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Preparedness

Quality Assurance

Introduction

DR Systems strongly recommends that every health care facility develop its own policies and procedures for quality assurance, backups, and disaster preparedness. This section is intended to facilitate this procedure, but not replace it. We recommend that the system administrator work with appropriate professional staff and information technology staff to assign individual accountability to the items described in the following sections.

Important items to review

Review DR Systems documentation. Carefully review the DR Systems System Administration Help, particularly the chapters on:

 Disaster Preparedness.  Backup and Recovery.

These chapters and online Help describe the steps for preparing for disaster recovery and for backing up your system.

Important items to document

 Review regulatory requirements. Review applicable Federal and State regulatory requirements, including those imposed as a result of the Health Insurance Portability and Accountability Act of 1996 and Medicare compliance regulations. Professional organizations, including the American College of Radiology, also provide useful information.

 Document your policies and procedures. Create appropriate logs for internal personnel to record and date the routine security and safety checks recommended in this document.

Q/A Checks and Procedures

PACS Server

Note: Do not restart the PACS Server or make any changes to the PACS Server, unless you contact DR Systems Customer Support.

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Check the following items on the PACS Server:

 Server lights. Check all lights daily to be sure they indicate normal status. Report abnormal status light conditions to your RIS/CVIS/PACS Administrator and to DR Systems Customer Support immediately.

 Server capacity. Filling all available storage space on your server can halt normal PACS operations. Based on configuration settings designed to meet your site requirements,

DR Systems Automation helps to ensure sufficient storage space. When the server fills to 85% capacity, Automation checks that exams are properly archived and then identifies and deletes exams.

Using any DR Systems workstation, verify that the available storage space on your server is not dangerously low. Examine the Data Source Properties dialog.

 Server capacity automation. DR Systems Automation monitors server capacity and enables report viewing and faxing reports to referring doctors.

Verify that the Automation application is running. Automation should be:

 Running autoprint and autofax.  Sending reports to Report Manager.

 Sending reports and billing requests to ResultsOut.

 Purging automatically to accommodate the needs of your facility. With Automatic Purging, the system automatically deletes exams from the Online and Worklist tabs if they have been archived. The system also deletes exams based on other configurable criteria, such as report status, acquisition, site, and modality.

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Archiving

Whether you use an automated or manual archive, verify the following items daily.

Archiving Workflow

Using an Ambassador on any workstation, check the following:

 Appropriate status for cases. Cases are automatically marked P (pending for archive) after they are read. All cases are archived appropriately and marked A.

 Threshold of days not archived. Determine your site’s threshold of number of days of not archived cases.

 Filters to check exam archive status. Use the filter feature to create a filtered list of read cases that are Pending archive (P), Restored (R), and Not Archived (N). The number of P cases should not exceed your site’s threshold in days. If the archive automation software is functioning properly, there should be no N cases. You may have N cases, if your site copied exams from another site.

 For sites using DVD archive: The number of P cases should not significantly exceed the capacity of one DVD.

 For sites using Centera or Disk Array Guardians archive: Verify that all Read (R) exams are automatically and promptly archived.

 Compression. No matter what media you use for archives, confirm that the data compression is set according to your specifications per modality and per device.

For example:

 If you specify compression before archiving when importing exams, verify that the compression when importing exams is what you intend.

 If you specify different data compression for web distribution, verify that compression for web distribution is what you intend.

Guardian Workstation

The Guardian products provide long-term archives for your exams.

 Check the Guardian hardware. For example, check the jukebox front panels, the disk array lights, and the Centera lights.

 Check to ensure that your Guardian archives are functioning:

Caution: For all Guardians, check for Guardian applications warnings. Never ignore warnings related to archive or restore failure.

 For DVD Guardian, check the DVD Guardian application.  For Centera Guardian, check HDArchive and HDRestore.  For Disk Array Guardian™, check HDArchive and HDRestore.  For DICOM Guardian™, check DIArchive and DIRestore.

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DbArch

Be sure that the DbArch (database archive) program, which is visible on the DR Systems Messenger module, is:

 Up and running.

 Does not have any text in red.

Caution: If any text is red, call DR Systems Customer Support.

 If your facility uses Instant Reporter, check the DbArch program daily to verify that all reports have been appropriately copied to DVD.

Protecting reports by using DVD Guardian or DICOM Guardian

For DVD Guardian and DICOM Guardian users, reports are not backed up in the same physical location as images and exam data, but are backed up using a separate DVD archive on the Messenger. Monitor DbArch to verify the backups to DVD.

Protecting reports by using Centera Guardian or Disk Array Guardian

For sites that have Centera Guardian or Disk Array Guardian, exam images, exam data, and reports can all be archived to the Centera or Disk Array.

To determine if your Centera Guardian or Disk Array Guardian archives both exam images and reports: 1. On the HDArchive application, which runs on systems with Centera Guardian and Disk Array

Guardian, click the View menu. 2. Select Configuration Settings.

3. In the Configurations Settings dialog box, scroll to the section PROCESSED CONFIGURATON SETTINGS.

4. Check the ReportManagerArchiveDirectory setting.

Workflow management

For details on how to accomplish each of the workflow tasks in this section, see the DR Systems User Guide, System Administration Help.

Check exam Status column

Check the exam Status column of the Worklist or Online list at least daily.  Are all of yesterday’s cases marked Read (R)?

 Are there any cases marked Hold for Edits (H)?  For Instant Reporter users: Are there any:

 TrH exams (transcription on hold for questions)?  DiH (dictation on hold for questions)?

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Check the Actions column

Check the Actions column on the Worklist or Online tabs at least 4 times daily:

 Are all Output actions consistently completed (such as Faxes, Report storage, ResultsOut sends to other systems).

 Use the Actions button as appropriate to evaluate any failed output actions and initiate retries as needed.

Check the Fax server

Click the View Log button daily to view the Fax Log daily and ensure faxes are sent regularly:  Is the workstation running the Fax Server program operational?

 Does the Fax Log show that faxes are successfully transmitted?

Image Quality

Once a week, select three cases for each connected image modality, and use the DR Systems-provided SMPTE pattern. For details on using the test pattern, see

http://brighamrad.harvard.edu/research/topics/vispercep/tutorial.html.

 Does image quality meet your standards? If not, notify your system administrator.  Verify print quality on film and paper at least weekly.

 For DR Systems mammography users, follow quality assurance instructions as described in the DR Systems Digital Mammography and Breast Imaging Implementation Guide.

AGS (Application Gateway Server)

The AGS delivers several types of service. Check each service daily. Notify your RIS/CVIS/PACS system administrator and DR Systems Customer Support if you find a problem.

 Check the AGS server applications. Check that the AGS application is running. If you have the Dominator I+, also check that the WebGate application is running.

 Check AGS website by using Ambassador I+ or ZDA. Log on and view an image or a recent exam.

 Check website by using Dominator I+. If you have Dominator I+, log on and view an image of a recent exam.

Catapult

 Scheduled tab. Check the Scheduled exam list at least daily for old cases. This provides a mechanism to be certain that all Scheduled cases were performed. Delete inappropriate scheduled exams or exams that were scheduled but not completed.

 In-Progress tab. Check the In-Progress list for inappropriate old cases daily. A case can remain on the In-Progress list if a patient was imaged, but the exam was not put online. The ability to check this list is a safety feature of DR Systems Catapult.

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Check for exams from the previous day that are still on the In-progress list. This could occur for a variety of reasons, including:

 A technologist forgot to put the case Online.

 Images on a particular case were sent to the PACS Server more than once, so that a duplicate or partial duplicate copy is left In-Progress even though appropriate images are also Online.

 You can determine the reason for old exams remaining on the In-Progress tab by checking the Online list or Worklist for the appropriate exams. If the exams are on the Online list or Worklist, use the DICOM Gateway to delete old duplicate images from the In-Progress list.

HIS/RIS/CVIS Interface

 If scheduled exams are not appearing properly, restart the HL7 Gateway.  If this fails to correct the problem, call DR Systems Customer Support.

Instant Reporter

 Instant Reporter users—check the Worklist or Online list at least daily for TrH (transcription on hold) cases or any case that otherwise failed to reach your desired final status. The final status is typically:

 TrX (Transcribed-external) for those using external transcription systems. Or

 ApD (Approved) for those using the full Instant Reporter.

 All cases should reach your final Report Status within the designated time period.

Dominator DC

For Dominator DCs set up for WAN reading, check the Received cases directory, which accumulates cases on the local hard drive of each Dominator when cases are read from remote sites. Delete old cases appropriately.

Audit Trail

Periodically, based on your own policy, use the Audit Trail software to determine the appropriate use of such functions as Search All by remote users. For details, see the online Help.

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Security and Off-site Archive Storage

For all customers

Periodically review the architecture of your system to verify that you are satisfied with your level of back-up and security.

 Are you satisfied with your virus protection? Firewalls?

 Is it time to consider additional back-up options such as mirrored servers, mirrored databases, off-site data centers?

 Are your devices physically secured?

 Are your critical devices all connected to functioning UPS units (uninterruptible power supply)?

For Disk Array Guardian and DICOM Guardian customers

Are you backing up and restoring correctly? See the System Administration online Help for instructions on monitoring your Disk Array Guardian and DICOM Guardian.

For Centera Guardian Customers

Have you considered using the Centera replication capability to accomplish automatic off-site storage of exam and report data?

For DVD Guardian Customers

To safeguard against data loss in archives, we recommend the following:

 Create DVD duplicates of archive media. By creating duplicates of DVD archives, you can reduce the possibility of data loss. Creating duplicates is a standard business practice for safeguarding critical data. DR Systems strongly recommends that you create a duplicate DVD immediately after you archive data on DVD. Disregarding this recommendation increases the risk of data loss.  Use only the recommended media for archives. To ensure data integrity for archives, always

use the high-quality DVD media recommended. For details, see “Use only the recommended media for archives” below.

 Avoid data corruption. Always use the DVD or cartridge write-protect setting before manually restoring data or examining a DVD. This can reduce the possibility of data corruption.

 Store separately. Store the duplicate archive discs in an area separate from where you store your primary archive discs—either onsite or offsite.

Note: You can also reduce the possibility of data loss by purchasing and configuring a Communicator to hold 12 months of exams. Duplicating archive media is critically important, if your site does not have a Communicator.

Use only the recommended media for archives

DR Systems recommends that you use only the following high-quality media for your archives, backups, and duplicates.

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DVD recommended media

Manufacturer Maxell

Model DVD-RAM 4.7 3x or 5x MPN 636040(3x), 636108 (5x) Capacity 4.7 GB, High Capacity, Rewritable Description DVD-RAM, single sided

Model 3x or 5x

MPN 636070 (1-PAK) or 636071 (5-PAK) ) or 636108 (50-spindle) Capacity 4.7 GB, High Capacity, Rewriteable

Description DVD-RAM, single sided, jewel case

Use write-protect setting in DVD cartridge

Use the write-protect setting in the DVD cartridge when manually restoring data.

Always use the DVD-RAM cartridge write-protect setting when restoring data manually or examining a DVD. Before mounting a disc in a drive for manual restore or examining a DVD, the disc must be contained in a cartridge having the protect switch in the active position. Without this protection, the data on the disc can be accidentally damaged.

To write-protect a DVD-RAM cartridge:

Use a ballpoint pen to slide the write-protect tab to the up position.

Critical Checklists

These check lists ensure that the components vital to the PACS and RIS are functional. Check daily (or more often)

√ Check Details

PACS Server operation Check all server lights for normal status color. PACS Server capacity Examine the Data Source properties.

Messenger Check DB archive program. Verify success of archive and that the screen is not red. Guardian Check the Guardian hardware. For example, jukebox front panels, disk array lights, Centera

lights. Check the Guardian software.

DVD Guardian Verify that duplicates of the DVD-RAM archive discs were made and that they are stored in a separate location that is away from the Guardian.

AGS Check the Communicator server software and hardware. For example, WebGate is active, disk array lights indicate normal status.

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√ Check Details

AGS Verify proper exam publishing by accessing via ZDA. AGS Verify proper exam publishing by accessing via ZDA. Catapult Check the Scheduled tab for complete booking. Catapult Check the Scheduled tab for old cases.

Catapult Check the In-Progress tab for inappropriate cases. HIS/CVIS/RIS Interface and

Instant Reporter users Check the Worklist tab or Online tab for TrH (transcription on hold), or any case that failed to reach the desired final status. Instant Reporter Users Check the Messenger DB archive program (DbArch) to verify that text reports are properly

backed up.

Workflow checks Check the Online or Worklist tabs to verify that output Actions are successful and examine any failure.

Archive status Check archive status of exams to verify that the number of Pending or Not Archived exams does not exceed the site standard.

Hold status Check for any exams in Hold status. Hold status for dictated and

transcribed Instant Reporter users check for DiH and TrH exams and clear any questions.

Workflow status, read cases Check the Online or Worklist tabs that read cases are marked A (archive) and are promptly archived.

Workflow status, yesterday’s

cases On the Online or Worklist tabs, all of yesterday’s cases are marked R (Read). Workflow status reports On the Online or Worklist tabs, all of yesterday’s cases approved.

Automation Check Automation for regular printing, faxing, report sending, billing sending, and exam purging.

Faxes On the fax server, check the View Log. Verify faxes are transmitting.

Check weekly (or more often)

√ Check Details

Image quality Verify at least weekly. Print quality Verify at least weekly.

WAN Dominator Check the Received cases directory and delete cases as appropriate. Security Audit Use the Audit feature periodically, based on your own policy.

P (pending) cases Check Online tab P cases. For DVD Guardian, ensure that the number of P cases does not significantly exceed the DVD capacity. For other Guardians, ensure that all Read (R) exams are automatically and promptly archived.

DVDs write protected Confirm the DVDs are write-protected when handled.

DVD storage Verify that all DVD media are stored in conditions that meet the manufacturer’s temperature and humidity recommendations.

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Be prepared

√ Check Details

Component Failure First try to restart the component. If this fails, immediately notify your RIS/CVIS/PACS Administrator and call DR Systems Customer Support.

Prior to Failed server drive

swap Check that back-up to Communicator, image archive, DB archive, and Report archives are current. Files backed up. Reports backed up. Days not archived The threshold of days not archived is appropriate.

Virus protection Virus protection for the site is sufficient.

Backup devices Backup devices sufficient or mirrored servers, mirrored databases or off-site data centers needed.

Devices secured Backup devices are physically secured. Devices connected to UPS Critical devices connected to UPS.

DVD media The DVD media used for archives and backups are the recommended types.

Compression Verify that data compression occurs as specified per device and per modality after installing any new, added, or replaced system, including Catapult, imaging device, or archive. Full coverage checking status Check that status of systems is maintained during staff vacations, weekends, and after hours.

Contact list

Role Contact

RIS/CVIS/PACS Administrator Contact:

Notify when RIS/CVIS/PACS Administrator is not available: Scheduling/Front Desk: Interface coordinator for the site:

Interface coordinator for the vendor:

Radiologist system administrator:

Notify when radiologist system administrator is not available: Local IT Support Personnel: Network Support Contact: Location of storage of back-up archive media:

DR Systems Customer

Support: 1-800-794-5955

About your settings

Site Location

Web address for your AGS DICOM Gateway location

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Disaster Preparedness

Component failure

 In the event of a component failure, try to restart the component.

 If this fails, immediately notify your system administrator and call DR Systems Customer Support.

Server disk failure

In the rare event that a drive in your RAID server fails, immediately call DR Systems Customer Support. For details, see the copyright page.

The following items should then be immediately verified prior to replacing a failed server disk:  If you have a Communicator, is the harvesting current?

The Communicator is one of multiple forms of near-term back-up of images and documents. If

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