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CD image import reduces unnecessary imaging exams in emergency rooms

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The ability to successfully import data from a CD-ROM containing a patient’s diagnostic medical images may help hospitals significantly reduce unnecessary medical imaging tests, according to a study published online in Radiology.

Investigators at the Brigham and Women’s Hospital in Boston found that implementing a system to upload CD images of emergency transfer patients into the receiving institution’s picture archiving and communication system decreased the rate of subsequent imaging by 17%, according to a Radiological Society of North America press release.

“Because there is no central repository for medical images or a large-scale system to transfer images electronically between hospitals, a CD with diagnostic imaging is among the most critical components in the hand-off of clinical information for patients transferred between hospitals,” stated lead investigator Aaron Sodickson, MD, PhD, in the release.

Study methods

Sodickson’s group attempted CD import of the outside examinations of 1,487 consecutive emergency department patients into the picture archiving and communication system (PACS) between Feb. 1 and Aug. 31, 2009. They then extracted from the electronic medical record subsequent rates of imaging performed within 24 hours of any CD import attempt and compared these findings between two patient groups: those with successful CD import and those for whom CD import had failed.

According to the study abstract, the Wilcoxon rank sum test was used to compare rates of all subsequent imaging and of CT imaging alone, with emergency department CT utilization in the successful import group being compared with that of a historical control group (254 consecutive emergency department patients transferred with outside hospital CDs between Aug. 2007 and Jan. 2008 prior to any implementation of import procedures).

A reduction in imaging

Sodickson and his group reported a 78% (1,161 of 1,487) success rate in CD import to PACS, as well as a 17% reduction in mean rates of all subsequent diagnostic imaging taken with patients who had a successful CD import. Patients without a successful import underwent an average of 3.3 examinations, compared with 2.74 examinations for patients with a successful CD import.

The group also reported a 16% reduction in subsequent CT utilization — from a mean of 1.41 down to 1.19 scans — for patients in the respective groups. Comparison with the historical control group reportedly revealed post-transfer utilization of CT in the emergency department was reduced by 29% from 1.18 to 0.84 scans per patient in the historical control group and the successful import group, respectively.

“Implementing CD import procedures has provided us with a far more efficient way to take care of our patients,” Sodickson stated in the release. “One of the goals of our health care delivery system must be to provide access to diagnostic imaging results to all locations involved in a patient’s care, either through implementation of a universal electronic medical record, image repositories or robust image transfer networks. But until those solutions reach maturity, ensuring that medical images can be downloaded from CDs in a standard, PACS-compatible format will help to streamline care, reduce costs and protect patients from unnecessary imaging exams.”

Reference:

• Sodickson A, et al. Outside imaging in emergency department transfer patients: CD import reduces rates of subsequent imaging utilization. Radiol. Published online before print April 19, 2011. doi: 10.1148/radiol.11101956.
• http://radiology.rsna.org
• Disclosure: No relevant financial disclosure was reported.

The study by Sodickson et al. provides interesting and important information. When patients are transferred from one institution to another for further treatment, it's vital that their imaging studies go with them. When this happens, substantial reductions in the number of subsequent, repeat imaging tests can be achieved. Hopefully all CD formats will be made compatible with all PACS so the success rate of CD importation will become 100%. Also, some of the other mechanisms now being developed for transferring imaging studies, such as cloud computing, should prove useful. They should make transfers even quicker and more seamless. The ultimate goal is an important one: the reduction in the need for unnecessary high tech imaging studies.

— David C. Levin, MD
Professor and chairman emeritus
Department of Radiology
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pa.

Sodickson’s study highlights an important issue for orthopedic surgeons, and especially traumatologists: rapid access to previously performed imaging. In a trauma setting and in our outpatient offices, patients arrive with their previous imaging on CDs. Some of it can be loaded into PACs (in the Sodickson's study, 78%), and some cannot. When previous imaging cannot be viewed, we repeat studies, wasting time and money — and in some cases, expose the patient to more radiation. Sodickson's study adds data to the empiric observation we all have about struggles with outside imaging. Perhaps it will be valuable information to validate the cost of time and personnel to do the uploading.

Physical uploading by the receiving hospital is a burden, without reimbursement to the radiology department that must provide the equipment and personnel. The next logical step is a cloud-based system (like Dropbox) that allows referring EDs (or outside imaging facilities, or patients themselves) to load the imaging before the patient arrives. This solution is rapidly advancing, and will likely be in wide use within a few years. My hospital will have these capabilities in a few months. This technology could radically improve care and efficiency at tertiary centers, but also creates a scenario in which patients, or outside hospitals, might ask a specialist at the receiving center to check images and offer opinions, without seeing the patient.

Orthopedic surgeons should follow these trends in transferable imaging and look for options that will improve the quality, efficiency and cost of caring for their patients.

— John M. Flynn, MD
Associate trauma director of orthopaedic surgery
Children’s Hospital of Philadelphia
Philadelphia, Pa.

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