You Want PACS?
Several people have commented on my previous Rad Rage posts that introducing an electronic Picture Archiving and Communication System will solve all the problems arising from image storage and retrieval, specifically in the context of comparing current radiology studies to previous ones.
Real life example: Patient had a "routine chest x-ray" (ordered through his workplace; NOT me.) Report comes back:
Possible nodule left lower lobe. If comparison to previous films cannot be made [emphasis mine] then chest CT should be performed.In my chart I have two previous chest x-ray reports (normal) from 2006 and 2004, performed at the same hospital -- NOT one with PACS. So once more, with great trepidation, I call and ask them to go ahead and compare the current study. Once more, at least with an apologetic tone this time, I'm asked to fax the request (and at least this time they don't lose it.) The next day I get an even more apologetic phone call: they found the patient's film jacket, but there were no films in it. (Reaction: somewhere between *WTF* and *sigh*) So he needs a CT of his chest.
As it happens, the patient's insurance requires him to go to a different facility for the CT than the hospital where his workplace-ordered (and paid for) "routine" chest x-rays were done. Although that hospital does not appear to have a full-fledged PACS up and running, they do provide the patient with an electronic copy of his film on a CD. He opened it on his computer at home, so he knows there's an image on the disk. Off he goes to the second facility -- the now proud purveyors of a brand-spanking new PACS system (meaning they presumably have computers and know how to use them) --for his CT and hands them the CD with his original chest x-ray image. The CT report:
Normal CT of the chest. No previous chest x-ray image available on our system.Slow. Deep. Breaths.
Cut me a fucking break!! Lessons one, two, three and four in Radiology are about comparisons to previous studies. The whole idea of "portability" is central to the concept of continuity of care, and is something the fans of EHRs everywhere are claiming is their strongest point. Here's a guy with his film on a CD in his hand and no one can be bothered to point and click -- as he was able to do with commonly available software on his home computer -- and compare the goddamn images!
Until everyone gets their act together and agrees on some version of electronic formatting for both images and medical records (and then USES them) abso-fuckin-lutely NOTHING is going to change.
Thank you for your attention. We now return you to your regularly scheduled blogging.
UPDATE: I had the opportunity to go to the hospital recently and review some films in the department of Diagnostic Imaging. While there, I mentioned this case. The radiologist with whom I was speaking pulled it up and in fact found the chest x-ray from the other hospital. Apparently, the tech had copied it from the patient's CD into the system. He scrolled down and saw the name of the doc who had read it and commented, "She must not know how to pull it up. I'll have to go show her how to do it." So it turned out -- as it so often does -- to be a matter of people not using the technology to its fullest.