{"id":8953,"date":"2018-11-12T20:46:51","date_gmt":"2018-11-13T01:46:51","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8953"},"modified":"2018-11-14T16:01:05","modified_gmt":"2018-11-14T21:01:05","slug":"sharing-radiology-images-across-emrs-is-frustratingly-terrible-and-it-doesnt-have-to-be-this-way","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/sharing-radiology-images-across-emrs-is-frustratingly-terrible-and-it-doesnt-have-to-be-this-way\/2018\/11\/12\/","title":{"rendered":"Sharing Radiology Images Across EMRs Is Frustratingly Terrible &#8212; and It Doesn&#8217;t Have to Be This Way"},"content":{"rendered":"<p>In the United States, any person who has tried getting their own (or their patient&#8217;s) radiology images from another hospital or practice will find this brief anecdote painful:<\/p>\n<p>https:\/\/twitter.com\/sarahkliff\/status\/1059518100821983233<\/p>\n<p>Here are several obvious reasons why the CD-ROM &#8212; briefly the darling of large-data transfer &#8212; is a truly terrible way to share radiology images in 2018:<\/p>\n<ul>\n<li><strong>They require physical transfer.<\/strong> Remember the term &#8220;snail mail&#8221;? Do people still say that?<\/li>\n<li><strong>They are slow.<\/strong> When you bring a CD-ROM down to your friendly radiologist to review the scans, also bring a good book &#8212; you will be waiting awhile for the images to load. Zzzzz &#8230;<\/li>\n<li><strong>There&#8217;s no universal software to read them.<\/strong> Watching even the most tech-savvy radiologist\u00a0trying to extract images from these disks is proof enough that this is a horribly outdated technology.<\/li>\n<li><strong>The blank disks are disappearing.<\/strong> When was the last time you purchased a &#8220;spool&#8221; of these things? Back when Napster was a thing?<\/li>\n<li><strong>The drives are disappearing from computers.<\/strong> They&#8217;ve been gone from most laptops for years. Desktop computers, especially the mass-market, small-form ones used in hospitals, often lack them as well.<\/li>\n<li><strong>Hospitals spend significant time and money transferring images from CD-ROMs into their EMRs.<\/strong> It works like this: you walk the disk down to wherever the uploading machine is located. You fill out some forms. You hand the disk over. It goes into queue with other disks. Later &#8212; hard to predict exactly when, could be later that day, or tomorrow, or next week, but <em>never<\/em> during your patient&#8217;s office visit &#8212; you can view the images in your patient&#8217;s medical record. However, sometimes (and this has happened more times than I can count), the disk is unreadable, or doesn&#8217;t even have images at all &#8212; only the radiology <em>report<\/em>, and not the actual images. Gak.<\/li>\n<li><strong>No one knows whether CD-ROM disks should be spelled &#8220;disk&#8221; or &#8220;disc.&#8221;<\/strong> Discuss among yourselves &#8212; I&#8217;m going with &#8220;disk.&#8221;<\/li>\n<\/ul>\n<p>Non-clinicians might wonder, what&#8217;s the big deal if you can get the radiology report? Isn&#8217;t that what &#8220;Care Everywhere\u00a9&#x2122;&#8221; does?<\/p>\n<div id=\"attachment_8957\" style=\"width: 226px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/11\/old-xray-nat-lib-congress.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8957\" class=\" wp-image-8957\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/11\/old-xray-nat-lib-congress.jpg\" alt=\"\" width=\"216\" height=\"225\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/11\/old-xray-nat-lib-congress.jpg 454w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2018\/11\/old-xray-nat-lib-congress-288x300.jpg 288w\" sizes=\"auto, (max-width: 216px) 100vw, 216px\" \/><\/a><p id=\"caption-attachment-8957\" class=\"wp-caption-text\">Xray of active tuberculosis, 1939; National Library of Congress<\/p><\/div>\n<p>Sure, having the report is better than nothing. But in complex cases, and when making difficult diagnostic or therapeutic decisions, it is <em>always<\/em> better to review the actual images &#8212; preferably with a radiologist specially trained in the involved anatomic region.*<\/p>\n<p><em>(*ID doctors do a lot of this kind of thing. This probably explains why getting ID consults on complicated cases is associated with better outcomes. And it definitely contributes to why we&#8217;re typically bottom-feeders in an RVU, procedure-based world. How do you bill for time spent chasing down images and reviewing them with radiology?)<\/em><\/p>\n<p>Of course it doesn&#8217;t have to be this CD-ROM way. If there ever were an irrefutable argument for the benefits of digitizing medical information, the switch from hard copy &#8220;films&#8221; to digital images would have to be right near the top.\u00a0Think of how far we&#8217;ve come from the days of searching for x-ray films that, not surprisingly, would disappear in direct proportion to how interesting the case, or how sick the patient.<\/p>\n<p>That&#8217;s why the current CD-ROM strategy is so frustrating. Never mind that a faster and more reliable technology (the USB flash drive) has been available for years. Though cheap and ubiquitous, and better than CD-ROMs, USB flash drives would also require physical transfer.<\/p>\n<p>The solution, of course, is to put the images on the web &#8212; which is apparently what many non-U.S. hospitals have been doing for years:<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">We were consulted on a patient transferred from a hospital in Thailand. We needed to review his MRIs. The doctors there kindly emailed us a link and, bingo, we could see them all (along with his whole medical record).<\/p>\n<p>This was at least 5 years ago. <a href=\"https:\/\/t.co\/I3ARLxEtO9\">https:\/\/t.co\/I3ARLxEtO9<\/a><\/p>\n<p>&mdash; Paul Sax (@PaulSaxMD) <a href=\"https:\/\/twitter.com\/PaulSaxMD\/status\/1060848799516631040?ref_src=twsrc%5Etfw\">November 9, 2018<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p>So here&#8217;s what I recommend we do, starting now:<\/p>\n<ol>\n<li>Patients scheduled for imaging fill out a form while they are waiting asking if they want their images available for review by the clinicians caring for them.<\/li>\n<li>If the answer is <em>Yes<\/em> &#8212; and I imagine it would be for all but the most paranoid individuals &#8212; then after the scan is done, they are provided a secure link. It can be communicated by email, text, a post-procedure print out, or all of the above.<\/li>\n<li>In order to make the link work, they need to click on it and verify that it can be accessed by others.<\/li>\n<li>They then get to choose the variety of ways others can access it &#8212; secure password? Two-step verification?<\/li>\n<li>The patients can then share the link with whomever they like.<\/li>\n<\/ol>\n<p>There, wasn&#8217;t that easy?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the United States, any person who has tried getting their own (or their patient&#8217;s) radiology images from another hospital or practice will find this brief anecdote painful: https:\/\/twitter.com\/sarahkliff\/status\/1059518100821983233 Here are several obvious reasons why the CD-ROM &#8212; briefly the darling of large-data transfer &#8212; is a truly terrible way to share radiology images in [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,8,9],"tags":[],"class_list":["post-8953","post","type-post","status-publish","format-standard","hentry","category-health-care","category-patient-care","category-policy"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8953","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=8953"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8953\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8953"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8953"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8953"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}