Issues being tracked

Here is a list of issues currently being tracked by the Radiant team that involve end users in the various imaging departments. If there is in an issue you feel should be addressed, let us know.

• MRI Armband scanning issue
• Requiring ambulatory MD's to answer questions specifying site and side for injection orders
• Revamping workflow for Interventional Radiologists to enter notes on "consult" visits
• Retooling the current Medical Imaging Order set to be more user friendly in each modality
• Including unscheduled orders on the control sheet and on the HTML field
• Updated visit label with more information
• Adding a column for accession number on the schedule orders report
• Cleaning up the confusion in ordering Swallow Studies
• Defaulting nothing in the "order mode" when ordering contrast
• Retooling the ordering of M-W-F Transcranial Dopplers
• Adding a comment field to the end exam process
• Providing a tip sheet for "changing" an order after it has been dictated and signed
• Attaching process instructions for nurses for IR studies

There are obviously many other issues being worked on as well, but these are the ones that most affect the day to day end users.

Thanks

CE Credits

Just a quick heads up that at the bottom of this blog there is a link to radiography websites. Many of these have options for CE credits and other general learning opportunities. Here are direct links to a couple that appear to be valuable.

https://www.asrt.org/Applications/ODIA/ODIALogin.aspx

http://www.admiralce.com/

Enjoy!

Reporting issues and enhancement requests

Recently, representatives from the CRC (customer response center), visited Madison to gain insight on the effectiveness of the program. During this time we were able to register all of our thoughts and concerns. It is their desire to make the process of reporting problems as efficient as possible.

So, as a reminder, when you have issues with the current functionality within EPIC hyperspace please call 5354. This will connect you with a representative with the CRC. They will connect you with a Radiant Product Specialist who will be able to help. It is important to take this route so that the CRC can register an official "ticket" so that this issue can be properly tracked and followed up on. Feel free to ask the representative what the ticket number is, so that you can follow up on it if you need to.

Also, if you have an "enhancement" request you can take them to your supervisor. They will then determine if it is something the department needs, and will present it to your group. If there is a department consensus, your supervisor will present the request to the Radiant team and we will log it and follow up.

Thanks

Changes coming on January 9th

As many of you know, changes to EPIC are now coming in a more scheduled fashion. The next date that these changes will be put into production will be January 9th. Here is a preview of some medical imaging related changes.

• New visit labels--We have taken your suggestions and requests and developed a more informative label.
• New information on your Control Sheets--We will be adding any "unscheduled orders" to the control sheet so you can better coordinate a patients visit to your unit with other modalities.

Another enhancement on the way, that will not likely be ready by January 9th is an updated approach to the Medical Imaging Order Set. Currently work is being done to reorganize the order set to make it more specific for your individual modality. Once that work is done, the order set will be built and ready for use. This will make ordering of contrast and medication more convienent for you as well as make the procedure more safe for the patient.

Daily Portable Chest update

The new process for Daily Portable Chests has finally cleared all of the hurdles it needs to clear and is headed for the home stretch. The new process will be rolled out on December 9th.

The old workflow had the MD order ONE parent order that release an automatic new child order each day. This became problematic when one of the children needed to be canceled for any reason.

The new workflow will look like this...

• MD picks Daily chest off of the pref list
• This sends a communication to the Unit Clerk of the patient but does not actually send an order that can be viewed by Medical imaging
• The message will include info for the Unit clerk about when to begin and end ordering daily chest xrays
• Each day the unit clerk will refer to a list and place an individual order for each person who needs a daily chest xray
• When the xrays are no longer required the unit clerk will "complete" that original nursing communication and no further xrays will be ordered.
• These orders will look, feel and act just like every other IMG order in the system now. If you need to cancel an occurance of a daily chest, it will be as easy as cancelling any other IMG. The next day if the Unit Clerk needs to order another portable chest, they will do so.

This should make for a much cleaner workflow and be more accurate in terms of patients receiving the amount of xrays that was expected.

Thanks

CT Contrast Administration instructions

After much work, the process for CT techs to inform RN's how to administer contrast for CT exams will finally be changing as of Dec 9. In brief a potential patient safety issue was uncovered due to the current process for sending administration instructions.

Currently the instructions were sent to the RN when the ORDER for the CT was placed. The problem is, it is not always 100% accurate. If the instructions call for barium and a nursing communication is sent later by a tech that gastroview will be used, 2 seperate and conflicting messages are viewable in the KARDEX.

To resolve this a few changes will be made. Specific admin instructions will no longer be linked to the ORDER. Instead the message along with the order will read "Please refer to the MAR for adminstration instructions". Each tech will have a group of favorite contrasts saved which will have specific admin instructions. When the tech orders the contrast for the exam, the specific instructions will be viewable by the RN in the kardex and on the MAR. This way, a consistent message is retained throughout the patients record and there is less chance for confusion.

CT techs will be given instructions for saving their group of favorites, with appropriate admin instructions, early in December in preperation for this change on the 9th.

Thanks.

Run Time Errors: What you can do

A group of users recently began experiencing the dredded "run time" errors while attempting to log into hyperspace. After some investigation it appears that a cause of certain run time errors is varrying resolutions on workstations throughout departments. In the recently discovered case, the users often accessed a workstation which had a different monitor resolution setting from their normal workstation and each time they went from one to the other, it errored out.

To be specific, the item that the workstation could not "resolve" was the vertical line that seperates your tech work list and your schedule orders report. When this sliding line was adjusted to far to the right at the home workstation and the user logged off, the error would occur when they logged into workstation B. To solve this particular error, it is suggested that you keep that sliding line (between the tech work list and the schedule orders report) located centrally on your screen.

Until we can get consistency in resolutions from monitor to monitor, this will save you some trouble.

Thanks

EPIC Special Upgrades being delayed

Due to the extensive volumn of "special upgrades" planned for the 14th, the install has been delayed. This delay was not specifically tied to any one area but rather occurred due to the overwhelming number of items that needed further testing.

When the new date of install is announced, we will let you know.

thanks

EPIC special upgrades coming Tuesday the 14th

EPIC special upgrades have been undergoing testing by each application over the past 2 weeks. We have identified a few problem areas in Radiant, but have hopefully corrected them. Given the complexity of our workflows in medical imaging and the overall number of SU's that are going to be installed there is always potential for strange things to occur.

As end users you should be aware that if you notice anything functioning in an odd maner on Tuesday the 14th, we encourage you to proactively document the issue and report it to the help desk.

One item that will change with the SU package is that when one tech begins an exam and another attempts to end it, a warning displays but can be overridden. Many of the other upgrades involve things that are not automatically installed but allow us to later use the function. An example of this is, soon we will be able to display the "unscheduled orders" of the patient on the HTML field in much the same way we currently display "other appointments".

If there is ever functionality that you think would be cool, let us know. It might be part of this package and we can use it, or it might be something we can request for future packages.

If there are problems that occur or you feel the system is not as user friendly as it was prior to the SU's, please let us know by contacting the radiant on-call person.

Thanks......

Finding contrast administered on prior encounters

This is a cumbersome workflow for techs who are simply trying to find out what contrast was given during the patients last appt and how much was given. Here is an alternative path to find out that information.

Click: Hospital chart
Locate: patient
Choose: correct contact (by date)
Click: MAR activity
Enter: same "start date" as contact date you initially picked
Click: "report"
Click: "given" next to the med you are interested in
View: details below

Hopefully this is a click-saver and an easier route to the information you are seeking.

thanks...

IP/OP Column added to Worklists

In response to a post live visit request the tech work lists for Nuc Med, Diagnostic and Fluoroscopy have been altered. We have added a column which distinguishes between inpatients, outpatients and ED patients.

The column is located just to the left of the patient info and will display an icon depending on the status of the patient.

A bed icon = inpatient or surgery day care patient
A little people icon = outpatient
A Ambulance icon = ED Patient

Thanks.

Accession Number Column added for Diagnostic Dept

The diagnostic department now has the Accession number column added to their schedule orders report. The reason this was put there, is that often times in the department an order might be scheduled, but then unscheduled after its been checked in and given an accession number. If the tech then gets the message that the order needs to be canceled, their actions depend on knowing whether or not the order has already been checked in once. If it has been checked in, they need to reschedule it and cancel it using the cancel/undo button.

If the order is on the schedule orders report and has not been checked in, it will not have an accession number and can be cancelled by the floor or by the tech using ancillary orders.

"Schedule Orders" button function

In conjunction with a patients scheduled orders now appearing on the control/transport sheet you also have access to a "sched orders" button on your tool bar. What this button does is launch a worklist that shows all of the existing orders for patients that need to come to radiology.

So, for example, if you have an order for a CT that you want to schedule, but want to make sure that the patient doesn't have any unscheduled orders for elsewhere in the medical imaging department, you can launch the list and find out. Simply sort the list on the patients name and see all their orders lumped together.

A slicker function would be to right click on the patient name column header and filter on the patients name. Then you will only see the patient that you are interested in.

Using this list along with having the "scheduled appointments" appear on the transport/control sheet should help eliminate extra trips to the unit for inpatients.

Patients "Other Appointments" now on Control Sheet

In order to reduce the amount of trips patients take to radiology, we have now included the patients other scheduled appointments on the control/transport sheet that prints when you "check in" an appointment.

Keep in mind that only the scheduled orders for the day will print on the page. Orders that are not scheduled will not appear.

This is a good safety net that allows transport staff to ensure efficient movement of patients.

There is also a second safety net which allows technologists to determine if a patient has other medical imaging orders that have not been schedule but might be able to be done during the same visit to radiology. See the post titled "Schedule Orders" button function.

Administration "routes" updated

Stemming from several requests from the medical imaging department, the Pharmacy team has made several adjustments to the available "routes" for various medications and contrasts commonly used in our departments.

You should be able to select an appropriate "route" of administration for every item that currently lives on the medical imaging order set. If you have never used the order set to enter orders for contrast or medications, you should know that it is available. Instead of using "order entry" you would use the "order set" activity and use order set 1512. This opens a pick list of all the commonly used contrasts/medications in the department. It is just an alternate way of finding the item you are searching for.

If you have questions about that, contact your super user or feel free to comment here on the blog.

Next Step with Daily Chests

Many of the diagnostic techs had a chance this week to review the Daily Portable chest revamp proposal. That was the first step of getting this proposed workflow from the idea stage to production. Now that we have cleared that hurdle, we need to present our plan to the group that represents unit clerks. That will be happening early next week.

The bottem line is that the old workflow was causing many problems, the new workflow seems like it will be an improvement but it will not be put in practice until we do some more groundwork and get everyone involved properly educated.

Thanks for all of the ideas about how to make improvements....

CT Dept Schedule Orders Filter Removed

As requested by the department the "expected imaging date" filter has been removed from the CT schedule orders report. What this filter did is allow only the exams that were to be done that day to display. Now all existing orders will display regardless of when they are to be performed. You may still do a manual filter by right clicking on the Expected Date column header and choosing "filter". Select only the day you wish to display. A purple dot will appear in the column header to let you know that a filter is currently in place.

thanks.

Searching for topics on this blog

This is a searchable blog. If there is something specific that you are looking for, simply use the "Search" box. As more and more posts get added, they fall off the front page, but using the search tool is a good way to find past posts pertaining to your interests.

Thanks.

*Alert to Techs*

Do to the build that is being done on the Dean side of Radiant you may soon see several new departments show up as choices when selecting your Tech Work List. What this means is that when you click on "settings" you will see many more departments that didn't previously exist. They will be alphabetical and will likely begin with DHS so you can simply ignore them.

Thanks.

Refresher on Cancelling

A couple of reminders on cancelling orders.

*Once you check in an order, you have released a "child order" and only a tech may now cancel that order.

The "what do I do if...." refresher.....

What do I do if .....

......I want to cancel an order that has been checked in? Since the order has been checked in, you need to cancel the "child order". This is the order that has the accession number attached to it. Since it is checked in, it appears on your tech work list. Find the cancel/undo button and click it. Select that you want to cancel the "order" and accept. This cancels the arrival, the appointment AND the order.

What do I do if.....

......I want to reschedule an appointment, but the order has been already checked in? The scheduled order appears on your tech work list. Find the cancel/undo button and select that you want to cancel the appointment. The order (for inpatients) will then jump back to your schedule orders report with the same accession number. It will stay there until you reschedule it. When you reschedule, your accession number remains the same.

What do I do if....

.......I cancelled the appointment of a checked in order, thinking it was going to be rescheduled, but now I want to cancel it? This one is slightly more complicated. When you checked in that order, you released a child order with an accession number. Thats the order that needs to be cancelled. Therefore, you should avoid using ancillary orders or verify orders for cancelling checked in orders. That only cancels the parent and the message that was sent to PACS by checking in, never gets updated. So, what you need to do is to reschedule that order (with the accession number) with the intention of cancelling it from your tech worklist. Simply reschedule it by adding it on to your schedule and use the cancel/undo button to cancel it.

What to do if .....

....I need to cancel an order that has NOT been checked in? Since this order has not been checked in, it has no child order to cancel. Therefore once you cancel the appointment for that order, either the floor or you may technically cancel the order. If it is you who does the cancelling you may do so from ancillary orders.

****There is a Visio that has been given to your department explaining these scenarios. If you would like to see it, ask your supervisor.****

Thanks...and happy cancelling!

Order Mode Selection for ordering Contrast/Labs

Order Mode Selection

Scenarios:

1. Ordering Contrast: In all cases of ordering Contrast use the mode “Per Protocol No Cosign Required”

2. Outpatient Lab Orders (with comment from Ordering MD): When an MD sends a message in a comment field to order Labs, use the mode “Per Protocol”. This sends a cosign message to the MD.

3. Radiologist orders Labs during exam: If a radiologist wants additional Labs ordered during an exam, use the mode “Verbal with Readback”. This will send a cosign message to the radiologist.

4. Non Dean Provider sends written order for Labs: Use mode Written Order No Cosign Required”. Send written order to Medical Records to be scanned in.



We will not be using the order mode “Standard” for any scenario In Medical Imaging.

Duplicate Warnings for Contrast/Med Orders

The Pharmacy team flipped a switch recently that will send warnings out whenever a duplicate order is being placed. You may see these warnings pop up, and it is to be expected when ordering a med or contrast that has recently been ordered. Just thought you should be aware that these warnings will be popping up. Thanks

Ordering Contrast clarification

Just wanted to clarify that the recent upgrade that allows techs to use the "order entry" button on the navigator is optional. You may continue to use the "encounter" button to order contrast if you wish. In fact, most often the CT techs will go that route since they often order contrast well before the point at which "begin exam" would be started.

Both routes are now available and will work.

Patrick

Memo to techs who order contrast/labs

**MEDICAL IMAGING TECH ALERT**
Ordering Medication/Lab’s/Contrast WORKFLOW REVISION

Effective August 20th we are returning the option to go back to the original workflow for ordering Contrast, Medications and Labs. You will no longer need to navigate through the encounter button to perform these tasks. You can now simply use your begin exam navigator as described below.

1. Click “Orders” on your Navigator
2. The orders pane opens
3. Enter the lab/medication/contrast in the Search field
4. A list of choices will appear. Select the correct item.
5. When you have finished click “sign orders”
6. A “provider” box opens
7. Enter a Order mode of “Per Protocol No Cosign Required”
8. Enter Ordering/Authorizing Provider information
9. Click Accept

“Orders and Order set” Sections
Search field
Sign orders here when entering is complete
Tech Navigator Available at Begin OR End Exam


**Note** If you would rather order your contrast or medication from an order set, you may do so. If that is your choice you can select the “Order Sets” section from the navigator. Enter “1512” in the “search for order sets” field. The medical imaging order set will then be available. To select from it, click the button called “Open order sets”. Place a check next to any med or contrast you wish to order and click “sign orders”. Make sure to enter the correct mode of “per protocol”. This will send a co sign message to the radiologist.
Documenting your contrast will not change from your current workflow.
If your workflow requires you to order contrast or labs well before the exam begins you have the option of using the “encounter” button.

Creating Favorites **UPDATE**

Ok, slight change of plans for those of you (probably CT techs) who have saved Metformin and Gastroview Nursing communications. Previously these messages were attached to a generic nursing communication. We simply renamed the display name and dropped in the message in the comment field. This worked fine until people attempted to add it to their favorites. For some reason the comment text was not copying over and blank messages were being sent.

To resolve this the Orders team created 3 unique EAP records for Metformin and both of the Gastroview messages. This means that, if you had previously added those items to your favorites, you need to remove them and add the newly added preference list items. Now when you add them, the text will be automatically sent to the nurse every time (even though nothing will appear in the comment box........I know.....that part is confusing!!!)

This boils down to two simple steps. Remove your old favorites and add them again and everything will be fine.

Thanks!

Be careful with Favorites

A recent issue of Nurses not being able to view nursing communication comments has been traced back to individual users preference lists. What appears to have happened is that users saved a Nursing communication order for withholding Metformin, but the default comments did not get saved along with it. Therefore if a user selected the order for withholding the med from the original preference list, the comments will display. If they added it to their favorites list and did not cut and paste the comment, the order would appear as blank.

Thanks

MRI Techs-->Printing Face Sheet

There was a question today about how to print up the MRI face sheet. This is the form that the MRI dept is printing that displays insurance info, among other things. The key here is what the status of the patient is. If your patient does not yet have an appointment, and remains on the schedule orders report he route that should be taken is....

• click the patient station icon
• highlight the correct admission
• click form reprint
• place a check next to "ssmw face sheet"
• change the printer id to the correct one
• click print

If the patient is scheduled to an appointment in EPIC then take the same route but simply select the appointment instead of the admission in the above flow. In this scenario the default printer will not need to be changed.

Therefore....

pt has appt=select the appt from patient station and print

pt does not have appt=select the admission, change the printer and print

That should work!

CT Techs - Gastroview communication

Two new nursing communication choices are now available on the inpatient preference list. Much like the nursing communication for withholding metformin, you may now send a communication to the patients nurse about the use of gastroview. There are 2 choices on the list. Pediatric instructions are available, as well as adult abdomen/pelvis instructions.

To find the nursing communication orders take the same route you would to enter orders for contrast.

Encounter button-->Look at the order tree-->Find these nursing communcations under "medications".

Thanks

Finding Contrast from previous Exams

If you are searching to see whether a patient had contrast administered on a recent exam, you can do this in the patients chart. Simply enter the patients chart and click the Medications tab. From there you will be launched in the patients Medications page. Click on the History tab. It may then be advantageous to click on the Filter tool. After clicking the filter icon you may place a check mark next to any of the meds listed. The list will be comprised of everything on the patients med list. As soon as you place a check by the med, it will display. Double clicking on the medication will then open a page offering details of the encounter.

Hope this comes in handy!

Ordering Contrast-->Rad co-sign *UPDATE*

OK.....final answer. The orders team has just given the OK for rad techs to list the Radiologist as the "ordering provider" when entering orders for contrast. This will ensure that the co-sign message is correctly sent to the radiologist who is authorizing the contrast order.

Sorry for the confusion.

Thanks

Canceling once an order has been checked in

Ok....here we go. The million dollar question.

EPIC Technical support offers this advice, and its surprisingly simple. The BEST way to cancel an order once it has been checked in is to simply highlight it on the tech worklist, click the cancel/undo button and place a check in each of the available boxes. This will unarrive the patient, cancel the appointment and cancel the order all in one swoop.

It is best explained this way.....If a tech cancels an appointment or unlinks an order from an appointment AFTER its been checked in........then if they cancel the parent order in ancillary orders, the child order (the one with the accession number) will not be cancelled.

I hope this helps!

Cancelling Appointments and Orders

A few issues have come up with the Cancel/Undo button not functioning as desired. If you run into a situation where, as a tech, you need to cancel an appointment and then an order, follow this path.

Go to the patients Appt Desk.

• Scheduling-->appts
• Find your patient and double click to open your patients appointment desk
• Locate your patients appointment on the "future" tab
• Highlight it and click "can/rsch"
• Place a check mark in the box next the the appt(s) you wish to cancel and accept

Now that the appointment has been canceled you can go to ancillary orders and locate the patients order and cancel it.

Thanks

More Run Time Error Issues

Many run time error issues were reported Sunday afternoon. EPIC is once again attempting to determine the cause of the errors. There seems to be some link to the Pre-Log In screens, as removing them allows the workstations to be used. The problematic part is that the Pre-Log In Screens seem to work just fine for weeks at a time and suddenly they all trigger this error simultaneously. We are working to figure out the problem and get the Pre-Log In screens back up and running as soon as possible.

Thanks

Schedule Orders Report Options

After discussion with the Interventional techs, they have decided they want a slightly different set up for their Schedule Orders report(SOR). They have decided that they want all of the orders that are expected to be done today, to appear with a unique background color. Those orders with an expected exam date other than today will not have a that color. However, in order to do that, their STAT orders will no longer appear in RED font. The will still appear on the top of the list and be labeled as "High Priority".

It boils down to these choices....

• We can put in a permanent filter (diagnostic has this) so that only your exams for today will appear. This means that you can't view orders for anything other than today on the SOR.
• You can do manual filtering on the expected imaging date column each day to filter on only todays Date. This way you can take the filter away to see whats in store for tomorrow.
• You can do a color coding scenario (like IR has opted for), but you lose the ability to have STATS appear in RED. They would still appear RED on the pre-login screen however.

If you would like to explore any of these options, let Karen/Patrick know and we'll work with you to make something happen.

Thanks

Pre Log In Screens back up

After discussing the issue with EPIC technical support we have decided to relaunch the pre log in screens. Days of troubleshooting uncovered absolutely nothing and no explanations have been made about why the pre login screen seemed to trigger a run-time error. We have turned them back on, as of 3pm Monday and will monitor them to see if any errors occur.

These need to be activated on a case by case basis, so if after restarting EPIC, you don't see your pre-loging screen, jot down your ETN number and let Karen/Patrick know.

thanks

Pre Log In Screens

Pre Log In Screens are still (for the most part) not activated. EPIC technical support is continuing to validate what/where/when/and why the issue occured. As you recall, nearly all of the Medical Imaging workstations experienced a run time error, which rendered the workstations inoperable. We removed the pre-login screens in order to allow the workstations to be used. It is not known if the pre-log in screens are the actual problem or if they simply exposed another issue, such as a virus or spyware. Until EPIC knows for sure what happened, we will wait to reactivate the pre-login screens.

Thank you for your patience. We will get those screens back to you as soon as it can be safely done.

ABN issue resolution

It appears we have discovered the cause of the ABN issue which was creating problems adding more than one order to a single appointment. What was occuring is that an ABN warning was firing when a user was attempting to add another order on to an appointment. The user was unable to add the order and was forced to create a new appointment. This meant that the user was forced to "begin" and "end" each seperate order. Time consuming and not a good workflow. We are continuing to monitor whether our discovery will be the ultimate fix for this issue, but in the meantime, the warning may still fire. In the event that it does, you WILL now be able to proceed through the warning and schedule your orders as needed.

Thanks

CT and Fluoro Panels now removed

All previously paneled CT and/or Fluoroscopy studies have been removed from preference lists. They have all been replaced on those lists with the study alone. All that has been removed is the associated contrast for the study. Therefore, techs will now enter orders for both Inpatients and Outpatients for any contrast to be used during the procedure.

This should lead to less confustion about when to order contrast. The answer is---> ALWAYS! Regardless of the patients IP/OP status.

Thanks!

Fluoro Panels are gone

Per your requests, all of the Fluoroscopy panels have been scrapped. This means that techs will now enter orders for contrast for both Inpatients and Outpatients.

CT panels will be removed by the end of today.

MRI panels will remain as they are today.

Thanks!

Lorna Doones and Vanilla Pudding...

In the next few days PACS director Cindy Marks will be in touch with many of you regarding a slight change in the Speech Swallow workflow. Everything will function as normal, from a technologist perspective, until you reach the End Exam Navigator. When you reach that point you will be prompted with a question. The question will ask you if you have allready sent your images to PACS and verified them. This is not a typical workflow since normally you would not verify your images in PACS until you had ended the exam in EPIC. However, for the new Swallow workflow you will be verifying your images FIRST and then ending the exam in EPIC.

Normal workflow --> End exam in EPIC--> Verify Images in PACS

New Swallow workflow --> Verify Images in PACS-->Answer End Exam Question and Accept in EPIC

Cindy will be in touch with more details.....

Thanks

Where did my Pre Log in Screen Go?

It went bye bye. But only temporarily. Many workstations were erroring out with "Run Time Errors", so as a temporary means of getting access to the workstations, the pre log in screens were deactivated. As soon as EPIC determines the cause of the error and fixes it, the PLIS will return!

Thank you for your patience.

Perinatology Issues

A few common issues have come up regarding Perinatology appointments. The first issue involves the end exam question that you are all familiar with. This question only fires if the proper visit type (5964) is attached. What happened is that, that visit type and question didnt exist at the time of cut-over so many IMG's got linked to existing appointments with old visit types. To fix this...

Go to the patients appointment desk (click appts from the scheduling menu)
Find the correct appointment and highlight it
Click "change" from the bottem toolbar
Change the visit type to 5964
Accept

Now the appointment has the correct visit type and your question should fire at end exam.

**

The second issue involves your exams not falling off of the tech work list at end exam. This is also a cutover issue. Somehow the IMG for your appointments also got linked to Dr. Davidsons schedule. In order for the order to fall off your worklist, it must be unlinked from Dr. Davidsons schedule under the appointment desk. It is unclear whether you have the ability/security to perform this function, but we are looking into it. In the mean time, Karen or Patrick will need to do the unlinking.

Thanks

Vascular Lab IP modality

The IP Vascular Lab modality has been removed from your Tech Worklists, per your requests. It has also been removed from the scheduling pools to which it was attached. This means that when you attempt to schedule an IMG with a visit type that contains a pool that used to have 400541 attached, it will not be an option.

Thanks

Daily Abdomen orders

Diagnostic techs are already seeing orders for Daily Portable Chests. The MD group has asked that we add an option for Daily KUB as well. Therefore, don't be supprised if you start seeing orders for Daily Abdomens.

Also, keep in mind that on July 8th, the MD's will be doing all of their own order entry so keep an eye out for things that might be entered incorrectly.

Logging off vs Xing out

St Marys I.T. department just sent out a memo urging people to log off correctly. The key is to actually click "Log Off" and not just "X" out.

Just a reminder!

Removing Large Comment Text

From time to time orders are being placed at area Clinics that contain huge amounts of text in the comment field. This is causing the Tech Work List to flip out and not dislay correctly. If you need to remove the text so that you can view your worklist in a more usable manner follow these steps.

Click Ancillary Orders
Find the order you want to edit
Highlight it and click
Choose "Change Order"
Remove any text from the comment section that you dont want
Accept and refresh your Tech Work List

Remember to review all of the text so that you dont remove something you later want to be able to view. Once you remove it, its gone.

Thanks

One catch with Study Notes...

Study notes is working nicely, however this is a catch. If you need to tag something on your tech work list with a message such as "this case is on hold per floor" you can do it. However, the order needs to be checked in in order for study notes to be usable. If you get an error saying that no order has been released, it means that the case is not checked in and you may not use a study note.

This tool was created by EPIC as a communication between tech and rad. We are using it as a tech to tech communication so it is not entirely taylored for what we are using it for.

Not seeing all modalities when adding on?

If you are not seeing all the modalities you expect to see when attempting to add on, try clicking the "show all modalities" box. If this doesn't display the modalities you are expecting to see, document it and call support.

Thanks

Study Note Column

Have a look at your Tech Work List. You should notice something new. 10 points if you noticed it this morning, without even checking the Tip Page! There is a new column called "Study Notes". If you see an icon in this column it means someone (most likely a fellow tech) has placed a note on this appointment. This will be your queue that you need to check out a message. To view the actual study note...

• Highlight the patient and click the "Study Note" icon on the toolbar

or

• Highlight the patient and click alt-o

Also, on the schedule orders report (right hand side of the screen) a column already exists that displays any notes that techs place on unscheduled orders.

Using Add-On at end of day

Questions are still coming in about the inability to "add-on" an exam prior to Midnight. The answer is no, you can not use "add-on" when the length of the appointment would cross over the midnight hour. Your options are either....

• Use the "schedule" function and change the length of the appointment to fit in the the current day. I.E. It is currently 11:44pm. Change your appointment length to 15 minutes so that it does not cross over midnight.
• Use the "schedule" function and schedule your appointment to begin on or after midnight.

Thanks

Canceling Orders

In the event that you need to cancel an order you may do so using the "Ancillary Order" tool. Follow this path...

1. Click the "Ancillary Orders" Icon
2. Search for your patient, click to open
3. All of the orders existing on your patients will display
4. Locate the order you wish to cancel
5. Click the cancel button on the toolbar
6. Enter required data and accept

There have been instances of users adding an order onto the Tech Worklist just so they could cancel it. This should be avoided as it assigns an accession number and creates downstream problems.

Thanks

Re Posting: Tagging items on your TWL with messages

In the event that a scheduled order is on hold you may wish to enter a message to fellow techs so they understand what is happening. This may occur when an OR case from the AM remains on the OR Tech Work List at shift change. It would be great if the tech could simply view any messages that the 1st shift tech may have entered. To do that follow these steps....

1. 
   Highlight the appointment you wish to flag with a message on your Tech Work List
2. 
   Click Study Notes from your Tool Bar
3. 
   Click "Add New Note"
4. 
   Enter a message and click Accept
5. 
   Your message is now viewable to other techs who wish to see it
6. 
   To view the message, highlight the appointment and click alt-o

Re Posting: Tagging unscheduled orders with a Message

If you need to flag some information on an order that remains on your schedule orders report, follow these steps.

1. 
   Highlight the patient on the Schedule Orders report
2. 
   Right Click and click Select
3. 
   The patients appointment desk opens
4. 
   Go to the "Orders" tab
5. 
   Highlight the order
6. 
   Click "Edit Notes"
7. 
   Enter your message and accept
8. 
   Your message is now available in the Notes column of your Schedule Orders Report

Printing Worklists (on one page)

There is some concern that when a worklist is printed, all the columns are not fitting on one page. This is easily fixed. After clicking PRINT, you have several options to taylor your print job.

In the orientation section click "Landscape" and "Fit width to page". Now your report will print in landscape fashion and will include all of the columns on your list.

Re-Ending Exams

If you forgot to enter correct begin/end times, failed to enter supporting staff or need to add a charge to an exam it is possible to re-end it.

How do I find a list of exams that were ended today you might ask? Well, we put together a new Tech Work List that will display only those exams which were ended today. The new list is called "END EXAM Report". Of course if you need to look at a list from yesterday or a previous day, simply go into the "setting" and change the Date range to reflect your search. Changing this field will only apply to your current search. The next time you log in, it will be defaulted into todays date.

Once on the list, simply highlight your patient and click "end exam".

Keep in mind that you can not and should not change orders after ending an exam.

Thanks

Printing Labels from the TWL :(

Printing labels from the Tech Worklist is not current functionality. If it was, you'd know all about it and would be doing it. The current flow to get extra labels is "cumbersome" to put it nicely. It would be possible to print more labels as a default at "check in". If everyone is interested in that, it is a change we could investigate.

It is an issue that is on EPIC's radar and a less "clicktacular" workflow is in the works.

Thanks

Viewing Pts Imaging orders from ED Trackboard

If you need to see a patients current orders from the ED trackboard you may find them in the Kardex report. The need for this could occur if the patient has multiple orders in more than one modality. If coordination between modalities needs to take place, knowing which orders have been placed on a patient is valuable.

To view the patients current orders (while viewing the ED Trackboard) follow these steps.

1. Click on the row of the patient you are interested in
2. Notice that a report opens up on the lower half of the screen
3. Change this report to the "Kardex" report
4. Scroll down to the Radiology orders

Imaging orders placed in the last 48 hours will appear here.

Now you can determine if coordination between modalities needs to take place.

Work List Colors and Font Size

There have been some tweaks to the Tech Work List and Schedule Orders Reports. Small font size was causing some people to have difficulty reading the information. Also, the row colors have been tweaked in attempt to make things as easy to read and navigate as possible.

Hope this helps!

Time Outs at Begin Exam

There were some instances of Time Out forms not displaying for certain procedures. Hopefully that issue is corrected. If you feel as if an exam that should have a Time Out attached is missing it, document it and we can make the change as needed.

Thanks.

Diagnosis Code now on OR schedule

The op time team has provided a diagnosis column to the Master Daily schedule. To view this schedule.....

Click the "Master Daily Schedule" icon on your toolbar
Select the "SMH Radiant OR Schedule" (you can make this your default if you wish)
Click Accept

The diagnosis code is now listed between the procedure and surgeon.

Thanks to the OP-Time team for that!!

User Manual IMG clarification

Let me clarify.

Currently in the printed copy of the user manual 3 items have the incorrect img# next to the name of the order.

• 
  US Upper ext right Art Doppler currently says 1432 in the book. It should read 1632...NOT 1432.
• 
  IR Perc Neph Right Stent Place currently says 1632 in the book. It should read 1633 in the book...NOT 1632.
• 
  IR Perc Neph Right currently says 1633 in the book. It should read 1634....NOT 1633.

Instead of printing 75 new pages, we were hoping to just make manual edits on those 3 items.

Make sure to Log Out!

Just a reminder.......

Make sure to log out of EPIC after you are done documenting. It is an easy thing to forget, but very important. You don't want people documenting under your user name. You can always determine who is currently logged in by looking in the lower left hand corner of the screen.

Your pre log in screen will launch after you log out, so you can continue to monitor incoming orders and view your schedule without actually being logged into the system.

6/03/08 Issues Round Up

A few items to mention.

• Using the Add-On function is not possible when the appointment would cross over midnight. It is a known EPIC issue and a fix will occur sometime in the future.
• Patients height and weight were not always pulling into your HTML fields. We think we tracked down why this wasnt always happening and have addressed the issue.
• A question came in asking if it was possible to print schedules. Yes, add all your orders to your schedules. From that point, just click Print in the upper right corner. Your workstation should have a default printer close by.
• Labels currently don't have accession number. It is being addressed and will happen in the future. The will also have appointment date and room number.
• Each department has unique end exam questions that can be answered. If they appear incorrect, report it and we can make changes. Keep in mind that the pregnancy question will not appear on Male patients OR patients over 60 years old.
• There are only 3 appropriate "priority" status' for imaging orders. STAT, ASAP or routine. If you see any others, let the floor know that they are entering those incorrectly.
• Time Out forms were not popping in for some invasive FL procedures. Should now be fixed.

We are working on many other issues as well and will update ASAP.

Orders missing Expected Exam Date

Some questions have been coming in regarding a blank Expected Imaging date column.

A little history first. This column is filled in when an order is placed on an inpatient by an MD. If the MD does nothing, todays date is defaulted in. If they choose, they can enter any date they wish.

When an order is placed somewhere within the Dean system for an outpatient to have an exam, the order does NOT populate the Schedule Orders Report. So this is not a concern. You wouldn't want to weed through every order that gets placed in the Dean system!

However, what can happen that might lead to the Expected Exam Date column being empty is this. When our front desk staff enters an order into the system from a paper order, they are not entering the order in the same way an MD would. This means that the section of the order composer that defaults in that data is bypassed. This is not really a concern due to the following reasons.

When an outpatient paper order happens, one of two things happen.

• The order is placed in EPIC prior to the patient arriving. The order should then be immediatly scheduled by the front desk staff. This removes if from the Schedule Orders Report.
• The order is placed in EPIC when the patient arrives. The front desk then contacts you and there is no confusion as to when to perform the exam.

Therefore, the only time the column should be empty is between the time the paper order is entered into EPIC and the time it is placed on a schedule.

Hope that helps clear this issue up.

Pre Log In Screen revamp

Check out your Pre Log In screens. They have been revamped in order to be more workable and less dependent on filtering. The reports are basically the same as you see once you log in, however any patient specific data will not be displayed in accordance with HIPAA guidelines.

Can't Find an Icon on your toolbar?

Make sure your screen is maximized. If you have your screen not opened to the maximum size, you may have icons hiding behind the little >> on your toolbar.

Maximize your screen and they will reappear!

If you still can't find an Icon, there might be a security issue. Call the Help desk at 5354.

Corrections to Tech User Manuals

There were 3 changes to IMG ID numbers following the publishing of the Radiant User Manual.

IR IMG1632 should be changed to 1633 in the Manual
IR IMG 1633 should be changed to 1634 in the Manual
US IMG 1432 should be changed to 1632 in the Manual

Thanks

Communicating Info on Unscheduled Orders

If you need to flag some information on an order that remains on your schedule orders report, follow these steps.

1. Highlight the patient on the Schedule Orders report
2. Right Click and click Select
3. The patients appointment desk opens
4. Go to the "Orders" tab
5. Highlight the order
6. Click "Edit Notes"
7. Enter your message and accept
8. Your message is now available in the Notes column of your Schedule Orders Report

Enjoy!

Tech to Tech Communication regarding Scheduled Orders

In the event that a scheduled order is on hold you may wish to enter a message to fellow techs so they understand what is happening. This may occur when an OR case from the AM remains on the OR Tech Work List at shift change. It would be great if the tech could simply view any messages that the 1st shift tech may have entered. To do that follow these steps....

1. Highlight the appointment you wish to flag with a message on your Tech Work List
2. Click Study Notes from your Tool Bar
3. Click "Add New Note"
4. Enter a message and click Accept
5. Your message is now viewable to other techs who wish to see it
6. To view the message, highlight the appointment and click alt-o

ENJOY!