Orders can come into the inbox electronically through RIS or from another system (typically a HIS) via HL7 or EDI.
An order from the inbox is then scheduled to be performed at a modality.
The PACS is notified (via DICOM) of the examination so relevant priors can be fetched or analog films are fetched from the Film archive for review.
At the time of scheduling, a patient letter may also be created for an out-patient. The purpose of the letter is to inform the patient about the scheduled examination and how to prepare for the examination.
The status of the examination is now Scheduled.
When the patient arrives in the X-ray department, his/her arrival is registered and the examination gets the status Arrived.
Billing related activities may also be performed at this stage, but those are highly country/site specific.
The staff at the modality will see on their screen that the patient has arrived and the modality may provide a modality worklist if this is supported by the modality.
When the patient is taken into the modality room and the examination is performed, the status is set to Started and documented in RIS.
The information registered during documentation includes information about who performed the examination, what contrast material was used, etc.
The documentation can also include registration of the amount of inventory items used.
The status is set to Completed or Exam Done when the examination has been documented and it is now ready for reading (dictation).
The radiologist reads the examination from a worklist of examinations that are available for reading.
If the radiologist is working on an integrated workstation then the images are automatically displayed when the radiologist selects the examination for reading in RIS.
When the examination has been read the status is set to Recorded or Dictated.
The dictation can optionally be submitted for speech recognition by NUANCE SPEECHMAGIC.
If online recognition is used then the radiologist can complete the transcription but if batch recognition is used then the transcription needs to be completed by the transcriptionist.
The transcriptionist works from a worklist of examinations that need to be transcribed.
If a recognized text from SPEECHMAGIC exists then the transcriptionist can select that text and compare it to the dictation, otherwise the transcriptionist will listen to the dictation and transcribe it.
Once the examination has been transcribed the status is set to Transcribed.
The report is now ready to be signed by qualified radiologists. RIS supports from zero to three signatures. The reports are signed electronically by radiologists who select them from a worklist of reports that need signing.
On a workstation connected to a PACS, the images are automatically displayed when a report that needs signing is brought up.
Once signing is complete, the status of the examination is set to Signed or Approved. At this stage the report may be sent automatically to the referring party. If the report is not sent electronically, then it needs to be printed and sent to the referring party. When the report is approved, the examination is in many cases cleared for billing and an HL7 message with billing information may be sent to the HIS.
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