Order Diagnostic Imaging Studies Directly from Your EMR... NOT!

The following email was received from a private diagnostic facility in Toronto. While it may be tempting to point a finger at the “for profit” nature of private diagnostics, competitive markets tend to drive efficiency and non-performers simply go out of business. As more physicians adopt EMRs, the demand for ways to leverage EMRs and improve efficiency is bound to grow.

Filling out different diagnostic requests for each facility is time consuming and takes away from patient care.

I am the Vice President Marketing at an Independent Health Facility with clinics within the Greater Toronto Area. Part of my job is ensuring that we deliver the highest level of quality to our referring physicians in the quickest way possible. With the introduction of Electronic Medical Records for physicians and specialist and with laboratories and diagnostic imaging all going in the direction towards paperless records, I have noticed a few hindrances.

In my opinion if a referring physician had the capability of filling out a request for consultation directly from their EMR and then having the option to either print the requisition or sending it electronically to the imaging facility of their choice, we would speed up the patient diagnosis process. This will eliminate the large number of patients who fail to fulfill their doctor’s request for tests as well as eliminate repeated tests.

This in essence will improve patient care as the entire process can be done quicker and with less phone calls between physician offices and diagnostic imaging clinics or departments.

We need a standardized referral template which can easily be added to any EMR software, where one can add in the specifics for a particular facility and which can easily be sent electronically to clinics, hospitals, specialists and other physicians. We need something that can communicate across the board within the wide array of software and programs we currently have in the healthcare industry.

This has already been done in New Zealand by MasIsaac Informatics for the Royal Australian & New Zealand College of Radiologists (RANZCR).

What are your thoughts? Do you have a process through your EMR to order diagnostic investigations? How would you want the process to work? Click on the “Comments” link below.

Comments

[james lane-Stayner]

I agree that a standardized referral template needs to be developed. Every Clinic/hospital has their special version. Presently (using PSSuite) we have a number of requisitions for local hospitals requisitions as custom templates that auto populate with patient demographics and are completed in the EMR. These are then printed and faxed to the institutions. Amazing how much more efficient it is to have a legible copy of the requisition in the chart-requests for lost reqs etc. The nirvana will come when we can easily fax the req directly to the institution or better yet using OntarioMD email to communicate.

[Cameron]

The diagnostic guy is completely right. I'm hoping for national standards for communication like this. Standard forms that every diagnostic clinic would accept would be a great first step to get the info into the EMR of what tests you want your patients to receive.

[Garth McDonald]

This "nirvana" will never happen until Canada emerges out of the dark ages and embraces a national coding system so that the form or forms that are created have the national code embedded in them. Why can't canadian health care funders (our federal govt) spend some time abroad (UK, NZ, etc.) and see for themselves the benefits of true standard codes instead of the hodge podge textual EMR attempts we have now. Most provinces now have printed pre-natal forms that are "standardized". The problem is that saving one of these as a pdf or other image type leaves no opportunity to transmit individual portions of the data collected to any other agency. All or nothing. And each province differs considerably from the next. A true coded form would allow individual portions of the data collected to be made available to only those who need to know, and would be available to all users who had the permissions to view those records. Seems like we enjoy beating our heads on the wall and complaining about the lack of information transfer because of all the different EMR and other systems out there. Not the software's fault. Get the data coded to a national (arguably should really be international like Snomed) and the rest is easy.

[Michelle Greiver]

We actually use a standardized interface to order DI. We just use the one that came with the EMR. It auto-populates the patient info. We have a couple of preferred DI facilities, we just use a pick list for those, and it puts in the DI facility info, like address, phone number etc. The DI reqs are saved with their preferred patient preps.

The DI facilities are good about it, they don't care that it doesn't look like "their" req, they want typed, legible, complete information. The hospital DI is good about it as well, except for MRI department, where the booking clerk insists that she will only take "their" req, and nothing else.

We print a copy for the pt. We fax the req to the hospital. An electronic copy is kept in the EMR as part of the encounter, and is matched to the incoming DI report when this arrives (unfortunately, by fax).