Radiology

A critical finding on Aparna Iyer's CT Chest report (study RAD-ACC-1-2, order RAD-ORD-1-2) was assigned to Dr Sravan. On the doctor's My Day page it appears under Needs you now with a red Critical badge. From there, the doctor needs four clicks to see the impression, and none of the screens on the way has an Acknowledge button. The Inbox shows the item as a normal "Imaging report ready" with a blue Review tag, with "0 urgent" in its header. The Acknowledge button exists only on the Radiology → Finalised Reports page, which a doctor may not be able to use. A critical result should reach the doctor clearly, and the doctor should be able to acknowledge it where they see it.

Environment: https://vvmc.test.clinq.health (Vetri Vivega Medical Center, test tenant), build v2026.10.4 Module: Doctor workspace (My Day, Inbox & Results, Patient Record) and Radiology → Finalised Reports / Critical Findings Example: Aparna Iyer (VVMC-000098, 66F), CT Scanner 1, "Test Impression", RAD-ACC-1-2, assigned to Dr Sravan Doctor account: sravanvaimely@gmail.com Reported by: Roshni Harish (roshni.h@expericia.com) Date: 8 Oct 2026 How this was checked: signed in as Dr Sravan and followed the path below, only reading. I did not click Acknowledge, Mark all read or Batch sign, and did not change anything.

Steps to reproduce
As admin or radiologist, flag a finding as critical on a final report (here Aparna Iyer's CT Chest) and choose the doctor to notify (Dr Sravan).
Sign in as that doctor.
On My Day, click the item under Needs you now (Aparna Iyer, "CT Scanner 1 · Test Impression", Critical).
On Inbox & Results, click the item "Imaging report ready".
In the small dialog, click Open record.
In the Patient Record, open the Imaging tab and click the study RAD-ACC-1-2.
Actual result
My Day: the item shows a red Critical badge. Clicking it opens the Inbox list, not the result.
Inbox & Results: the item is "Imaging report ready" with a blue Review tag. The header says "0 urgent · 0 awaiting your signature · 1 total". Batch sign and Mark all read look greyed out.
Tabs: All and Needs action both show the item. Done is empty.
Dialog on the item: it shows only "Aparna Iyer, CT Scanner 1 · RAD-ACC-1-2 · Test Impression" and an Open record button. It does not say the result is critical, and there is no Acknowledge button.
Patient Record: it opens on the Snapshot tab, with no critical-result alert or banner on it. The Imaging 1 tab lists RAD-ACC-1-2 with a red Critical badge.
Study dialog (Imaging tab): it shows "CT Scanner 1 · RAD-ACC-1-2, Reported 8 Oct 2026, 13:46, Critical, Test Impression". There is no Acknowledge button, no name of the radiologist or of who flagged it, and no finding text beyond the one-line impression.
Also noticed
Counts disagree. On My Day the briefing says "1 results awaiting your signature", and the Review & sign card says "1 awaiting you". The Inbox says "0 awaiting your signature" and "0 urgent".
The item may never reach Done. It is under Needs action, but there is no Acknowledge or Sign action on it, so I can't see how it would ever move to Done.
Acknowledged, but still open for the doctor. The Finalised Reports page (admin view) shows Aparna Iyer's report as "Acknowledged · 1 min", but the doctor's screens still list it as needing attention (Critical in Needs you now, and "Review" in the Inbox). I can't tell from the screenshots who acknowledged it, or whether the doctor's list updates after it.
An older critical result is not on the doctor's list. Roshni Harish's report (7 Oct) shows "Notify Sent" with an Acknowledge button still waiting, about a day later, with no sign of escalation. The Needs you now heading says it "includes hospital-wide critical results", but only Aparna Iyer is listed. The Roshni Harish result may be assigned to another doctor or may not be critical. I haven't checked.
The Radiologist column is blank for both finalised reports, and both show "Reported By: admin@clinq.local".
How it should behave (for the developer)

1. Life of a critical result

A critical result moves through these states, and every screen shows the same state:

Flagged: the radiologist (or lab) marks the finding as critical and picks the doctor to notify.
Notified: the system sends the notification to that doctor (and records the time).
Acknowledged: the doctor confirms they received it. The system records who, when, and an optional note on the action taken.
Closed (optional): the doctor records the action taken, or the result is closed by the doctor after follow-up.
Escalated: if it is still not acknowledged after the time the hospital sets, the system alerts a second person (for example another doctor or the department head) and shows the result as overdue.
2. What the doctor sees
My Day, Needs you now: the critical item shows the patient, test, finding summary, "flagged by" and "how long ago". Clicking it opens the result itself, not the Inbox list.
The result view (one screen, no extra clicks) shows: patient name, age and MRN, study and time, the full impression and findings, who flagged it and when, and the radiologist's name. A clear Acknowledge button is at the top or bottom of this view.
Acknowledge dialog: one required confirmation ("I have read this critical result") and one optional text box ("Action taken"). On Save, the doctor's name and the time are stored. The doctor can't acknowledge on behalf of another doctor.
After acknowledging: the view shows "Acknowledged by Dr Sravan at hh:mm" with the note. The item moves to Done in the Inbox. The Needs you now count and the other counts go down straight away.
Patient Record: while the result is not acknowledged, the Patient Record shows an alert banner at the top (for example "Unacknowledged critical result: CT Chest, 8 Oct 13:46"), linking to the result. The Imaging tab row also gets the Acknowledge button.
3. Inbox & Results
All: everything routed to the doctor, with critical and urgent items first.
Needs action: items that still need the doctor to do something (acknowledge, sign or review). Critical results always appear here until acknowledged.
Done: items the doctor has acknowledged, signed or reviewed, newest first. It is empty only when nothing has been handled.
Header counts: "urgent" includes unacknowledged critical results. "Awaiting your signature" counts items that need a signature. Both numbers are the same on My Day, in the Review & sign card and in the Inbox.
Mark all read: marks items as read, which clears the unread dot only. It must not acknowledge, sign or close anything. It must skip unacknowledged critical results, which stay unread until acknowledged. If there is nothing unread, the button is disabled.
Batch sign: signs the selected routine items (for example normal lab results) in one go, with a checkbox on each row and a confirmation. It must not include critical results, which are acknowledged one at a time. It is disabled when nothing is selected or nothing needs a signature.
Row tags: a critical row shows a red Critical tag and the action Acknowledge (not Review). A normal report shows Review or Sign.
4. What radiology sees
Radiology → Finalised Reports and Critical Findings show the same state for each critical result: Notified, Acknowledged (by whom, when, and how long it took), or Overdue.
When the doctor acknowledges, the radiologist who flagged it gets a notification.
An unacknowledged result shows how long it has been waiting, and turns red after the hospital's time limit.
5. Counts and dashboards
One source of truth for every count (My Day, Inbox, Review & sign card, Radiology Dashboard "Critical findings" card).
The Radiology Dashboard card "open" count equals the number of unacknowledged critical results. It goes down when the doctor acknowledges.
6. Escalation and settings
The hospital sets the acknowledgement time limit, and who is notified next if the limit is passed (in Admin settings).
Reminders go to the doctor before the limit. Overdue results show in the radiology team's view.
7. Permissions and audit
Only the doctor the result was assigned to (and the person they delegate to, if the hospital allows it) can acknowledge it.
Every step (flagged, notified, acknowledged, escalated, closed) is written to the audit log with the person, the time and the note.
8. How to know it is fixed (checks for the tester)
Flag a finding as critical and assign Dr Sravan. The Inbox header shows 1 urgent, and the row has a red Critical tag and an Acknowledge action.
Clicking the item in Needs you now opens the result directly, with the full finding, the radiologist's name and an Acknowledge button.
Acknowledge with a note. The row moves to Done, all counts drop, the Patient Record banner disappears, and Radiology shows "Acknowledged by Dr Sravan at hh:mm".
With a critical result still unacknowledged, Mark all read leaves it unread and Batch sign can't select it.
Leave a critical result for longer than the time limit. It is shown as Overdue, and the next person is alerted.

Should the doctor acknowledge it?

Yes, it is good practice. A critical result should be a closed loop: the lab or radiology team flags it, the responsible doctor confirms they received it, and the system records the name and the time. Without that record, the hospital can't show that a critical result reached anyone. Acknowledging should not replace the doctor acting on the result, so a short "action taken" note is useful. The hospital sets the acceptable time to acknowledge and what happens if it is missed. This is a general practice point and not a legal or accreditation opinion.

Why it matters

A critical finding is a patient-safety event. If the doctor sees it as an ordinary report, or can't acknowledge it where they see it, it can sit unread, and the radiology team can't tell whether it was received. The doctor also has to click through four screens to read a one-line impression.

Priority

Medium to High. It is an enhancement, but it concerns critical results and patient safety, and the screens disagree about the same result.