Critical Results Reporting

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Use case: “NOW notification”

• This is a Priority interrupt• Drop what you're doing, react now• your patient may die today, e.g., pneumothorax

• A chest X-ray reveals a pneumothorax• The reading radiologist immediately

• Obtains provider information for patient, from imaging order information. • Obtains notification information for the provider(s) involved.• Sends NOW notifications by all identified methods. Sends NOW notifications by all

identified methods. (Page, Office, Nursing station)• Tries to locate patient• Sends NOW notification to patient location

• ER Physician responds to page, and accepts responsibility• Treats patient• Closes out patient NOW issue later.

• Radiologist• Notes that ER Physician has taken responsibility. Closes out NOW notifications.

• ER Nursing station• Responds to message, is informed of ER Physician that has been notified and

accepted responsibility.

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“NOW” notificationNotification Sender PWP Notification Repository Notification Recipient

NOW Event

Find Notification MethodsSMS

Call Office

PageCall Nursing Stn

Call Exam Room

Multiple Log events (for each attempt)

Returns PageLog success on page, log closure on SMS,Office call, nursing call, exam room call

Log Success and CompletionOn page. An hour or two laterAfter treating patient?Same person? Different person?

Issue multipleNotification NOW

Find Patient

Patient Locator

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Use case: “later” notification

• This should not interrupt the patient treatment• Schedule a follow-up, your patient might die next year, e.g., suspicious

lung mass.• Chest X-ray to check for broken ribs after traffic accident reveals

suspicious lung mass.• Radiologist

• Writes Report, finishes order• Obtains notification information for “later” notifications for that provider.

Patient’s internist is listed.• Sends a “later” notification to the internist, indicating the relevant report to

read.• Internist

• Receives notification.• Retrieves report, takes responsibility, notifies radiologist of accepting

responsibility.• Interacts with patient and begins followup.• Notifies radiologist that patient has been informed and follow-up begun,

closing the “later” notification.

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“Later” notificationNotification Sender PWP Notification Repository Notification Recipient

“later” EventReports finished

Find Notification MethodNAV

Log attempt (for NAV)

Responds with AcceptanceLog Acceptance of responsibility

Issue notification

Reports resultsLog Acceptance of reports

Log receipt (for NAV)

PatientInteraction

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Find Information for critical results notification

• Find Information• Who should be notified• How can they be notified• This will be relevant for both “Now” and “Later”

notifications, but with perhaps different information needs.

• Likely Approaches• PWP

• Are additional fields needed or optionality affected?

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Find Information for critical results notification

PWP ServerNotification Information

Query Actor ITI -24

Query/Display/Report Requirements

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Reporting requirements

• Log Notification Activity• Successful Notifications• Unsuccessful Notifications• Use of notification• Other?

• Reporting• Notification Activity• Outstanding Notification Problems

• Notification Information Query Actor• What queries are mandatory? Optional? How to handle

extensibility?• What display capability is mandatory? Optional?

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Log Activity

• Likely Standard: Syslog-TLS• Use ATNA?

• ATNA reliability, access, and security needs can be different from the needs of logging notification activity

• The decision whether to use the same server for both should be a deployment decision.

• Federation requirement?• Schema must be defined, perhaps stealing a lot of

content from ATNA.

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Log Activity

LocalRepository

Any NotificationActivity

ITI-XX1, LogNotification Activity

SuccessesFailuresOther

Notification LogQuery/Report Actor

Time PeriodPatient RelatedProvider (person, group, etc.) Outstanding IssuesSuccess/ Outstanding

CentralRepository

ITI-XX1

ITI-XX2, QueryNotification Activity

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Notification Log Queries

• Reporting• Notification Activity• Outstanding Notification Problems

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Notification methods

• Notification methods• NAV (ITI-25, 26, 27, 28)• SMS• Voice• Fax• Pager• XDS• Other

• What is appropriate and ready for IHE to specify in an interoperability profile?• Transports• Content Profile