DOSE outside DOSE

By Filippo Miniati, Senior Project Manager at Qaelum

The major problem with implementing a new tool within a hospital is time. Healthcare operators (doctors as well as all other professionals) need to invest time, not only in order to learn how to use the tool, but they also have to find time in their daily routine to use it correctly. Healthcare operators are already so busy! This time problem can become so big that it may limit the number of operators who become active users, or in the worst-case scenario, the implementation of the new tool may also fail. How can this be avoided? How can Qaelum help you with the implementation of radiation protection legislation, such as the European directive EURATOM/59/2013?

Qaelum knows how valuable time is, especially in a hospital environment: for this reason, we have developed several integrations, with the goal of making key functions of DOSE more accessible and user-friendly. These functions can be integrated into the tools and equipment that radiologists, radiographers, medical physicists and other professionals are already used to handling on a daily basis. In other words, operators should be able to keep their daily routine the same, receiving the necessary information directly in their normal workflow. Operators shouldn’t spend time checking for notifications and tasks: notifications should come automatically to them!

These integrations are part of the standard DOSE package, and they can be implemented in a wide range of third-party applications.

Dose information in the PACS

Radiologists should be able to get information about a study (dose, notifications, required actions) while creating the medical report for that study. Opening a new browser tab for DOSE and searching for the specific study can be an option, but some radiologists would find that inconvenient. For this reason, Qaelum developed a webservice which is easy to integrate and appears as a tab within the study details of the PACS. This webservice shows a general overview of the study: so, in a user-friendly and clear way, the compliance to applied limits (e.g., DRLs) is shown, thanks to a colored bar on the upper side of the page.

The webservice also allows the application to list all notifications created for a specific study, and highlights whether these notifications require some actions (e.g., legislation may oblige operators to justify excessive irradiation).

The page also displays whether comments and justifications are already present, without the need for any additional clicks or additional waiting time.

The operator can also type in a comment, which may be used later to handle the notifications.

Users can also request the webservice to redirect them to the DOSE application to visualize the whole dataset and the root cause analysis. According to the user, reference sites, and the key users, the webservice tool alone can lower the load for radiologists for any single study.

Notifications on your desktop

In many cases, DOSE users are not interested in having feedback for every single study performed on a daily basis, only for the problematic ones. Radiologists and radiographers, interviewed by Qaelum, requested a solution to meet this need. DOSE can send emails for every notification, but this is sometimes not considered optimal as it can increase the so-called “noise level” on that medium. Qaelum came up then with the idea for the Quality Agent. This tool works in the background of the desktop (e.g., personal computer, RIS/PACS workstation). It only becomes visible at the moment a notification is created (e.g., exceeding DRLs or study parameters outlying the configured limits). In the case of a notification, a “pop-up” is shown on the screen, and the operator can immediately take care of it.

As for the webservice above, the number and the type of notification are shown, and operators can immediately revise and/or fill in any comments. If there is a need for additional details, the operator can follow the link to the study details in the DOSE application.

Dose information in the RIS

The European Directive requires organizations to store and print the value of the dose together with patient and examination information. However, DOSE users reported a desire to have notifications visible at the RIS level, to be able to justify them promptly. In reply to this request, Qaelum improved the output of DOSE, adding details about compliance with the HL7 messages that can be sent to any third party. The result is that any RIS or EMR system can receive, collect, and show information about the dose, notifications, and status of each study.

This function was considered of particular interest in the DACH market, where Qaelum collaborates with Agfa HealthCare in order to offer a complete integration between DOSE and ORBIS RIS. ORBIS RIS users can check DOSE compliance feedback when searching for orders at the RIS level, without the need to open an additional tab. Since Agfa HealthCare is one of the market leaders, the integration is always developing and gets ever more complex, and the more customers are using DOSE and ORBIS RIS. One example, which is highly appreciated by the DOSE customers is that the documentation which was made during the examination within ORBIS RIS is automatically sent to DOSE. Therefore the technicians or radiologists don’t need to document dose-relevant information repeatedly. In the case of exceeded DRLs, ORBIS RIS automatically shows the radiologist, that they should comment on the study.

Collect comments from every source

Sometimes, operators are able to type some minor comments directly at the modality console (e.g. regarding patient size or ability to follow the instructions), at other times, they prefer to comment when using the PACS or the RIS instead of browsing to DOSE. Independently of where the user is working or what they prefer, DOSE always collects the documented information. With DOSE, users don’t need to change their current workflow: they can proceed as usual, lowering the risk for the patients and improving radiological practices with minimal effort.