Michael Franczak, Presenter: Nothing to Disclose

Leighton P. Mark MD, Abstract Co-Author: Nothing to Disclose

Flavius Daniel Raslau MD, Abstract Co-Author: Nothing to Disclose

Jo Bergholte, Abstract Co-Author: Nothing to Disclose

Madeline Klein, Abstract Co-Author: Nothing to Disclose

John L. Ulmer MD, Abstract Co-Author: Stockholder, Prism Clinical Imaging, Inc Medical Advisory Board, General Electric Company

Remote-site teleradiology is a growing phenomenon in Radiology practices today. Yet, this risks reducing physician-to-physician contact and effective medical communication. At the Medical College of Wisconsin, emergency department (ED) Neuroradiology interpretations are provided via on-site teleradiology, physically removed from the ED. ED physicians are required to electronically enter all clinical information pertinent to the requested imaging study, analogous to off-site teleradiology strategies. At the same time, the institutional PACS is fully integrated with the EMR which is additionally mined by the Radiologists for relevant clinical information prior to and during all clinical imaging interpretations. This structure provides a model for estimating the impact of EMR access in the ED setting.

A prospective rater analysis of 2,000 ED head CTs (CCT) acquired over a 3 month interval compared ED physician-entered clinical data to relevant clinical data retrieved from the EMR, supported by physician-to-physician phone contacts where necessary. Three Neuroradiologists independently rated; 1) discrepancy in medical content between the two informational sources, and 2) likelihood that a discrepancy would adversely influence image interpretation and medical management.

On average, discrepancy in medical content between ED physician-directed and EMR retrieved clinical information occurred in 49.3% of patients, while in 9.0% inadequate clinical data was “very likely” to have had an adverse effect on image interpretation and medical management. Thus, approximately 180 patients over the 3 month interval would very likely have been adversely affected. Additionally, 14.0 to 38.9% would “possibly” have been adversely affected.

EMR access may prevent significant interpretation errors in at least 9% of ED CCT patients. As it is virtually impossible for ED physicians, to anticipate and directly communicate all clinical data that might influence CCT interpretations, direct access to the full EMR by interpreting Radiologists is crucial. Remote-site teleradiology strategies should consider the serious implications of inadequate access to the full medical record.

Decoupling teleradiology strategies from access to the full medical record can have serious implications for patient care.

Franczak, M, Mark, L, Raslau, F, Bergholte, J, Klein, M, Ulmer, J, Adverse Implications of Decoupling Teleradiology from the Electronic Medical Record.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12024493.html