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The purpose of this development effort was to evaluate the possibility of using digital technologies to solve image management problems in the Department of Radiology at the University of Florida. The three problem areas investigated were local interpretation of images produced in remote locations, distribution of images to areas outside of radiology, and film handling. In all cases the use of a laser film digitizer interfaced to an existing Picture Archiving and Communication System (PACS) was investigated as a solution to the problem. In each case the volume of studies involved were evaluated to estimate the impact of the solution on the network, archive, and workstations. Communications were stressed in the analysis of the needs for all image transmission. The operational aspects of the solution were examined to determine the needs for training, service, and maintenance. The remote sites requiring local interpretation included were a rural hospital needing coverage for after hours studies, the University of Florida student infirmary, and the emergency room. Distribution of images to the intensive care units was studied to improve image access and patient care. Handling of films originating from remote sites and those requiring urgent reporting were evaluated to improve management functions. The results of our analysis and the decisions that were made based on the analysis are described below. In the cases where systems were installed, a description of the system and its integration into the PACS system is included. For all three problem areas, although we could move images via a digitizer to the archive and a workstation, there was no way to inform the radiologist that a study needed attention. In the case of outside films, the patient did not always have a medical record number that matched one in our Radiology Information Systems (RIS). In order to incorporate all studies for a patient, we needed common locations for orders, reports, and images. RIS orders were generated for each outside study to be interpreted and a medical record number assigned if none existed. All digitized outside films were archived in the PACS archive for later review or comparison use. The request generated by the RIS requesting a diagnostic interpretation was placed at the PACS workstation to alert the radiologists that unread images had arrived and a box was added to the workstation user interface that could be checked by the radiologist to indicate that a report had been dictated. The digitizer system solved several problems, unavailable films in the emergency room, teleradiology, and archiving of outside studies that had been read by University of Florida radiologists. In addition to saving time for outside film management, we now store the studies for comparison purposes, no longer lose emergency room films, generate diagnostic reports on emergency room films in a timely manner (important for billing and reimbursement), and can handle the distributed nature of our business. As changes in health care drive management changes, existing tools can be used in new ways to help make the transition easier. In this case, adding digitizers to an existing PACS network helped solve several image management problems.
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