In the Nick of TIME

Streamlining diagnostic imaging in the ER

Email Print

As the emergency helicopter makes its final descent onto the hospital roof, the surgical team brace themselves against the blast of stabbing cold wind. The call had come in an hour earlier from one of the hospital’s rural satellite facilities:

A young skier had been caught in an avalanche, and buried amid a dense stand of small trees under 3 feet of debris for several hours. After an extensive search and rescue operation, the skier was found alive but suffering from severe hypothermia, a badly broken left leg and arm, and multiple internal injuries.

Three members of the air medical team are out of the helicopter and pushing the gurney along the helipad even before the helicopter has fully landed. As the surgical team takes possession of the IV bag and heart rate monitor, the air medical team leader shouts over the roar of helicopter blade, “the patient has a weak pulse and had lost consciousness during the transfer.” There is no time to lose.

The surgical team rushes the gurney inside and, seconds later, the air medical team is back in the helicopter and lifting off. Jogging alongside the gurney, the youngest member of the surgical team shuffles hastily through the paperwork in the folder the air medical team leader had given her. Inside the folder, she skims through the patient’s medical charts, an EKG printout, emergency transfer orders signed in triplicate, and forms from the satellite facility – but where are the patient’s medical images?

Seconds to Lose

In an emergency, when every second counts, today’s trauma professionals need to have all available information before they can proceed – and nowhere is that need more evident than in an emergency transfer to another hospital. Dealing with possible internal injuries and unseen complications caused by these injuries, healthcare professionals need to have access to the patient’s most recent medical images to know what is happening beneath the surface. While film images had been the most common (and tangible) medium to convey patient information, in an age of digital imaging, the CD has become the most widely used vehicle for sharing exams across non-
networked sites. However, the CD is not without its pitfalls.

Able to hold dozens of patient images and give receiving trauma teams a better view of the patients, nevertheless, CDs are known to be unreliable, contain problematic third-party viewers, and allow limited sharing. Some receiving trauma centers are forced to re-image transfer patients simply because the staff cannot access the contents of a CD, or the exams on the CD cannot be transferred to the PACS or EMR.

Moreover, this is not an isolated problem. A December 2009 study in The American Journal of Surgery found that more than 53 percent of trauma patients undergo duplicate imaging exams after being transferred – a staggering statistic considering that an estimated 500,000 adult patients are transported to hospitals for major trauma each year in the United States.

Streamlining the Process

According to Frederick Millham, MD, chairman of the Massachusetts State Trauma Committee and chairman of the department of surgery at Newton-Wellesley Hospital in Newton, Mass., “Severely injured patients are routinely referred to trauma centers after receiving initial treatment and imaging exams at a referring institution. These patients arrive at the trauma center with CD or film copies of their exams, though sometimes in the haste to transfer critically ill patients the images do not make the trip.”

He adds, “Frankly, with all the advances in medical technologies, connecting trauma centers and referring facilities to a secure network for sharing vital information does not seem like a huge leap, but it is one we have yet to take. A reliable, secure system that offers radiographs at optimal resolution instantaneously will be a great advantage over the present process.”

In an attempt to streamline the treatment of trauma patients and cut down on the excessive cost of duplicate imaging, one company is taking Milham’s observations to heart. 

lifeIMAGE, a Newton, Mass.-based provider of medical image e-sharing platforms, recently announced the release of its Internet-based Trauma Image Management & Exchange (TIME), intended to improve the way critical diagnostic imaging information is shared during emergency transfers. A strategic clinical tool, TIME allows trauma centers to securely collect diagnostic images, reports, and other relevant files from referring facilities via secure Internet.

TIME avoids rescanning transfer cases because the prior exams will already be in an electronic, standardized format and can be easily shared within the hospital and imported to its PACS if necessary.

“When imaging CDs accompany the patient as they travel to the receiving hospital, or when patients are inappropriately transferred to another facility, valuable time is wasted,” says Hamid Tabatabaie, president and CEO of lifeIMAGE. “By electronically receiving imaging information before a transfer is even initiated, trauma centers can remotely consult on cases early, avoid unnecessary transfers, and improve the speed and accuracy with which trauma decisions are made.”

Taking TIME in an Emergency

TIME is a trauma-specific application of lifeIMAGE’s lila DropBox™ product, a service which allows sending sites to quickly e-share diagnostic image data with trauma centers with an Internet
connection and Web browser.

When a trauma center learns that an outside facility would like to initiate a transfer or remote consultation, it generates dynamic credentials for the sending site to start uploading exam data to its secure, cloud-based trauma DropBox.

“TIME does not require that the sending site have a relationship with lifeIMAGE – or even a virtual private network connection,” says Tabatabaie. “Image data is securely uploaded to the receiving trauma team’s DropBox, where clinicians and administrators at the trauma center can view, and if desired, download them to their local system.”

Imaging information can be instantly and securely shared with the receiving site’s trauma DropBox, where clinicians and administrators can preview and examine images. TIME also provides workflow for receiving trauma centers to incorporate outside exams into patients’ internal medical records. Additionally, trauma centers’ frequent sending sites may opt to deploy the lifeIMAGE Smart Agent (lisa™), a small application that can be used by affiliated referring sites for advanced uploading capabilities.

According to Tabatabaie, “With lisa, the referring site can query and retrieve imaging data directly from a PACS or modality. lisa allows the referring facility to include non-DICOM files or to convert files to DICOM for inclusion with the patient’s imaging studies [such as] reports, discharge summary, medication history, allergy information, or photos and non-DICOM images.”

Patients on the Line

TIME can be crucial in the treatment of any trauma patient who has undergone an emergency imaging exam, or who has prior exams available at another location that could be relevant to providing emergency care. This technology can be vital to patient care in several trauma scenarios, including:

• 1) TIME can be used to electronically share images from one emergency department to another, as in the case of a trauma patient being transferred for surgery after stabilization.
• 2) In the instance when a second opinion is needed but a transfer is not possible, imaging exams can be shared and viewed by physicians at other institutions, who can then consult remotely.
• 3) For trauma patients who are transferred to a trauma center with an imaging study saved on a CD, TIME can quickly access the contents of the CD, regardless of format or size. In this scenario, the contents of the CD can be instantly accessed and shared with other care providers, and imported to PACS if desired.

“TIME gives surgical teams more time to prepare to treat a patient because it drastically reduces the gap between receiving a trauma transfer and reviewing their imaging history,” says Tabatabaie. “In most instances, a trauma center has to wait to receive a CD with medical images before it can begin the sometimes lengthy process of accessing the data and disseminating it to relevant care providers.”

By receiving electronic imaging studies prior to the patient’s arrival, the trauma team can instantly review the images and ensure they are staffed with the right specialists, supplies, and resources for the emergency procedure. Since the TIME service transmits full-fidelity, diagnostic quality images that can be easily downloaded to a diagnostic workstation or imported to the PACS or EMR, the trauma center is also less likely to order duplicate exams, which saves further time and avoids unnecessary patient radiation exposure.

– Bob Stott is the consulting editor for rt image. Direct questions and comments to editorial@rt-image.com.