Mobile PACS powers real-time treatment decisions
ORLANDO - A new mobile access to PACS transmits images over high-speed wireless networks to a physician's cell phone or personal digital assistant (PDA), allowing physicians to make real-time decisions about a patient’s care, according to a presentation at the 2008 HIMSS conference by Neil Martin, MD, founder and CEO of Global Care Quest and chief of neurosurgery at UCLA Medical Center. 

“We are moving toward a future in which comprehensive electronic medical records are globally accessible; the most important first step is simply to deliver all relevant data to clinicians,” Martin said.

Wireless technologies “are getting closer to where we need to be,” he said. “Also, a wireless connection is approaching broadband speed.”

Martin said that PDAs and “smart” phones on a network have experienced several advancements, including wired (cradle) synchronization; digital images can be sent to these devices; many have email access with a link to web capabilities; and there is a two-way cellular interface.

The Global Care Quest mobile PACS viewer leverages these capabilities to connect to a PACS and allows presentation of images on a mobile device with a DICOM viewer.

Martin said a hospital can determine if they want their clinicians to have the capability of storing diagnostic images. If they don’t want the physician to store images, the PDA or smart phone simply acts as a viewer.

An advantage of the device is its real-time data capacity that can be used to leverage the skills and extend the reach of critical-care physicians.
The technology can decrease delay time, he said. When a patient presents with a traumatic brain injury or acute stroke, “the clock is ticking, and every minute counts,” and if the neurosurgeons can make a determination remotely and quickly, this technology could save lives, according to Martin.

He cited the “golden hour, which is the first hour after a [brain] injury or after recognition of an emergency, when rapid response improves outcome.” He also noted the importance of a doctor intervening within three hours of a patient suffering from a stroke. 

He cited a study in Critical Care Medicine that found that each one-hour delay in evaluating an ICU patient was associated with a 2 percent increased risk of hospital death, and promptly seen patients had shorter hospital stays and lower costs.

Martin said that, according to a standard medical decision cycle, 30 to 90 minutes elapse between the time the doctor is notified and when he or she is able to make a determination. The time lapse between notification and treatment order includes transiting to the hospital, reviewing vital signs, labs and imaging.

With wireless mobile data access, the time to determination can be reduced to three to five minutes. With wireless capabilities, physicians are now more mobile, and not tethered to a workstation.

In regards to regulatory concerns, Martin said that Global Care Quest has not encountered concerns about their technology in discussions with the FDA, because the PDA and smart phones are considered communication devices, and not yet considered medical devices.

Martin also noted that the mobile technology will not directly impact radiologists, who have access to monitors with high-level diagnostic quality.

He said that the key is getting all relevant medical information to physicians in the most timely, comprehensive manner as possible—and providing them with the tools needed to make a diagnosis and treatment decision.