A multimedia medical communication link between a radiology department and an emergency department

Multispecialty Enterprise Imaging Workgroup Consensus on Interactive Multimedia Reporting Current State and Road to the Future: HIMSS-SIIM Collaborative White Paper

Diagnostic and evidential static image, video clip, and sound multimedia are captured during routine clinical care in cardiology, dermatology, ophthalmology, pathology, physiatry, radiation oncology, radiology, endoscopic procedural specialties, and other medical disciplines. Providers typically describe the multimedia findings in contemporaneous electronic health record clinical notes or associate a textual interpretative report. Visual communication aids commonly used to connect, synthesize, and supplement multimedia and descriptive text outside medicine remain technically challenging to integrate into patient care. Such beneficial interactive elements may include hyperlinks between text, multimedia elements, alphanumeric and geometric annotations, tables, graphs, timelines, diagrams, anatomic maps, and hyperlinks to external educational references that patients or provider consumers may find valuable. This HIMSS-SIIM Enterprise Imaging Community workgroup white paper outlines the current and desired clinical future state of interactive multimedia reporting (IMR). The workgroup adopted a consensus definition of IMR as “interactive medical documentation that combines clinical images, videos, sound, imaging metadata, and/or image annotations with text, typographic emphases, tables, graphs, event timelines, anatomic maps, hyperlinks, and/or educational resources to optimize communication between medical professionals, and between medical professionals and their patients.” This white paper also serves as a precursor for future efforts toward solving technical issues impeding routine interactive multimedia report creation and ingestion into electronic health records.

Emerging technology: remote analysis of traumatic musculoskeletal radiographs transmitted by electronic mail

OBJECTIVES

To determine whether remote analysis of radiographs via electronic mail (e-mail) had an impact on treatment decision-making.

DESIGN

Prospective.

SETTING

Level I trauma center.

PATIENTS/PARTICIPANTS

Twenty-five cases randomly selected from previous emergency room consultation.

INTERVENTION

Textual descriptions obtained from emergency medicine physicians were compared with computer-digitized images of radiographs sent via e-mail and with the actual radiographs. Four board-certified orthopaedic surgeons reviewed all three forms of data to determine fracture diagnosis and treatment plans. MAIN OUTCOME ASSESSMENT: Diagnosis and treatment plans were obtained via written questionnaire after review of each group of data (textual, digitized image, and actual radiograph). Results were then compared across groups to determine whether digitized images were better than textual descriptions and equivalent to actual radiographs.

RESULTS

Statistical analysis revealed a significant improvement in the frequency of correct diagnosis and treatment planning when digitized images were used (91 percent) compared with textual descriptions alone (48 percent) (p < 0.001). The difference in correct diagnosis and treatment plans between digitized images and actual radiographs was not statistically significant (p = 0.27).

CONCLUSION

Digitized radiographs sent via e-mail can significantly improve accuracy of diagnosis and treatment compared with a simple verbal description.

Multimedia E-mail systems for computer-assisted radiological communication

In the film-based organization of communicating radiological results to the referring physician, the different media (text, images, graphics, voice) are separated. When using computer technology, multimedia reports containing links between these different media can be used. This changes the way radiological reports are generated, accessed, and possibly discussed. We performed experiments in a clinical setting using two different metaphors for communicating multimedia information. In the 'paper metaphor', labels in the report text are linked to annotations in selected images. In the 'slide presentation metaphor', annotated images are presented synchronously to a spoken report. With both systems additional interaction between radiologist and referring physician is supported using multimedia 'electronic mail'. The experiments indicate that multimedia does not only significantly increase the efficiency of information transfer, but also has the potential to make reporting itself more efficient. Given that the amount of image-related information keeps growing, multimedia links are a promising method to give efficient access to the most relevant information.