<title>Automated results notification system for PACS</title>

Abstract

Purpose: The purpose of this study was to determine if the interval between an examination being ordered by an Emergency Department physician and his or her review of the report and images could be shortened by notifying the physician that the results were available. This hypothesis was based on work done previously in the Medical Intensive Care Unit that showed that physicians would wait to review results for a time considerably longer than the time required for the radiologist to review the images and provide a preliminary report [1,2].Methods: Various notification methods were proposed and reviewed with the Emergency Department physicians, but the simplest was thought to be pager notification. The PACS that the Radiology Department uses (General Electric Medical Systems, Milwaukee, WI) has a prototype feature that allows a change in examination status to trigger the sending of a pager message. The interface used between the PACS and RIS (IDXrad, IDX Corporation, Burlington, VT) provides for notification of the PACS by the RIS when an examination status changes (as from "completed" to "dictated" through a radiologist's dictation of a report). The PACS also provides a facility that allows a radiologist to enter a short report. This report is analogous to the one formerly written onto cards and placed on the multiviewer with the films. The paging feature was modified to page the physician who ordered the examination (another data item sent by the RIS) and to send the short report. The Emergency Department physicians carry alphanumeric pagers that will display this report when the page is received. Recent transition to speech recognition (TalkTechnology) required some modification of the software since many radiologists have stopped typing in the short report because of the rapidity with which the full report is made available. The software developed extracts the "impression" section of the report and sends that with the pager message, so as to avoid overfilling the pager text buffer.Results: The software developments operate properly and show that even simple integration of multiple information systems (PACS, RIS, speech recognition) can provide useful features. Early results indicate that the Emergency Department (ED) physicians prefer the notification system over the previous (travel to check on images and reports) methods. The hypothesized time reductions did occur, though it is not clear that the notification system accounted for all of them.Breakthrough work: With increased emphasis on integration of information systems in medical imaging, the work the authors have done showed that even fairly simple integration, in this case of the speech recognition, RIS, and PACS, could be used to automate previously manual (telephone, written record, film multiviewer) procedures. The software and systems for this application operate automatically. Conclusion: A system for automated notification of radiology results availability has been shown to be possible and practical. To do this required automated interaction of thre...

Modifying Clinicians Use of PACS Imaging

“…This has been noted in previous studies which have proposed that an appropriate "flag" may be required in order to alert clinicians. [10,12,17,25,26] Overall, the comments from participants were very positive and participants consistently commented that they felt that the notification system was very beneficial especially with regard to optimising time efficiency. None of the participants felt that the notification was either detrimental or intrusive and many stated that they felt more confident knowing that they were going to be "reminded" about an investigation that they may have requested a number of hours previously.…”

Integrating Multiple Clinical Information Systems using the Java Message Service Framework to Enable the Delivery of Urgent Exam Results at the Point of Care

“…The 14.9-min reduction in the mean time to results encounter was the largest of the three metrics; however, this difference was not found Breakdown of ED residents' access methods for wet-reads during the PDA evaluation period. The percentages indicate the amount of the time they felt they used a specific means for obtaining wet-reads 0% 1Y25% 26Y50% 51Y75% 76Y100% PDA 3 3 1 2 PACS 2 7 Printouts 7 2 Other comments (both positive and negative) regarding the wet-read PDA application (1) I actually like to view the films (2) Great when worked (3) I always want to look at the actual films, so using wet-read PDA was best at notifying me that readings are actually available (4) Not as useful as you still need to see the actual film (2) Yes, orders could be on them and nurses could use them (3) Yes (4) Yes, but better in inpatient setting (5) This can potentially be used by the nursing staff, however, it may be more practical if the patient list can be customized to only those for whom the nurse cares be statistically significant (0.063). This detail can be explained by the large variances of both datasets (SD = 104.8 and 54.6 for the fax and PDA periods, respectively; see Table 1) caused by a number of Boutliers^.…”

“…Additionally, the wet-read module contains a quality assurance (Q/A) component for tracking the performance of residents and fellows who generate wetreads during on call readout. Because it has been shown that the use of mobile computing technologies can facilitate the communication of radiological exam results to the requesting physician in an urgent care setting, 3,4 the wet-read module was extended to provide access to wet-reads and radiology reports at the point of care using wireless enabled personal digital assistants (PDAs) with the expectation that the physician's first encounter with the radiology results via the PDA would be faster than the original fax-based procedure. This paper describes the extension of the wet-read module and provides an assessment of its performance versus the original fax-based procedure.…”

‘Wet Reads’ in the Age of PACS: Technical and Workflow Considerations for a Preliminary Report System

“…4,5 Because of the high volume of ED cases at our institution, however, we decided to reserve pages for a subset of ED cases that are particularly urgent or have a high possibility of going unnoticed and unread by the radiologist, namely trauma cases, cases marked Bstat^by the ordering clinician, or teleradiology cases.…”