HI595 Unit 10 Capstone Project Report Example

Scanned in Surgery, Missing at the Scanner: A Unit 10 Capstone Project Report on Implant Records for MRI Screening

[Student Name]

Purdue University Global

HI595: Master's Capstone in Health Informatics

Unit 10 Capstone Project Report

[Instructor Name]

[Date]

Carrowby Health, its departments, audit results and every figure are composite; the sources cited are real.

Executive Summary

To the vice president of imaging services: outpatient MRI screening at Carrowby often cannot confirm a patient's implant before the scan, and exams wait or are canceled while staff search. A baseline audit of 150 eligible exams found that 51, or 34 percent, already held the device maker, model and labeling in coded form by the booked scan day. Thirty-eight exams were delayed on the day and nine canceled. The data needed mostly exist already: the operating room scans each implant's identifier into its supply log, but the identifier rarely reaches the patient's record. This capstone produced version 1.0 of a specification for a structured implant entry, a screening worklist, exception rules, and a patient letter and card. A tabletop test showed the rules would have handled 139 of the 150 audited exams without a manual decision. One decision is requested: schedule version 1.0 for configuration by imaging informatics.

Problem and Scope

The project covered outpatient MRI at Carrowby's two hospitals for adults with implanted devices. A missed identification was defined as an eligible exam without structured implant details before the scan date. Inpatient and emergency MRI, pediatric patients, other modalities, device programming and MRI safety policy were excluded, each for a stated reason in the Unit 3 scope statement.

Evidence

The literature review answered four design questions. Identifiers captured by barcode at implantation are reliable, while transcribed details are not (Drozda et al., 2018). Ownership of implant information is a recognized organizational gap with no tested solution, so the specification assigns roles by reasoning. Cards confirm devices but go missing, so the specification prints the card from the entry. Finally, the three labeling terms MR Safe, MR Conditional and MR Unsafe, with an Unknown category for unidentified devices, were adopted from industry and radiology guidance (ASTM International, 2023; Harwood et al., 2024).

Approvals and Status

Status is stated for every step. Obtained: quality improvement determination, course site approval, sponsor charter, privacy approval for the audit, permission to draw on the supply log, health information management agreement to own entry completeness, MRI safety committee review with two requested changes, both made. Pending: imaging informatics feasibility confirmation for two fields. Not yet requested: configuration and go-live, which this report recommends.

Method

The project ran five phases with exit tests. The baseline audit abstracted 150 consecutive eligible exams; double abstraction of 20 showed 94 percent field agreement. Seven interviews in five roles produced requirements. The draft was tested on paper against all 150 audited cases and reviewed by the safety committee and a patient representative.

Results

Baseline: 51 of the 150 audited exams, 34 percent, met the definition. Results differed sharply by origin. For devices implanted at Carrowby since 2019, the identifier appeared in the operating room supply log for 92 percent, but only 41 percent of those devices had a structured entry in the patient's record. For devices implanted elsewhere, 12 percent had structured details before the scan.

The information existed for most Carrowby implants; it was simply stored where screening never looked.

The tabletop test found that the draft rules would have flagged every audited exam and handled 139 of 150 without a manual decision. The eleven unhandled cases were all outside implants with partial or conflicting documentation; they led to the partial-card exception added in version 0.3.

What Surprised the Project

Two findings were unexpected. First, the delay log had suggested that outside implants caused most delays, but the audit showed that Carrowby's own implants accounted for more than half, simply because there are more of them. Second, screening nurses already kept a private spreadsheet of verified devices for repeat patients, a workaround that held information the record lacked. The specification absorbs that spreadsheet's purpose into the implant entry, and the nurses who kept it reviewed the draft.

Cost of Configuration

Imaging informatics estimates about eighty hours of build and testing for the entry and worklist, plus a supply log interface that the operating room vendor already offers. No new staff are requested; screening nurses' verification time is expected to fall for Carrowby implants and rise modestly for outside ones, which the balancing measures will track.

The Specification

Version 1.0 contains four parts: a structured implant entry populated from the identifier where available; a worklist with five screening statuses, each defined by entry and exit conditions, including the separation of Verified from Cleared that the seminar exercise exposed; exception rules for outside implants, partial documentation, removed devices and retained fragments; and a patient letter and card generated from the entry.

Evaluation Plan

The evaluation will repeat the baseline definition after go-live, with a target of 80 percent, three process measures and three balancing measures, read on a monthly run chart (Provost & Murray, 2011). The plan also lists the outside events that could mimic an improvement.

Limitations

The audit covered six months at two hospitals and may not reflect seasonal variation. The tabletop test is a paper exercise; configuration could reveal problems it did not. The design depends on the operating room's barcode practice continuing. Evidence on ownership and on patient cards is limited, and the specification relies on reasoning there. Improvement reporting guidance asks that such limits be stated plainly (Ogrinc et al., 2016).

What Comes After Approval

If the sponsor schedules configuration, the first step is the supply log interface, because Carrowby implants are the largest group and their data already exist. The worklist follows, then the letter and card. A backlog of existing patients with implants will be worked by screening nurses over three months, starting with those who have MRI orders. The evaluation's run chart begins three months before go-live so that the baseline period is visible on the same chart as the result.

Reflection

The most useful step of the term was the one I nearly skipped: handing the draft to a classmate outside radiology and watching her work from it alone. It showed that my own understanding was doing work the document was supposed to do.

Recommendation

Schedule version 1.0 for configuration, beginning with the implant entry and the worklist at the larger hospital, with the evaluation plan's run chart starting three months before go-live.

Appendices

A: specification version 1.0. B: abstraction form and audit data summary. C: approval log. D: evaluation plan.

References

ASTM International. (2023). Standard practice for marking medical devices and other items for safety in the magnetic resonance environment (ASTM F2503-23). ASTM International.

Drozda, J. P., Jr., Roach, J., Forsyth, T., Helmering, P., Dummitt, B., & Tcheng, J. E. (2018). Constructing the informatics and information technology foundations of a medical device evaluation system: A report from the FDA unique device identifier demonstration. Journal of the American Medical Informatics Association, 25(2), 111-120. https://doi.org/10.1093/jamia/ocx041

Harwood, M., Fahrenholtz, S. J., Wellnitz, C. V., Kawashima, A., & Panda, A. (2024). MRI in adult patients with active and inactive implanted MR-conditional, MR-nonconditional, and other devices. RadioGraphics, 44(3), e230102. https://doi.org/10.1148/rg.230102

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Provost, L. P., & Murray, S. K. (2011). The health care data guide: Learning from data for improvement. Jossey-Bass.