structure the order to suit the test

12. The Big Issues Cancer referrals ?CT request without seeing the patient Follow-up inpatient and outpatient Pre-ordering

13. The Big Issues Eg “Please investigate for pulmonary embolism” Let the imaging department decide on the relevant tests Consider “advanced” ordering

14. The Big Issues The receipt of the report and its acknowledgement - but the biggest is:

15. Patient safety, ordering Wrong patient selection All the risks relate to the report Very few risks:

16. Patient safety, reporting Who receives the report? What happens when an emergency inpatient is transferred? How is the report acknowledged? What is acknowledged? What happens when the requester is not around? What happens when an inpatient is discharged? Where does the reporter’s responsibility stop? What action has been taken? When all of these have been answered for all working practices then the paper report could be switched off.