APPROVED BY: Director of Radiology Page 1 of 5 Purpose: EPIC, PACS/RIS Image Processing Errors To establish guidelines for the communication of processing errors associated with RIS tracking and image archiving. The policy will also provide the associated accountability for recognizing and correcting errors as well as the actions that will be taken for those errors that cannot be corrected or impact the patient s medical record. These guidelines are intended to ensure that accurate information is available for the diagnosis and treatment of patients. Definitions: Tracking errors are a result of not following procedures or intentional misuse by a user. This problem has a number of facets but all can potentially jeopardize patient care by having the wrong images assigned to a patient, no images present, etc. In addition, tracking errors can also lead to incorrect billing or misdiagnosis. The most common tracking errors are listed below: 1. Failure to track exam to complete or verify images the exam is not displayed on the physician s unread RIS worklist and cannot be interrupted causing delay in timely diagnosis. 2. Track to complete but later finding and correcting an error errors must be corrected but it is important to realize that the correction will not be made in the patient s lifetime clinical record or the hospital information system. 3. Tracked to complete but not correct these errors can result in several issues including billing a patient incorrectly, 0 images for the test and a flawed electronic medical record. 4. Tracking an exam to complete in TEMP room exams that are tracked to the TEMP room are not included in technologist productivity and department statistics. 5. Tracking an exam with no EPIC order # tracking an exam to complete that does not have an EPIC order # presents several issues including, final report does not post to EPIC, no link to images on EPIC, and no charges drop. But most importantly the patients medical record is incomplete. University Health Shreveport Page 1
APPROVED BY: Director of Radiology Page 2 of 5 6. Scheduling multiple exams to one schedule one or both of the orders could fail to match up with the schedule message on RIS, will cause one of the exams to not cross to RIS. This presents the possiblity of the technologist tracking the exam to complete without an order #. 7. Not following the EPIC schedule workflow could result in no referring provider error. The order will end up on the RIS Scheduling queue and need to be corrected. 8. Not performing all required tracking steps required tracking steps include: a. ARRIVE b. BEGIN c. COMPLETE d. DEPART 9. Entering incorrect information a. Entering incorrect patient information goes beyond a RIS tracking error. It results in incorrect data in the RIS; however, this type of error is in violation of good clinical practice and hospital policy. As an example, entering a test as done on a day prior to that stipulated by the physician s order, is considered failure to follow a physician s order. b. Placing one patient s images in another patient s file is considered patient misidentification. The seriousness of the error depends on the step at which it is caught. i. Before being sent to PACS if the error is caught and immediately corrected then there is no impact on the patients care or medical record. ii. Before reading if the error is caught before the radiologist completes interpretation then the medical record is not affected but any physician who has already viewed the images has seen the incorrect images. iii. After reading and report is finalized if the error is caught after the radiologist has read and finalized the report than the medical record is permanently incorrect. The only option is for the radiologist to addend the report to explain the error and dictate findings for the correct image. University Health Shreveport Page 2
APPROVED BY: Director of Radiology Page 3 of 5 10. Not correcting an exception on RIS or unspecified on PACS the exam is not displayed on the physician s unread RIS worklist and cannot be interrupted causing delay in timely diagnosis. 11. Uncompleting an exam on RIS this creates an exception on RIS that must be corrected immediately or the exam is not displayed on the physician s unread RIS worklist and cannot be interrupted causing delay in timely diagnosis. 12. Cancelling an order with images present this error results in images being on PACS but no report or record of the exam will be available. This can only occur by cancelling an order improperly and can create a situation in which the physician would not have the appropriate information to diagnose or treat a patient. a. Cancelled in error the exam must be reordered and images moved to into the new folder on PACS. New order must also be tracked on RIS. b. If exam must be cancelled all images must be deleted from the exam folder on PACS. The resulting exception on RIS must also be removed. 13. Not verifying images on PACS prior to completing on RIS can cause the exam not to show up on the physician s unread RIS worklist and cannot be interrupted causing delay in timely diagnosis. 14. Not adding exam modifier or adding incorrect exam modifier on RIS can cause the patient to be billed for an exam in error. Please see policy on RIS modifiers for complete list. Policy: All image processing errors must be documented for the purpose of quality assurance. This data will be trended to determine if steps of the process are causing a problem, equipment failure is a problem or additional staff education is needed. Since the image and associated data is a critical component of the patient s care, all errors will be reviewed and staff will be held accountable for polices and procedures. Since these errors vary in the degree of consequence, there must be varying levels of corrective action. In order to initiate corrective action, errors will be divided into the following categories with the listed steps taken for corrective action. 1. Errors corrected by the technologist with no impact on the patient s medical record: No penalty is associated with this error; however, repetitive errors can University Health Shreveport Page 3
APPROVED BY: Director of Radiology Page 4 of 5 increase the potential for a more serious error. An employee with a corrected error rate of greater than 2% of exams performed will undergo additional training and may be reviewed for disciplinary action if the problem continues. 2. Errors that cannot be corrected by technologist but are corrected by the supervisor with no impact on patient s medical record: No penalty is associated with this error; however, repetitive errors can increase the potential for a more serious error. An employee with a corrected error rate of greater than 2% of exams performed will undergo additional training and may be reviewed for disciplinary action if the problem continues. 3. Errors that cannot be corrected or corrected errors that impact the patient s medical record: a. First Occurrence Verbal notification and employee must provide a written response. b. Second Occurrence The user will be counseled and required to provide a written response c. Third Occurrence Mandatory education and competency check. d. Fourth Occurrence Review by the section manager and department director for possible disciplinary action. The employee may have two occurrences within three months. An occurrence outside of this timeframe will start the process over. Intentional misuse of the system by entering false data will result in a review by the section manager and department director for disciplinary action. Monitoring: The shift supervisor will monitor the worklists to ensure all exams are tracked properly. This process should be ongoing during the duration of the shift, but double checked at the end of each shift. The shift supervisor should also ensure there are no unspecified images on PACS or exceptions on RIS. If there are unspecified and/or exceptions they MUST be corrected IMMEDIATELY. In addition, all technologists must report any error they find immediately to their shift supervisor. All staff should understand that errors could lead to misdiagnosis and/or incorrect treatment of a patient. University Health Shreveport Page 4
APPROVED BY: Director of Radiology Page 5 of 5 Reviewed: April 2016 Updated: October 2013 Revised: January 2013 Reviewed: January 2012 Revised: August 2012 Revised: January 2011 Revised: March 2011 Reviewed: January 2009 Revised: December 2006 Written: December 2003 University Health Shreveport Page 5