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5/20/2013 Epic and Q-Path Workflow
Posted: Monday, May 20, 2013
Joined: 8/31/2011
Posts: 231


Excuse the "reply all" if you are not interested in this but we've had enough inquiries about EPIC and Qpath that I thought I would share our experience (I believe there are now more than 50% of academic medical centers on EPIC now, and even if you don't use EPIC/Qpath some of same issues may apply) -- we have had Qpath for about two years and transitioned to EPIC about three months ago.

Here is our workflow:

- "order" for bedside ultrasound entered in EPIC
- This allows the patient to show up on the machine worklist (wirelessly connected) to be picked by the operator - thus includes full name, MR#, etc. and avoids entry errors

- Images captured on machine --> are transferred wirelessly to QPath, which then transfers to Hospital PACS (Fuji Synapse)
- We are currently transferring ALL images captured (educational or diagnostic), though filters could be applied

- Interpretation, operators, etc. completed on QPath. This is done by the primary operator - typically a resident.
- Attending electronically signs in Qpath and then selects "Transfer" for diagnostic studies --> a text and .pdf of the report are then transferred into EPIC Only attendings can transfer.
- Educational studies are filled out in Qpath for QA and credit but not transferred

- Images are accessible either through QPath or via a link to Synapse from within EPIC (same way that radiology images are viewed from within EPIC), or could be accessed directly via Synapse.

- If a study is done prior to an order being placed (acute trauma, code, etc.), then an order should be place in EPIC after the images are caputred. The images will be available in Qpath, and if the MR# is entered in QPath and "refresh" is hit it will automatically fill in the name and transfer to Synapse with correct information and will allow "transfer" of the study report to EPIC.

If we were simply doing diagnostic studies we could have bypassed Qpath and created smart phrases in EPIC for interpretation, but Qpath allows us to require certain fields be filled in, allows us to track #s and stats, provide QA, have a place for educational studies etc.

Issues we are still having:

-When an order is placed the information of the ordering physician and attending are available as part of the order. However, our version of EPIC does not use the correct DICOM format for this information "^LastName etc." so Qpath cannot reliably interpret it. We are hoping to correct this so that this information can go automatically into Qpath.

-The studies we do in the ED, while marked as "ED FAST", etc., are typically placed in a radiology folder, ED Echo often in cardiology folder, or somewhat randomly placed within the EPIC chart. We are working on getting all ED ultrasounds into one folder, which will help our coders.

-Logging into a separate system to fill out US interpretation is not ideal, but the benefit we get from QA and tracking makes it worth it to us at this point. Would like to work it out so that Qpath could be opened from within EPIC.

Would be interested to hear if others have suggestions or solutions on this workflow that have worked for them.

Great to see many of you in Atlanta and great job on Sonogames!


Christopher L. Moore MD RDMS RDCS
Associate Professor, Department of Emergency Medicine
Yale University School of Medicine
464 Congress Avenue Suite 260
New Haven CT 06519
(o) 203-785-3843
(c) 203-687-6776
assistant Hilmer Ayuso 203-785-4058

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