UK Digital Imaging Forum

RCR alerts document open for comments

The RCR has a draft document on
Recommendations on Alerts and Notification of Imaging Reports
and would like comments back by Friday the 13th of May

Form for replies is on the following page

Regards
Mark

1 Like

From a quick view of this document, I’m a bit unclear how it integrates with BFCR164 (Standards for the communication of radiological reports & fail-safe alert notification) esp. as it seems to be discrepancy in guidance for CRITICAL.
Also, I think it’s risky using HL7 report segment to transmit codes, as these are prone to errors (misspelling, unintended use (as code) of the word in report, etc…), and may be confusing for non-reporters when viewing reports (especially patients when they view these in patient portals). IMO better use the dedicated result urgency field (easier to audit and integrate with downstream systems).
I would have preferred an updated BFCR164 rather then a sperate guidance.

1 Like

Agree with Marcus. The principles are sound but the method (red(?) text at the top of the report) seems too prescriptive. We have a result urgency field which we use, that both flags the result in the HIS, and prompts manual intervention by our results team. For many of the critical results I would have thought a phone call was always required, and if documented in the report should suffice. I don’t see the need to flag it if it has already been communicated effectively.

My understanding was that the purpose of this document was to define “what”/list needs to be communicated via alerts- in order for RCR to comply/respond with the HSIB report.

HL7 is well established global method of communication of failsafe alerts using OBX8 flag as described. We described this in BFCR 164. The HL7 standards/global technology remains the same. So industry does not need to modify anything in their software.

Recommendations is more for radiologists and reporting radiographers/sonographers. “What” needs to be alerted! HSIB and AORMRC feel that the more should be done by radiologists.

Like Andrew, I do have problems with “CANCER” text on a report. It maybe a “suspected cancer” which may turn out “not“ to be cancer post histopathology, but the radiology report remains labelled as “CANCER”, which can be misleading in future, unless all radiologists add addendum post MDTM- “NOT CANCER”.

On our RIS we have a “FAILSAFE Worklist”, and radiologists can put any report they want communicated to the referrer, can be put there by “1 click”. The communication is done by admin staff (NOT reporters themselves). This itself has led to a very low threshold for alerting. We are happy to comply with any need for alerting.

At Doncaster, for suspected cancer alerts: Radiologists/referring doctor can also simply refer via ICE to Infloflex cancer tracking system- with end to end digital audit trails. The MDT Co-ordinators then track and ensure that the alert is acted upon. We have not had any problems of missed cancer alerts since we implemented this.

With robust HL7 ORU transmission we have 100% transmission of “reports” to receiving systems- HIS, EPR, GP systems, Ordercomms systems etc.

Not all reports need an “alert”. The purpose of this RCR document was to have a “list” of what needs to be alerted. However, methodology for alerting needs to follow HL7 global standards and must not increase the workload of already tired/demoralised/depleted workforce of radiologists.

Dr. Neelam Dugar
Consultant Radiologist

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adownie Dr A C Downie
27 April

Agree with Marcus. The principles are sound but the method (red(?) text at the top of the report) seems too prescriptive. We have a result urgency field which we use, that both flags the result in the HIS, and prompts manual intervention by our results team. For many of the critical results I would have thought a phone call was always required, and if documented in the report should suffice. I don’t see the need to flag it if it has already been communicated effectively.