Institutions that struggle with managing patient CDs from outside locations should consider taking advantage of the Integrating the Healthcare Enterprise's (IHE) Cross-enterprise Document Sharing for Imaging (XDS-I) integration profile, according to a presentation at the 2009 European Congress of Radiology (ECR) in Vienna.
"I would urge you to do away with CDs for all regular referrals," said Dr. Nicola Strickland, a consultant radiologist at Hammersmith Hospital in London. She discussed the need for XDS-I during a presentation at the meeting.
Outside CDs can lead to a host of workflow challenges. These imaging exams can be utilized in a number of ways, including being reviewed on their own or in comparison with other images on an institution's own PACS or on other CDs, she said.
They sometimes need to be uploaded to a PACS due to the patient being admitted, and they occasionally need to be re-reported if there is no report on the CD or the report can't be opened, Strickland said. An addendum sometimes also needs to be added to the report.
A number of technical problems can also occur with these outside CDs, including an inability to read the CD, Strickland said.
"And it may be that there is not a self-launching viewer and, therefore, you have a whole mass of several thousand images and no means of automatically viewing them," she said.
A wrong or incomplete study could also be burnt on the CD, and even if items are correctly included, it can still be quite slow and include a nonfamiliar graphical user interface, she said. Direct study comparison may be impossible, and uploading images to the PACS and reports to a RIS can be problematic, she noted.
Also, sites may choose to upload images to PACS for the wrong reasons, which wastes storage. These reasons include a desire for fast viewing of the images, the use of familiar software, easy image comparison, and incorporating addenda into the permanent record, she said.
"Really, the only right reason for uploading a study to PACS is that patient being transferred to your care at your hospital," she said. "It's in the patient's best interest to have them on your own PACS, because that patient will have subsequent studies and you'll need to make comparisons."
The solution
XDS-I, which provides for the cross-enterprise sharing of radiology images and reports, offers a solution to all of these problems, she said.
However, even though XDS-I has been defined by the IHE, it's not currently recognized by most PACS, RIS, and electronic patient record vendors, she said. "We need to push the vendors to include XDS-I in their equipment."
Also, XDS-I is not understood or used by the nonimaging clinical world. As a result, radiologists and information technology personnel need to educate their colleagues in other specialties on the benefits of this approach, according to Strickland.
"Otherwise, we risk having the imaging solution remain in isolation in a glorious standalone world that is not interfaced with our histopathologists, cardiologists, and so forth," she said.
Those companies that have incorporated XDS-I capability also need to continue developing these offerings to improve their practical benefit and usability, such as statistics and audit trails as well as the use of sophisticated image viewing software, she said. "[We would like to] have all of the powerful software we're used to having on our own PACS," she said.
Other work-around solutions such as the use of DICOM e-mail or DICOM push or query/retrieve can be used, but they are not typically satisfactory for high-volume work, she said. They are point-to-point and manual solutions and don't generate reports, and they also lead to information governance issues.
XDS-I allows institutions to transfer reports with images, with the ability to send back addenda to the referring hospital, Strickland said. In addition, it's as automated as possible and provides an easy option to upload images to your own PACS.
"It's up to us, the imaging community, to educate other clinicians of the need for this solution," she said.
By Erik L. Ridley
AuntMinnie.com staff writer
April 14, 2009
Related Reading
British rads blast U.K. IT initiative, April 3, 2009
IHE publishes new supplements, March 24, 2009
IHE readies extensions to PDI profile, March 9, 2009
IHE launches new domain, March 27, 2007
Testing procedure improves usability of DICOM CDs, January 22, 2007
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