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Cerner Millennium:Integration with RIS and PACS

UK PACS & Teleradiology Group Newquay, March 30th 2007

Roger Irish, Maggie Nicholls

March 2007

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Contents

• Introduction• Overview of Millennium integration with PACS and RIS• Order Communications Project Issues• Order Communications in other Clusters• Questions

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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

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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

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Integration Architecture between CRS and RIS

RIS Domain B

RIS Domain A

RIS Entity P

RIS Entity Q

RIS Entity R

RIS Entity S

RIS Entity T

RIS Entity U

RIS Entity V

CRS Domain 2

CRS Domain 1

CRS Entity P

CRS Entity Q

CRS Entity R

CRS Entity S

CRS Entity T

CRS Entity U

CRS Entity V

CRS to RIS Communication • 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

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Overview of Demographic Propagation

RIS Domain B

RIS Domain A

RIS Entity P

RIS Entity Q

RIS Entity R

RIS Entity S

RIS Entity T

RIS Entity U

RIS Entity V

CRS Domain 2

CRS Domain 1

CRS Entity P

CRS Entity Q

CRS Entity R

CRS Entity S

CRS Entity T

CRS Entity U

CRS Entity V

CRS to RIS Communication

• 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

ADT

ADT

ADT

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Order communication data flow

EventEventEventEvent

• 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

AcceptedAttended

Requested

ProvisionalComplete

Ordered (Complete)

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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

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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.

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S) Summary of Findings

Priority for Resolution

Clinical Priority

High 4 5 24

Medium 4 2 1

Low 9 - -

Yes – Long Term/No workaround required

Yes – Short Term No

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

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Summary of Issue Progression Route

Route Number of Issues

Refer to Requirements Definition Group 18

Design Requirements Authority Action 7

Refer to R2 Design Groups 5

Review by Technical Architects 4

Deployment Team Action 6

Change Board Action 1

Orderables Project Action 4

None Required 8

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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)

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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

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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

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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

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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

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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

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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

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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

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Questions