BRIT System's BRIT UrgentWorks is a pure browser based solution that supports the flagging of urgent findings and critical test results by reporting clinicians and the immediate communication and on-going tracking of results to the ordering clinicians. The critical findings and history of the communications can be viewed and updated by all involved users on the browser interface. BRIT UrgentWorks also sends messages by email, fax, and proactively calls or texts the ordering clinician. The UrgentCall feature converts the reporting clinician's text to an audio message that can be acknowledged on the fly by the recipient. All updates to the critical result are instantaneously available across the enterprise. A reporting clinician can easily use BRIT UrgentWorks to effectively communicate their findings in accordance to ACR guidelines and Joint Commission initiatives.

Critical Test Reporting System: Workflow for Communication / Tracking of "Stat" Results and Urgent Finding

BRIT UrgentWorks can be readily implemented within any workflow environment. BRIT UrgentWorks builds a patient worklist via either an HL-7 interface to a department's order entry system or via DICOM by regenerating order information from a study's DICOM header meta data. Reporting clinicians log in through any Internet browser and enter the critical result, which will automatically trigger the Actions needed message over the browser-based interface and over the phone (Figure 1). The recipients of a message are determined from the ordering physician and patient location in the order. The recipients each have a log-on to the system where they can manage their own contact information and establish the rules for how to contact them based on the severity of the test or test results. All messages and actions by all clinicians are recorded in the critical results history log.

    Why you'll love this system:
  • Meets Joint Commission National Patient Safety Goal Objective #2
  • Seamless interface to existing workflow (PACS, RIS or EMR)
  • Reporting clinician simply types their note in a browser and the system utilizes a multi pronged
    approach to contact the ordering physician
  • Ordering clinician is notified proactively via the web, fax, email and phone.
  • Auto-calling of results happens immediately and is logged as a part of the critical results history
  • System can connect reporting physician to recipient by phone
  • System supports read-backs
  • All system actions logged and uers can enter notes on conversations. Web interface can be
    accessed on a computer, laptop or smart phone
  • Administrator panel for message monitoring and statistical analysis
  • Critical history log for audit trails including messages, users involved and time stamps archived
  • Once "Completed", history of communication sent as an addendum to the final report

Design Criteria

UrgentWorks was designed to fix the major road blocks preventing these critical results systems from moving into general use. These features include:

  • Tools to assist in the set-up and maintenance of user contact information -
    • (accomplished with our FireDrill)
  • Tools to allow users and system administrators to easily and dynamically change their contract information via the browser interface
  • Flexibility in contact methods
  • A rich set of escalation tools to assure someone acknowledges the finding
  • Unimpeded workflow for the radiologists (Click me!)
  • Ability to enter and follow urgent findings from workstation / web application
  • Hassel-free delivery of the urgent finding (Click me!)
  • Return of Urgent Findings to multiple RIS, HIS and EMRs
  • Ability to extend the communication system to other areas of the hospital, including using it for ER discordance and for lab work.

The design also considered the requirements to:

  • Produce reports and statistical analysis for the department managers, available anytime, anywhere, for any time period.
  • Contact patient locations in addition to individuals
  • Provide a SaaS purchase model, so facilities can utilize the service with minimal IT support and little to no capital costs

Roentgen Works Browser Interface for User Contact Methods

The FireDrill - and other set-up and maintenance tools

The largest task in setting up a site is entry of the information instructing the system how to contact the users and locations. This is not the type of information that is generally available anywhere within the clinical environment today. Parts of it may be available via a format that BRIT can import into the system from the HIS or from the medical records department. But generally, the application is looking for a richer set of contact information. This includes office numbers, mobile numbers, pagers, emails and who backs them up when they are not available. We refer to these as "contact methods". The user also sets up the order of the contact methods . The system manager determines how many times each number is called and the time between each call.

Once some information is in the system, the manager runs a FireDrill. The FireDrill includes a tool for informing the users when the call will occur. It calls every number in a selected group (or all groups) and verifies that the number . Users can modify their numbers and contact priorities at this time. This tool is then run periodically as part of the general hospital's emergency drill.

The system manager can view reports of all verified numbers, all failed numbers, correct numbers and retry.

Web Interface

Users can access the Urgent Finding via the web interface and acknowledge from there, as well as via a phone call.

Rich Escalation Tools

The escalation path is established by the referring physician and also by the site administrator. If the referring physician and their backup fail to acknowledge the findings, the system escalation path activates. All attempts to deliver the message are fully documented.

Return of Urgent Findings via Report

The history of an urgent finding can be included at the end of the report, showing who was contacted, the action they took and the turn-around time to acknowledge the urgent finding.

Statistical Analysis

Unimpeded Workflow for Radiologists

UrgentWorks parses out the Urgent Finding from the radiologist's report. Parsing is just a fancy computer word for searching through a document, looking for a phrase and then grabbing something associated with the phrase, or the item itself. Urgent Works provides a tool to defining the starting point and ending point of an urgent finding. These are used to pull the results out of the report.

Hassel-Free Delivery of Urgent Finding

When the system calls a user with an urgent finding, the user simply hits a key on their phone verifying they are the right person. The message is then played and they can acknowledge the finding and hang-up OR they can hit another key to connect to the radiologist. Simple and efficient.

When calling a location, the person answering the phone must enter a 4 digit user ID, then the workflow is the same as when calling a user directly. Simple and efficient.