Report Linking

Link and unlink related reports that share the same Medical Record Number (MRN) to create a unified reporting workflow across multiple studies.

Requires your administrator to enable Enable Report Linking under Integration Settings.

Overview

Report Linking enables radiologists to combine multiple reports for the same patient (matched by MRN) into a unified group with shared content. This is particularly useful when:

• Multiple imaging studies are performed for the same clinical encounter

• A follow-up study needs to reference prior findings

• Related procedures need to be reported together

Where to Find It

• Sidebar: The Linked Reports section displays all currently linked reports for the active report

• Toolbar: The Link Reports button opens the linking dialog to manage report associations

Core Concepts

Report Groups

When you link two or more reports together, the system creates a Report Group with:

• Shared content: Transcript, final report, metadata, and drafting status are synchronized across all linked reports

• Shared ownership: One radiologist owns the entire group; ownership changes apply to all reports

• Shared workflow state: Status changes (draft, signed, etc.) affect all reports simultaneously

• Individual identity: Each report maintains its unique identifiers (Accession Number, Order ID, Site ID)

Default Report

The first report in a group becomes the default report, which:

• Serves as the primary entry point for the group

• Receives event notifications and workflow actions

• Can be changed if needed

Linkable Status

Reports can only be linked or unlinked when they have these statuses:

• unread (newly created, not yet opened)

• draft (currently being worked on)

• cancelled (no longer active)

Signed or finalized reports cannot be modified to prevent breaking audit trails.

Linking Reports

Basic Workflow

1. Open any report in the editor

2. Click the Link Reports button in the toolbar

3. Select one or more reports from the list of available reports with matching MRN

4. Close the dialog to apply changes

The system immediately:

• Creates a report group (or expands an existing one)

• Synchronizes all shared content

• Opens the linked report automatically (triggers an "opened" event)

What Gets Shared

When reports are linked, these fields become shared across the group:

• Transcript: The dictation content

• Final Report: The formatted output

• Metadata: Clinical history, views, contrast, laterality, comparison, study date/time

• Status: Current workflow state (draft, signed, etc.)

• Drafting state: Whether the report is actively being edited

• Ownership: Which radiologist is assigned

What Stays Individual

Each report retains its unique:

• Report ID

• Accession Number

• Native ID and Assigning Authority

• Order ID

• Site ID

• Created/updated timestamps

• Study and template associations

Advanced Linking Scenarios

Merging Existing Groups

If you link a report that's already part of Group A to a report in Group B:

• The system merges both groups into a new combined group

• All reports from both groups are linked together

• The first report from the original request becomes the default

Adding to an Existing Group

If you link new reports to one that's already in a group:

• The new reports join the existing group

• Existing content is preserved

• The default report remains unchanged

Overlapping Selections

If you try to link reports that are already linked:

• The system detects the overlap

• Only new reports are added to the group

• You'll see an error if all selected reports are already linked

Unlinking Reports

Basic Workflow

1. Open any report in the linked group

2. Click the Link Reports button

3. Uncheck the reports you want to separate

4. Close the dialog

What Happens

When you unlink reports:

• Shared content separation: Unlinked reports keep a copy of the shared content at the moment of unlinking

• Ownership preserved: User assignments are copied to individual reports

• Group dissolution: If you unlink all reports, the group is completely removed

• Event tracking: An "unlinked" event is recorded for audit purposes

Unlink with Discard (API Only)

When using the API /unlink endpoint with unassign_and_discard: true:

• Reports are unlinked AND unassigned from their owner

• Content is discarded back to the last saved snapshot

• Useful for returning reports to the worklist after incorrect linking

Integration with Report Recall (Oops Factor)

When you sign a linked report group with Report Recall enabled:

1. Scheduled Publishing: All reports in the group are scheduled for publication after the recall delay period

2. Group-Level Scheduling: One schedule applies to the entire group (not individual reports)

3. Cancellation: If you cancel the scheduled publish, all reports return to draft state together

4. Immediate Override: You can bypass the timer and publish immediately if allowed by org settings

5. Unlocking: After signing, you can still unlock and edit the group before the timer expires

See Report Recall (Oops Factor) for more details on delayed publishing.

Ownership and Access Control

Single Owner Model

• Only one radiologist can own a report group at a time

• Opening any report in the group assigns you as owner (if unassigned)

• Attempting to open a report owned by another radiologist shows an error

Ownership Transfer

When ownership changes (via assignment or user selection):

• The new owner is set on the shared group

• All individual reports are updated to match

• Previous owner receives a notification (if enabled)

• An ownership change event is recorded

Permission Checks

The system enforces permissions at the group level:

• Sign permissions are checked against the group owner

• Only authorized users can prelim sign, final sign, or add addendums

• Multi-author workflows respect individual report ownership rules

Report Status Workflow

Allowed Transitions

Linked reports follow these status transitions as a group:

From Status	To Status
Unread	Draft, Cancelled
Draft	Unread, Prelim Signed, Signed, Cancelled
Prelim Signed	Signed, Addendum Prelim Signed
Signed	Addendum Signed
Addendum Prelim Signed	Signed, Addendum Prelim Signed (new addendum)
Addendum Signed	Addendum Signed (new addendum)

Status Synchronization

All reports in a group share the same status:

• Signing one report signs all reports in the group

• Draft changes affect the entire group

• Cancelling one report cancels all (and unlinks them automatically)

Automatic Actions

On Cancellation

When you cancel a report in a linked group:

1. The report is automatically unlinked from the group

2. Status is set to cancelled

3. Remaining linked reports stay grouped

On Discard

When you discard changes to a linked report:

1. The report reverts to its last saved state

2. If the report is linkable, it's automatically unlinked

3. Content is restored from the most recent snapshot

On Sign with Addendum

When signing a signed report (creating an addendum):

• Org settings may automatically clear the final report content

• An addendum header may be automatically inserted

• These actions apply to the entire group

Display and Identification

In the Sidebar

The Linked Reports section shows:

• Each report's Accession Number

• Study Name (e.g., "CT Chest with Contrast")

• Created On date

• Click to view details

Hover for Details

Hovering over a linked report reveals additional identifiers:

• Medical Record Number (MRN)

• Order ID

• Site ID

• Native ID and Assigning Authority

In the Linking Dialog

Available reports display:

• Badges indicating how many additional reports can be linked

• Study information for context

• Disabled state if reports cannot be linked (e.g., already signed)

Event Tracking

The system records events for audit and integration purposes:

Event Type	When It Occurs
report.linked	Reports are successfully linked into a group
report.unlinked	Reports are separated from a group
report.owner_changed	Ownership is transferred (includes linking side effects)
report.opened	Linked group is opened (after linking completes)
report.published	All reports in group are published together
report.publish_cancelled	Scheduled publication is cancelled

Events include:

• Affected report identifiers

• Group ID

• Report IDs

• Timestamps

• Action metadata

API Endpoints

See Iframe integration guide for more detailed API specifications

Limitations and Constraints

What Cannot Be Linked

• Reports with different MRNs cannot be linked

• Reports without an MRN cannot be linked

• Signed or finalized reports cannot be linked

• Cancelled reports can only be unlinked (not added to groups)

• Addendum reports follow special rules based on base report status

Minimum Requirements

• At least two reports are required to create a link

• All reports must belong to the same organization

• All reports must have the same MRN

Database Constraints

The system enforces uniqueness across these identifier combinations:

• Accession Number

• Native ID + Assigning Authority

• Order ID

• Site ID

• MRN

• Organization ID

This prevents accidental duplicate report creation.

Tips and Best Practices

Before Linking

• Verify the MRN matches across all reports

• Ensure all reports are in the correct organization

• Check that reports aren't already finalized

• Review existing content before merging groups

During Linking

• Link related studies in chronological order when possible

• Use the default report (first in group) as your primary workspace

• Save your work frequently when editing linked groups

When to Unlink

• If reports were linked by mistake

• If a study was incorrectly associated with a patient

• If organizational policy requires separate reports

• Before transferring individual reports to different radiologists

Integration Workflows

• Linking triggers the report.opened event by default

• Use trigger_open_event: false to suppress this during bulk operations

• Monitor webhook events for report.linked and report.unlinked to sync with RIS/PACS

• Check linked_identifiers in webhook payloads to update external systems

Coordination

• Communicate with your team before making bulk linking changes

• Unassign reports before linking if they're owned by different users

• Be aware that signing affects all reports in a group simultaneously

Troubleshooting

"No reports available to link"

Cause: No other reports exist with the same MRN, or all matching reports are already linked or not linkable.

Solution: Verify the MRN is correct and that other studies exist for this patient.

"No linked reports"

Cause: The current report isn't part of a group yet.

Solution: Select one or more reports from the available list and close the dialog to link them.

"Cannot link report X with status Y"

Cause: One or more selected reports have been signed or finalized.

Solution: Only reports in unread, draft, or cancelled status can be linked. Unlock signed reports first if allowed.

"Reports belong to different groups"

Cause: You're trying to unlink reports that are in different groups simultaneously.

Solution: Unlink from one group at a time, or link the groups together first, then unlink specific reports.

"Report not owned by user"

Cause: Another radiologist currently owns the linked report group.

Solution: Have the current owner save and close the report, or contact an administrator to reassign it.

Controls Disabled

Cause: The report is in a non-linkable state (e.g., locked, finalized, or scheduled for publication).

Solution: Check the report status and recall schedule. Cancel any pending publications or unlock the report if possible.

"All specified reports are already linked"

Cause: You attempted to link reports that are already in the same group.

Solution: No action needed. The reports are already grouped together.

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