The need for procedures and methodologies used in clinical information standardization is continuous, requiring the current telemedicine networks to evolve and adapt by using mature standards and guidelines as the basis for clinical documents transmitted through the network. In this work, we present a different approach for large-scale use of DICOM SR in telemedicine networks using structured vocabularies as its foundation, resulting in a reliable, efficient and data mining ready application applied in a real world telemedicine network . This approach is applied in a large-scale network where 60 physicians report daily an average of 400 reports; resulting in more than 80,000 reports written and stored in the last nine months. We conclude that the use of this approach can reduce eventual syntax or conceptual mistakes by using proper structured vocabularies in addition to DICOM SR.

Background: A growing use of telemedicine has been observed, especially as regards the sending and evaluation of electrocardiograms (ECG); this is a low-cost procedure with a high potential to save lives.

Introduction: Large-scale asynchronous telemedicine networks can offer a unique opportunity for the acquisition of detailed epidemiological information if the data are acquired and handled in an appropriate way. In this work, an approach is presented for the integration of medical reports in the Digital Imaging and Communications in Medicine (DI-COM) Structured Reporting standard in telemedicine networks using structured vocabularies. Materials and Methods: The use of these structured vocabularies is extended beyond radiology, and a case study in telecardiology is presented. The approach was applied in the context of a real-world statewide public telemedicine network; nowadays on average 470 written electrocardiographic structured reports daily are being performed. Cardiologists provided more than 220,000 written structured reports, and these reports are stored into a central database. Results: This study was performed during a 12-month period, and it was possible to examine possible associations between a list of co-morbidities and cardiac risk factors with a diagnosis that indicates the presence of cardiac ischemia, cardiac injury, or possible necrosis by using DICOM Structured Reporting. Our application is responsible for coordinating the process of issuance of reports through various technologies and devices. The system works as a library in an HTTP server, which accesses information from studies in DICOM format from the database and from structured vocabularies. Conclusions: Results indicate that traceability of morbidity, diagnoses, and patient clinical information can be achieved, resulting in an efficient data mining-friendly framework. A multidevice application for Web-based and smartphone-based platforms showed that it is a viable solution for applying the DICOM Structured Reporting standard in telemedicine networks.