1. Purpose 

This IFU explains the facility-level settings that control whether the “With Support” signing options are available, and whether the system automatically selects “Critical with Support” for Stroke- and Critical-priority exams. 

2. Background 

This feature introduces facility-level controls for the "Critical with Support" communication condition. Facilities can enable or disable the "With Support" signing options altogether, giving teleradiology groups without dedicated workflow support staff the ability to remove those options from the reporting screen. Additionally, facilities can independently configure whether "Critical with Support" is automatically applied to Stroke-priority and Critical-priority exams, allowing each site to align this behavior with its own workflow and critical-communication tracking preferences. 

3. Facility Setting: Enable Communicate With Support 

1. Open Facility Settings for the facility you want to configure. 

2. Locate “Enable communicate with support.” This is enabled by default. 

• Enabled: radiologists see both Critical With Support / Critical Without Support and Confirm With Support / Confirm Without Support options in the current report and addendum editors (current behavior). 

• Disabled: the “With Support” options are hidden. Radiologists assigned to exams from this facility will only see Critical Without Support and Confirm Without Support. 

4. Facility Settings: Automatic Critical with Support for Stroke/Critical Exams 

Two additional facility-level toggles are available, each enabled by default, and each clickable only while “Enable communicate with support” is enabled (otherwise they are greyed out and turned off): 

• Set critical with support for stroke exams 

• Set critical with support for critical exams 

5. Behavior When a Toggle Is Enabled 

With a toggle enabled, the following rules apply for that priority (Stroke or Critical, respectively): 

1. Opening an exam with that priority automatically sets Critical With Support as the signing condition. 

2. The radiologist can manually change the condition after auto-selection. 

3. If the priority increases to Stroke or Critical before signing (via HL7, OPR, or manual edit), the condition automatically switches to Critical With Support. 

4. If the priority decreases from Stroke or Critical before signing, the condition resets. 

5. Automatic behavior does not apply once an order reaches Completed. 

6. Behavior When a Toggle Is Disabled  

When a facility disables one of these toggles, the system will not automatically set Critical With Support for that priority in any of the following situations: 

• Opening a Stroke exam (if the Stroke toggle is disabled) or a Critical exam (if the Critical toggle is disabled) 

• Priority changing to Stroke or Critical via HL7, OPR, or the UI 

• Opening prelim Stroke or Critical exams 

In this state, the radiologist may still manually select Critical With Support — no auto-selection occurs, and the system takes no automatic action on the condition if priority changes afterward. Signing a report continues to follow normal logic based on whichever condition is selected. 

7. Edge Cases 

Completed exams 

If an exam is Completed, priority changes (from HL7 or otherwise) never alter the signing condition. 

Existing “Critical With Support” conditions 

If a toggle is disabled after an exam already carries a Critical With Support condition, that existing condition is left in place; it is not removed automatically. 

Manual overrides 

A radiologist's manual selection always overrides the automated behavior while a toggle is enabled. 

Switching a toggle Enabled ↔ Disabled 

Changing a facility toggle does not change the condition on existing exams. It only affects exams from the moment of the change forward. 

8. Configuration Summary 

Note: The Stroke and Critical toggles are only clickable while “Enable communicate with support” is enabled; if that master setting is disabled, both toggles are greyed out and turned off.