Order lifecycle

ordered → scheduled → performed → read → reported, and what breaks between each step.

Generic domain reference (backlog E5.1). Site-specific system names come from the site profile, not from here — if you’re answering a user, cite which parts of this you’re grounding generically vs. from their profile.

Depth 1 — one line

An imaging order moves from ordered to scheduled to performed to read to reported, and each stage has a status that other systems key off of.

Depth 2 — the stages

Ordered. A referring provider (or the EHR on their behalf) creates an order. This is where the order number is assigned.
Received. RIS receives the order — either entered directly or via an interface from the EHR (see topology-patterns.md). This is typically where the accession number is assigned, distinct from the order number (see accession-vs-order-number.md).
Scheduled. The order is matched to a modality, room, and time slot. Scheduling failures here are a common “order exists but nobody can find it” symptom.
Published to modality worklist. The scheduled order becomes visible to the imaging modality as a worklist entry (see modality-worklist.md) — this is the step a broken RIS-to-PACS/modality interface most visibly breaks.
Performed. The technologist executes the study; images are acquired and sent to PACS. Order status updates to reflect this.
Read. A radiologist reads the study, typically via PACS, sometimes using a dictation platform.
Reported. The report is finalized and released — usually back through RIS, and often back out to the EHR the order originated from.

Depth 3 — where it breaks, and what that looks like

Order stuck at “received,” never scheduled. Usually a scheduling rule or a missing modality/resource mapping — not typically an interface problem.
Order scheduled but never reaches the modality worklist. Classic interface symptom — the RIS-to-PACS (or RIS-to-modality) interface is down or queuing. This is the single most common overnight ticket shape.
Study performed but report never appears in the EHR. Look at the far end of the pipeline — report release from RIS, or the outbound interface back to the EHR — not the imaging side.
Order exists in EHR, not in RIS at all. The inbound order interface (EHR-to-RIS) is the first thing to check, before assuming a RIS configuration problem.

Each of these maps onto a differential branch in the triage skill — this document is what a triage differential’s “RIS configuration vs. interface vs. PACS” branching is actually reasoning about.

Depth 2 — the stages

Ordered. A referring provider (or the EHR on their behalf) creates an order. This is where the order number is assigned.

Received. RIS receives the order — either entered directly or via an interface from the EHR (see topology-patterns.md). This is typically where the accession number is assigned, distinct from the order number (see accession-vs-order-number.md).

Scheduled. The order is matched to a modality, room, and time slot. Scheduling failures here are a common “order exists but nobody can find it” symptom.

Published to modality worklist. The scheduled order becomes visible to the imaging modality as a worklist entry (see modality-worklist.md) — this is the step a broken RIS-to-PACS/modality interface most visibly breaks.

Performed. The technologist executes the study; images are acquired and sent to PACS. Order status updates to reflect this.

Read. A radiologist reads the study, typically via PACS, sometimes using a dictation platform.

Reported. The report is finalized and released — usually back through RIS, and often back out to the EHR the order originated from.

Depth 3 — where it breaks, and what that looks like

Order stuck at “received,” never scheduled. Usually a scheduling rule or a missing modality/resource mapping — not typically an interface problem.

Order scheduled but never reaches the modality worklist. Classic interface symptom — the RIS-to-PACS (or RIS-to-modality) interface is down or queuing. This is the single most common overnight ticket shape.

Study performed but report never appears in the EHR. Look at the far end of the pipeline — report release from RIS, or the outbound interface back to the EHR — not the imaging side.

Order exists in EHR, not in RIS at all. The inbound order interface (EHR-to-RIS) is the first thing to check, before assuming a RIS configuration problem.