Filmless Image Ready Notification by Telecommunication System Tebby Lee Systems Analyst Information Technology Department United Christian Hospital
Introduction O Full filmless in UCH since February 2011 O Hardcopy of the radiological films no longer be produced and distributed to wards O Clinicians need to view the radiological images on the computers
Problem Encountered O Before filmless, radiological films were hardcopy and physically seen by clinicians and nurses at wards when films were ready O After going filmless, clinicians and nurses need to check in the computer system from time to time to see if the patient s radiological films are ready or not O May have risk if the clinicians missed checking the films Delay in treatment
Objectives O To prove the concept of: O Filmless notification through DECT phone and desktop phone in UCH O Push notification effectiveness O Acceptance of frontline colleagues on push notification through telephone O System interface between HAIT and telecommunication system
Project Partner O Alcatel-lucent - the manufacture of the existing PABX system in UCH and some other hospitals O Technically ready in interfacing with existing PABX O They can provide a workflow engine Genesys iwd for testing in the POC
Requirement Study O Several visits to different wards (general wards, ICUs, Psy ward) and Radiology O Tried to understand and observe the existing workflow of each ward visited O Discussions with hospital IT, nurse representatives (IT-Smart Ambassadors) and radiographers
IT Smart Ambassadors
Project Scope O Provide a simple way (ie. barcode scanning) for users to manually input the filmless request and image ready status O Notify nurses and/or doctors by either voice or text messaging through DECT / desktop phone according to the user preference O Provide a dashboard for wards and Radiology to check the notification status of each radiology request
User Involvement O Nurses and Radiographers were involved in the system design O They worked with Alcatel s developers to come up with:- O Workflow in wards O Workflow in Radiology O Screen layout O Notification message format
System Security O No HK ID number is captured O Only capture (1) HN no., (2) English name, (3) Bed no., and (4) Ward O Servers are located in UCH PABX server room with sufficient physical security control O Servers are placed in a medical network with HA firewall protection (standard Medical Network setting)
Network Architecture HA Network HA Firewall UCH Database PABX Medical Network
System Implementation (Phase I) O Pilot in two different wards:- O a general Medical ward (6A) on Aug 15 O NICU ward (3A) on Sep 21 O The system can cater for different workflows in different types of ward (general vs intensive care)
Workflow in General Ward Nurse prepares purple form Nurse scans HN no. and inputs into Notification Manager update Patient is transported to Radiology Radiology takes image Radiology staff scans HN no. to indicate Image is Ready update Dashboard System notifies doctor update Nurse notifies doctor and updates status in Notification Manager Nurse aware Image is Ready
Workflow in Intensive Care Ward Radiographer goes to ward and takes image Radiographer goes back to the office and processes the image Radiographer scans HN no. to indicate Image is Ready update Dashboard Nurse acknowledges the message and forward the message to the doctor System notifies doctor System notifies to the Nurse in-charge update update Doctor acknowledges the message
User Review O Review meeting conducted on Sep 16 O Positive feedbacks from both nurses and radiographers O Reduce administrative time by the nurses who previously had to go through the cases manually O Nurses are happy with the system as it totally fits into their workflow O Radiographers find the Dashboard very useful as it lists clearly all the radiological requests with progress status
Objective of Phase II O To demonstrate how to integrate the POC System to the HA IT System for providing an Image Ready signal once an X-Ray or CT-Scan has been performed
Phase II Workflow O No change in workflow to the wards O Only workflow change to Radiology O Radiographer no longer need to scan the patient barcode to record to the image ready time O Once Radiographer has pushed the x-ray images to filmless server, the image ready message will be sent to POC system via UCH polling program
Phase II System Architecture RIS 1. Send out all Image ready message in XML format to EAI as of existing practice EAI 2. Selection of UCH image ready message HAITS 3. Transformation to HL7 format and send to UCH IT -------------------------------------------------------------- UCH IT Genesys iwd 4. Filtered information will be sent to iwd 5. Send message to ward/clinician s DECT phone and update to the dashboard UCH
Results O Automatic and immediate notification messaging to colleagues DECT / desktop phones in either voice or text format is do-able O The workflow engine is customizable to fit in different ward s workflows O Interfacing between HAIT system and telecommunication system is feasible O Machine generated phone message is acceptable to the frontline colleagues
More Findings O Nurses do not enjoy making phone calls to Clinicians O Clinicians like voice message more than text message O Local support of the system is necessary O System heartbeat monitoring is necessary O Users are more happy to use the system which is designed by them
Outcomes O UCH IT Team made use of the hospital IVRS system with outbound broadcast function and has built our own workflow engine to replace the POC system
Thank You