Feature: Strategies for Taming the CD Beast

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New IT systems and image exchange standards may yet get more images where they need to be. And not a minute too soon. Hospitals continue to contend with the clinical and operational challenges associated with loading and cueing CDs, which include patient care delays and stalled workflow. Denver Health Medical Center, an acute care hospital with 477 licensed beds that houses Rocky Mountain Regional Trauma Center, an academic Level I Trauma Center, has developed a multi-pronged system to streamline the CD import process. The solution encompasses DICOM morphing, auto-routing and a CD import kiosk and has sped patient care and cut the CD failure rate to zero.

Before and after

Before Denver Health implemented its server-based PACS two years ago, the typical trauma consultation/patient transfer was an 11-step process that could take 20 to 30 minutes or more to import trauma images from the transfer facility. Now there are just four steps and the process takes only several minutes after the exam is performed, said Vince Doyle, medical imaging manager.

“We averaged about 15 to 20 percent failure to import CDs,” he said. “I remember plenty of pages in the middle of the night because the CD was fine, but it had a DICOM standard format issue.”

About two and a half years ago, the organization began exploring the idea of a PACS solution that was not only a DICOM router but also had flexible and configurable DICOM morphing strategies. Denver Health worked with its PACS vendor to develop image requirements, workflows and morphing strategies. They devised a server solution called Outside Safe Gateway (OSG) that automates DICOM morphing on nonclinical tags. “We have a lot of DICOM tags that are automatically stripped after the DICOM-conformant statement hits 64 characters,” explained Doyle. This keeps the tags in conformance with Denver Health’s formatting rules and enables images to be read more quickly and without failure.

“The second twist was we needed [a system that would] follow our standards in terms of how we do CD imports,” Doyle added. Prior to implementing OSG, Denver Health had to manually strip the accession numbers from remote facilities and put ‘outside study’ in front of the study description, then prefix the medical record and the remote facility’s patient ID. Now, morphing handles this and automatically forwards the CD images into the enterprise PACS.

Denver Health also rolled out CD import kiosks in its emergency department in January. “We’ve enabled these kiosks with a program that [enables physicians to] pop in the CD and click CD import.” It sends the entire CD through the OSG and imports it as if a remote facility had sent it. “So far maybe 20 CDs have come through it, but that’s 20 CDs that our file room and CT techs haven’t had to go through,” Doyle said.

The system has produced workflow improvements across the image exchange chain, noted Doyle. However, the clinical value of the model may surpass these. Getting more information on a trauma patient before he or she hits the door—and getting it into the hospital systems sooner—leads to faster, more effective care, says Doyle.

On the standards front

Standards help is on the way. For example, Integrating the Healthcare Enterprise (IHE) is developing the Portable Data for Imaging (PDI) Integration Profile for interchange of image data and diagnostic reports on CDs. PDI updates were included in the recent IHE Connectathon event; additional testing continues.

IHE’s PDI Integration Profile addresses how images, diagnostic reports and related information can be exchanged among imaging and viewing devices using DICOM-conformant CDs, so there is more reliable exchange of data resulting in the transfer of full fidelity images that should be identical to those used by radiologists for primary interpretations, said Steven Falcone, MD, MBA, associate professor of radiology, neurological surgery, and ophthalmology at University of Miami.

“This allows for the distribution of complete data sets of diagnostic quality images,” Falcone explained.