Overview
This section describes the typical exam workflow, the status changes an exam moves through, and how those statuses may be manually corrected by an authorized administrative user.
Typical exam workflow
An order is created in the EMR/RIS and sent to the platform via HL7 order (ORM) message.
Images are acquired at the modality and sent to the platform as DICOM.
The platform attempts to match the incoming HL7 order to the DICOM images using identifiers such as patient ID, accession number, and study date.
If no match is found, the exam remains in Unmatched status until matching data arrives; once matched, the exam moves to Pending
While in Unmatched, the platform continues to monitor incoming HL7 and DICOM data and moves the exam to Pending automatically as soon as a match is made.
In Pending, the exam is staged for validation and awaits manual validation by a technologist. for HL7-integrated facilities with Auto-Validation (AV) enabled, the exam advances automatically to Inflight.
Once validated, the exam moves to Inflight, indicating it is ready to be read by a radiologist. From here, an exam may also branch to a side workflow:
7a. Communicate – if the radiologist marks a finding Critical or Communicate.
7b. Support Request – if information needed to complete the read is missing (e.g., missing priors or worksheet).
7c. Consult Request – if the radiologist requests a consult on the exam.
Once the radiologist reads and signs the exam, the exam status changes to Completed and the digital report (ORU) or an automated fax is sent to the ordering facility.
Exam status and life cycle
The status of an exam changes as it progresses through the workflow described above:
Exam status | Description | Manually changeable? |
|---|---|---|
Unmatched | Holds incoming HL7 order messages that have not yet been paired with their corresponding DICOM images (or vice versa). This typically happens when an HL7 order arrives before its images, or when image metadata does not meet the criteria for an automatic match. The platform continuously checks incoming HL7 messages against DICOM images (using identifiers such as patient ID, accession number, and study date) and automatically moves the exam to Pending once a match is found. | Yes – can be manually changed to Pending, Inflight, or Completed. |
Pending | The initial staging area for exams that have been received but are not yet ready for final interpretation. DICOM-only facilities: images arrive with no HL7 order, so a technologist must manually validate the exam by reviewing and confirming metadata. HL7-integrated facilities: once HL7 and DICOM are matched, the exam auto-advances to Inflight if Auto-Validation (AV) is enabled and its criteria are met; otherwise it remains in Pending for manual validation. | Yes – can be manually changed to Completed or back to Unmatched. |
Inflight | Exams move to this status once validated in Pending. This status signals that all required information and images have been confirmed and the exam is ready to be read by a radiologist. | Yes – can be manually changed to Completed or reverted to Unmatched. |
Completed | Set once the radiologist has read and signed the exam. The digital report (ORU) or an automated fax is sent to the ordering facility. On the exams list, an exam can move to the ‘Completed’ tab through a manual status change. | Yes – Unsigned exams with no external report can be returned to Pending or Inflight. Signed exams can only be returned to Pending or Inflight through the Addendum Request workflow. |
Communicate | Populated when a radiologist marks a finding as Critical or Communicate. On the exams list, the exam remains in the ’Communicate’ tab until a user confirms the receiving location has the report with no outstanding questions for the radiologist. | No – governed by its own Critical/Communicate workflow, not the manual status-change permission. |
Support Request | Holds exams that are missing information needed to complete the read — for example, missing priors or a missing technologist worksheet — until the issue is resolved by a technologist or other user. On resolution, the exam returns to its prior status. | No – uses the dedicated Support: Internal Request action; any user who can request support may initiate it, even on a Completed exam. |
Consult Request | Used when a radiologist requests a consult on an exam. Like Support Request and Communicate, it is a dedicated workflow separate from the general status list. | No – uses its own dedicated Consult Request action. |
Manually changing exam status
A dedicated permission, Ability to Update Exam Status (ACL: update_exam_status), allows authorized internal users to manually change an exam’s status for troubleshooting and operational correction — without waiting on HL7/OPR reprocessing or engineering support. This permission is disabled by default and enabled only for Global Admins.
Where status can be changed
Reporting Screen → Exam Information tab, using the Status dropdown.
Exams List → right-click an exam, or use Actions menu → Exam: Status.
Available options are dynamically filtered based on the exam’s current status and applicable restrictions.
Restrictions
This permission cannot be used to change status to or from Communicate, Support Request, or Consult Request — those statuses use their own dedicated workflow actions.
Moving directly to Completed makes the exam non-editable, and does not add a submission timestamp or “once signed” event.
Moving a Completed exam back to Pending/Inflight is only allowed if it has no “once signed” event and no external report.
If linked exams exist, moving one to Completed moves all linked exams to Completed.
HL7/OPR logic always overrides a manual change — if triggered, the exam can move back to Completed automatically.
Note: All manual status changes are logged in the existing audit trail, recording the user, date/time, previous status, and new status. Manual status changes are intended for troubleshooting and correction, not routine workflow. |