Exam Processing Rules User Guide

Exam Processing Rule 

A configurable rule that triggers automated actions on incoming exams when specified conditions are met. Previously called an Order Processing Rule (OPR).

Condition  

The criteria an incoming exam must meet to trigger a rule. Conditions evaluate a DICOM tag or HL7 field against a specified value. 

Action 

What happens when a condition evaluates to true. Options include Set Value or Normalize. 

Procedure Normalization 

The process of matching an incoming exam to a standard exam code (e.g., a Global Exam Code) to ensure a consistent look and feel across the platform. Original values are preserved for outbound communication. 

Client Exam Code 

The original exam code received in the DICOM or HL7 message. 

System Default Exam Code 

The standardized global exam code associated with an exam within the platform. 

RegEx (Regular Expression) 

A pattern-matching syntax used in Normalize rules. The platform contains a set of built-in RegEx rules to automatically determine exam codes. 

Groups / Subgroups 

Organizational containers for rules. Groups can have their own conditions, so rules inside only apply when the group condition is met. 

Custom Order Tag 

A tag applied to an exam for filtering and display purposes. Does not affect exam workflow. 

Default Order Tag 

System-defined tags that drive specific workflows (e.g., Default Template, PC Process, Skipped). 

Add Tag (Action) 

A rule action that applies a custom order tag to an exam when the rule conditions are met. Tags are used for filtering and display in the Orders list. Multiple Add Tag rules can apply to the same exam. Unlike Set Value, Add Tag rules can fire for all DICOMs received for an order, not just the first. 

Trigger on DICOM Updates 

A per-rule checkbox that, when enabled on a DICOM-based rule, allows the rule to re-evaluate when a new DICOM series is received for an existing exam (at least 60 seconds after the previous series). Only applies to DICOM-based rules. 

Exam Processing Rules are enabled or disabled at the facility level. Rules will only execute when the Exam Processing toggle for the facility is set to ON. Configured rules have no effect if this setting is disabled.

Rules are evaluated from top to bottom in the order they appear in the rule list. Important behaviors to understand: 

• First match wins for the same field: If one rule successfully sets a field (e.g., System Default Exam Code), no other rules for that same field will apply to that exam. 
• Multiple fields can be set: Different rules can set different fields on the same exam. For example, one rule can set Priority while another sets the Exam Code. 
• Group conditions must be met first: Rules inside a group are only evaluated if the group's own conditions evaluate to true. 
• Rule status must be ON: Rules with their status toggle set to OFF are skipped, even if their conditions would match. 
• DICOM trigger scope: By default, DICOM-based rules evaluate when the first DICOM is received for an exam. Rules with the Trigger on DICOM Updates checkbox enabled will also re-evaluate when a new DICOM series arrives at least 60 seconds after the previous series. Rules will not re-fire for new images added to an existing series, for exams that are reported or locked, or for exams in Completed status. 
• Field-lock protection: If a user has manually edited a field on an exam (e.g., Priority or Status), subsequent OPR triggers will not overwrite that field. The Add Tag action is always permitted regardless of field locks. 

When defining condition details, the following syntax applies: 

"value" 

Strings must be wrapped in double quotes. Example: "chest" 

* 

Wildcard character. Example: "thora*" matches "thorax" and "thoracic" 

|| 

Logical OR. Example: "chest" || "thora*" matches any of these values 

&& 

Logical AND. Both conditions must be true. 

Field: DICOM tag 0008, 1030 (Study Description) 

Condition: Contains 

Details: "chest" || "thora*"  →  Matches "chest", "thorax", or "thoracic" 

Before configuring a rule, review your incoming HL7 messages or DICOM metadata to identify the field values you want to use as triggers. 

Ask yourself: What consistent field values in the incoming data should cause an automated action? 

Example: If all exams with a specific insurance value in HL7 field IN1.4 should receive a specific tag, that field becomes your condition trigger. 

Open the correct facility settings to access the Exam Processing tab:

• Go to the Accounts tab in the platform.  
• Open your Group, then select the Facility where the rule should apply.  
• Click the Exam Processing tab within the facility. 

Before you begin: Confirm the Exam Processing toggle for the facility is enabled. Rules will not execute unless this is turned ON. 

Start creating a new rule from the Exam Processing tab:

• Click  "Add Rule" at the top of the page, or within the group header where the rule should be organized.

A new rule row will appear. Click "Add Condition" within the new row to begin defining the rule criteria

Define what criteria must be met for the rule to fire: 

• Select the source type: Choose HL7 or DICOM using the radio button.
• Select the field or tag: Choose the relevant HL7 field or DICOM tag from the dropdown. If the needed field is not listed, select Custom to enter it manually.
• Choose a Condition Type: Options include Contains, Equal To, Starts With, Does Not Contain, or Date. 
• Enter the condition details: Type the value(s) to match, using the syntax rules described earlier (quotes, wildcards, ||, &&). 
• Add more conditions if needed: Click "Add Condition" to add additional criteria for the same rule. All conditions must be met for a rule to trigger.
• Click "Add Conditions": Save conditions and return to the rule list.

Date Condition Details : When the condition type is Date: specify the number of days (0–999) and whether the date is More or Fewer days from the current date. 

Specify what should happen when the condition is met:

• Open the Action dropdown in the rule row and select one of the following:

Set  

Directly sets an exam attribute. Available attributes: System Default Exam Code, Priority, Status, or Read Type. 

Normalize 

Uses the built-in RegEx rules to automatically assign a standard exam code. If no match is found, the exam continues through subsequent rules. 

Add Tag 

Applies a custom order tag to the exam. Select an existing tag from the dropdown or enter a new tag name. Multiple Add Tag rules can apply to the same exam. If the tag already exists on the exam, the rule is skipped. 

• If using Set: Click "Add Result" and choose the attribute to set (e.g., System Default Exam Code) and its value. For exam codes, a search dialog will open to select the appropriate code. 
• If using Add Tag: Select the custom tag to apply to the exam.
• Auto-save: The rule saves automatically once all required values are provided. 

Before the rule goes live, confirm the following: 

• Rule status is ON: Check that the status toggle for the new rule is enabled.
• Facility Exam Processing is ON: In the right panel, verify the facility-level Exam Processing setting is enabled. Rules will not fire without this. 
• Clone from other facilities if needed: Use "Clone Rules From..." To completely replace the current list of rules with the list of rules from another facility within the facility group. 

Best Practices:

• Test the rule with sample orders before going live. 
• Review rule order carefully — rules evaluate top to bottom and the first match wins for the same field.
• Use Groups to organize rules by modality, facility type, or workflow to keep the list manageable. 
• Revisit rules periodically as workflows and HL7/DICOM data patterns evolve.

Rules can be organized into nested Groups and Subgroups. This is especially useful when managing large numbers of rules. Groups can also carry their own conditions — for example, requiring that Modality equals "CT" — so that all rules within the group are only evaluated for CT exams. This speeds up rule processing and keeps administration clean. 

When you select the Normalize action, the platform uses a built-in library of RegEx (regular expression) rules to determine the appropriate System Default Exam Code based on the incoming exam description and modality. This provides a consistent exam code assignment without needing to manually enumerate every possible client exam code.

Key behaviors of Normalize rules:

• If a matching exam code is found, the exam code, modality, region, and procedure type are all updated to match. 
• If no match is found, the exam continues through subsequent rules — a later Set Action rule may still assign a code. 
• Only one rule can set the exam code for a given exam. Once set (by either Normalize or Set Action), all other exam code rules are skipped. 
• Normalize rules work with both DICOM tag and HL7 field conditions. 
• For HL7, the platform uses OBR.4.2 (Exam Description) and OBR.24 (Modality) to find the correct code. OBR.24 may be a comma-delimited list of modalities. 
• For DICOM, the platform uses 0008, 0060 (Modality) and 0008, 1030 (Study Description) to find the correct code. 

When an HL7 ORU message is received and matches an Exam Processing Rule that sets the status to Completed, the platform will:

• Create the exam in Completed status if no matching exam exists in the system. 
• Move the exam to Completed if the exam is currently in Unmatched status. 

Images can still be added to Completed exams after the fact. 

Custom tags and tasks can be applied to exams via Exam Processing Rules using the Add Tag action. These tags are used exclusively for filtering and display in the Exams list — they do not affect exam workflow. All custom tags are visible at the Facility Group level under Accounts → FG → Tags and Tasks. 

When configuring a rule with the Add Tag action: 

• In Step 5, select Add Tag from the Action dropdown, then click Add Result. A Tag dropdown appears listing all existing custom tags and tasks for the facility group, sorted alphabetically. 
• Select an existing tag from the dropdown. Click Add Result to save. 
• The selected tag name is displayed in the Result column of the rule list. 

• Add Tag rules can fire on: the first DICOM received, the first HL7 received, additional DICOMs received after order creation (when the Trigger on DICOM Updates checkbox is enabled), and HL7 updates received after order creation (as long as the exam is not in Completed status).

• Multiple Add Tag rules can apply to the same exam, resulting in multiple tags being added. The first-match-wins restriction does not apply to Add Tag rules. 
• If the tag specified by a rule already exists on the exam, the rule is skipped — duplicate tags are not applied. 
• Each tag application is recorded in the exam’s Audit Trail with the message: [Tag Name] tag added to order by Exam Processing rule [ID]. 
• Once a tag has been used in a rule, it becomes available as a Tags or Tasks filter option on the Exams list and in the Configure Presets admin tool. 
• When a user with access to multiple facility groups filters the Exams list by tag, the facility group name is shown after the tag name to distinguish tags with the same name across different facility groups (e.g., "AI Finding (Facility Group A)" vs. "AI Finding (Facility Group B)"). 

By default, DICOM-based rules only evaluate when the first DICOM is received for an exam. The Trigger on DICOM Updates checkbox on individual rules extends this behavior to allow re-evaluation when new DICOM series are received post-order creation. This is the mechanism that enables AI product integrations and any other workflow that depends on data arriving in a second or later DICOM transmission. 

• A new DICOM series is received at least 60 seconds after the previous series for the same exam. 

• The first DICOM arrives for an exam that was originally created from an HL7 message (i.e., HL7 created the exam, DICOM arrives later).

• A new image is added to an existing series (not a new series). 

• A new series arrives less than 60 seconds after the previous one (treated as part of the same transmission). 
• The exam has been reported (read type is Final). 
• The exam is locked by a user. 
• The exam is in Completed status. 
• The modality is not valid per DICOM checker logic. 

When rules re-fire due to subsequent DICOM series, a field-lock mechanism prevents OPRs from overwriting fields that a user has manually edited. If a user has manually changed a field such as Priority or Status, subsequent OPR triggers will skip updating that field, while still applying any other field changes and all Add Tag actions. This protects intentional manual corrections from being reversed by later DICOM arrivals. 

The rule list includes search fields beneath each column header. Key search behaviors:

• Search is not case-sensitive. 
• Searching by Condition will match on the tag/field name, the condition type, or the details — including conditions on parent groups. 
• Searching by Result will match on the result attribute or result value. 
• When a rule is found, its parent group and subgroup are also displayed. 
• Filtered views automatically expand all groups and subgroups. Rule reordering is disabled while a filter is active.

Enable Exam Processing 

Accounts → Group → Facility →  Toggle ON 

Add a New Rule 

Click "Add Rule" in the Exam Processing tab 

Set an Exam Code 

Action: Set → Result: System Default Exam Code → Search and select exam code 

Auto-assign Code via RegEx 

Action: Normalize (no result needed) 

Manage Custom Tags and Tasks 

Accounts → FG → Tags and Tasks 

Copy Rules to Another Facility 

"Clone Rules From..." option within the target facility 

Search Existing Rules 

Use the search fields below each column header in the rule list 

Apply a Custom Tag via Rule 

Step 5: Action → Add Tag → Add Result → select tag name 

Re-trigger Rule on New DICOM Series 

Enable the "Trigger on DICOM Updates" checkbox on the rule (DICOM-based rules only). Rule will re-evaluate when a new series arrives ≥60 seconds after the previous one.