Imaging orders and reports

Turning on Imaging

Owners and Admins can turn it on. In Settings, go to Diagnostics, then Imaging, turn on the switch and select Save changes. It applies to the whole practice.

Imaging then appears under Diagnostics in every patient record and visit. Faxes can also be sorted as imaging reports.

The Imaging page

In the left sidebar, click Patients, then click the patient's name. In the patient record, under Diagnostics, click Imaging. The list on the left has three groups, and whatever you select opens beside it:

• In progress: orders that are still open. Any that need someone's attention come first.
• Follow-up due: follow-ups whose due date has passed.
• Reports: every report, newest first, marked with what's left to do.

Closed and archived, at the end of the list, holds closed orders and archived records.

Ordering a study

Select New order. The footer of the order says what's still missing.

1. Choose the Exam. The form asks only what that exam needs, such as side, contrast or views.
2. Set the Priority and write the Reason for exam.
3. Add the Diagnosis. Search ICD-10 by name or code, or select one of the patient's recent diagnoses.
4. Choose the Imaging center. To add a new one, select Add new contact.
5. Choose Payment: the patient's insurance or Cash. For exams that usually need authorization, you can record its status, the case number and the benefit manager here.
6. Work through the Safety check, if the exam has one.
7. Open Sends with the order to choose which documents go along with the requisition.

Select Preview to see the requisition as the center will receive it. Then sign it:

• Sign and fax sends it to the center. Practices without fax see Sign and print here instead.
• The arrow beside it offers Sign and print and Sign and give to the patient.

The safety check

The safety check changes with the exam and your choices, and the chart fills in what it can. An MRI asks about implants, pacemakers and weight. Choosing contrast asks about contrast allergy, kidney function and metformin, with the latest eGFR filled in from the patient's labs.

Confirm each row, or select Confirm all. You can type over any value, because the chart can't know everything, such as a knee replacement elsewhere.

The order also warns you when a choice raises a problem, such as a contrast allergy on the chart.

Drafting with Ona

At the bottom of the order, Ask Ona can fill it in for you:

1. Choose the visit to work from, or No visit · chart only. From a patient's chart it starts on their latest visit, and from a visit page on that visit.
2. Say what to order, such as "Follow-up CT chest for the lung nodule", or press Enter to draft from what the visit planned.
3. Check the draft, and read any notes Ona left about what's missing.

To change the draft, tell Ona in the same box, such as "make it urgent". Answers you've already given stay as long as the exam stays the same. If a visit planned several studies, each gets its own draft, and signing one moves you to the next.

Ona fills in only what you asked for, or what the visit and chart already say. It doesn't suggest an exam of its own, and if nothing is planned it tells you so. Ona never answers the safety check or chooses the center or payment, and nothing is saved until you sign.

Following an order

An order moves through Signed, Sent, Scheduled, Performed and Report. Under the steps, the order says what it's waiting on, with a button for the next step, such as Mark scheduled or Mark performed.

An order is flagged and moves to the top of In progress when it needs attention:

• Not sent: it was signed but hasn't gone out, or the fax failed.
• Not scheduled: it was sent more than 14 days ago.
• No report: it was performed more than 7 days ago.
• Auth denied: the authorization was denied.

To record or change an authorization, go to Payment on the order and select Add authorization or Update. Ona keeps the record, but doesn't submit authorizations to the payer.

The … menu at the top of the order has the rest:

• View requisition opens the signed requisition.
• Send by fax or Send again faxes it.
• Not performed yet undoes Mark performed.
• Close order closes it with a reason.
• Archive moves it out of the list. Open an archived record to restore it.

Adding a report

Reports reach the page in two ways:

• Upload: select Upload report on the order, or at the top of the page, and drop in a PDF, JPG or PNG up to 25 MB. From the top of the page, you can choose which open order it belongs to under Order.
• Fax: a fax sorted as Imaging report and linked to the patient is filed here. It lands on an order if that's the patient's only open order at the number it came from. Otherwise it's filed on its own, and you can select Link to order on the report.

When a report arrives on an order, the same record becomes the report, so the order stays with it. Selecting Unlink from order in the … menu separates them again.

Whoever placed the order gets an Imaging report received notification, unless they filed the report themselves. A faxed report with no order notifies your operations team.

Reviewing a report

Ona reads the report as soon as it's filed, usually within seconds. You can read the report while it does. If Ona can't read it, select Read it again.

• Impression: the radiologist's conclusions. Select a line to jump to where the report says it.
• Recommended follow-up: anything the report says should happen next.
• Values: measurements, such as a nodule's size or a calcium score.
• Report: the report's text. Select Original to see the file itself.
• Study: the facility, radiologist, dates and accession number. Select the pencil to correct them.
• Order: the order behind the report, with View order.
• Images: Ona stores the report, not the images. Select Link to add a link to the study.
• Internal note: seen only by your team.

Signing off

The three marks at the top of the report stay in view as you scroll:

1. Mark reviewed records who reviewed it and when. Until then, Ona's summaries treat its reading of the report as unconfirmed.
2. Action records what you did: No action needed, Discussed at visit, Follow-up ordered, Referral sent or Medication changed.
3. Tell patient records how the patient found out: Portal note, Told by phone or Told at a visit.

Select a mark again to undo it, or choose Clear from its menu.

Keeping follow-ups on track

When a report recommends another study, Ona adds it under Recommended follow-up, marked Read from the report, with a due date counted from the study date. Recommendations that depend on something else are marked If indicated and have no due date.

For each follow-up, you can:

• Select Order to start an order with the exam and reason filled in. The follow-up then links to that order.
• Select Confirm to accept what Ona read.
• Select the pencil to change the due date or the owner.
• Select Close and give a reason, such as Done elsewhere or Patient declined.

Select Add to enter a follow-up yourself. Once its due date passes, it stays in Follow-up due until someone orders or closes it.

Asking Ona about imaging

Ona can see the patient's open orders and their five newest reports. That means the Assistant, patient summaries, care plans and visit briefings all take imaging into account. With a report or order open, the Assistant knows which one you mean, so you can ask "What did this report recommend, and has it been done?"

What patients see

Patients see nothing from Imaging until you share a report:

1. Open Tell patient on the report and select Portal note. Ona drafts a plain-language note for you to edit.
2. Select Share with patient. This also marks the report as reviewed.

The report appears in their portal under Health records, with your note, any image links and the file. By default the patient also gets an email saying it's there. Ona's reading and your internal notes stay with your team.

To take it back, open Tell patient and select Stop sharing. Removing the Reviewed mark also stops sharing.