Director, Product Management, Healthcare Calgary Scientific, Canada
In today’s healthcare environment, the ability for providers to exchange and share imaging is becoming increasingly critical on many fronts. Electronic access to images improves provider workflow, clinical operations and patient care through time savings and efficiencies. When providers access images with mobile devices, these benefits increase. Mobile devices are perfectly suited to the pervasive mobile workflow of clinical care providing untethered access to patient information and communications. When used for mobile image viewing, mobile devices support faster interpretation and consultations and improve patient outcomes. This article reviews the clinical and patient care time savings of electronic image exchange using mobile devices and describes the features that mobile image viewers require to achieve these efficiencies safely and securely.
Using smartphones and tablets for clinical patient care is rapidly becoming the norm for providers. Physician adoption rate of mobile devices has risen rapidly going from 53 per cent in 2010 to 84 per cent in 2015, according to research from Kantar Media. Until recently most providers were using them to conduct research or communicate with colleagues but those use patterns are changing. According to research from Black Book Market Research, between 2013 and 2014 the percentage of U.S. physicians using mobile devices for patient care tasks, such as ordering prescriptions, accessing records, ordering tests or viewing results, has grown from 8 to 31 per cent.
One reason for this rapid adoption of mobile health IT among clinicians is that applications which run on desktops interrupt workflow and hamper efficiency by requiring doctors to sit in one place while using them. According to a study published in the November 2013 issue of the Journal of the American College of Radiology, time spent simply accessing images on PACS workstations before reading them, for example, can total as much as 173 minutes, or over two hours, per day.
A study published in the May 2015 issue of the Journal of Medical Internet Research reports on research testing the hypothesis that mobile image-viewers provide faster image access. The study tested time-to-image speed and showed that improving this speed is a primary clinical benefit of mobile image-viewers.
For the study 19 clinicians, including 9 radiologists, 3 surgeons, 4 neurologists, and 3 physician assistants, compared time-to-access a PACS viewer, an internally-developed desktop viewer and a mobile image viewer. Data was collected for 565 image-viewing events, conducted over two separate 7-day periods. Time to first image for the PACS viewer and internally-developed viewer included time required to get to a workstation, log-in and display the first image.
For the mobile viewer, time to first image covered logging into the virtual private network (VPN), launching the mobile image viewer application and displaying the first image.
The mobile image-viewer’s mean time to first image of 2.4 minutes was significantly faster than both the PACS viewer, which had a mean time to first image of 12.5 minutes, and the custom desktop viewer, which had a mean time to first image of 4.5 minutes. Diagnostic confidence was similar for the mobile image-viewer and PACS viewer, and was worst for custom desktop viewer.
For providers that are constantly viewing patient images on mobile devices can transform workflow and standard practice. Christopher Duma, MD, a neurosurgeon that practices in Orange County California, says that using an iPhone to access to patient information, he can now provide better, more effective care.
“If I’m walking around the hospital and I need to look at a patient’s image I don’t go to a PACS terminal, I just use my iPhone. It’s easier and it’s faster,” he says.
For radiologists, mobile access offers both the benefit of better workflow and the ability to participate on patient care teams. Today’s radiologists typically practice their profession in rooms populated with the hardware of dozens of PACS. They roll between monitors, opening a different user interface at each PACS to read images, write or record reports and send them on to colleagues, a practice called “swivel chair workflow.”
One path to bringing health IT and efficient physician workflow together is liberating patient data from proprietary information systems and allowing it to flow freely across all types of devices, including smartphones, tablets, laptops and workstations, from any and all locations. Mobile access to patient data not only meets provider needs, it is also essential for healthcare institutions need to remain competitive. Simple, secure access to patient images, for example, eliminates the need for repeat imaging, saving both time and money.
Mobile image access not only improves the workflow of radiologists, it also allows them to hold in-person meetings with referring physicians and patient care teams. Research shows that this face-to-face communication improves patient care. A study published in the February 2016 issue of the Journal of the American College of Radiology, shows that in-person communications between radiologists and acute care physicians improved patient care. For the study, researchers analysed the results of rounds held between an acute care surgery team and abdominal radiologists. In 43 per cent of these in-person meetings, the acute care physicians changed their diagnosis, making significant changes in their surgical plans for the patients.
The benefits of such care coordination reach across all providers. Electronic image sharing supports patient care coordination, giving providers timely access to critical patient data. When patients travel between providers and clinical settings, image availability at the point of care is critical to making effective care decisions.
Many providers use CDs as a method of providing this access between providers and hospitals. This method, however, does not always work. CDs are frequently lost or misplaced requiring re-imaging, which takes time and delays diagnosis and treatment. They can also be damaged making images inaccessible. In addition, if the CD does not have an image viewer included on it, providers have to take the images, upload them to a local PACS and then viewed, a significant amount of manual effort which also delays patient access to treatment. Without access to outside images, trauma patient transfers can lead to a much as 25 minutes of treatment delay according to a study published in the Journal of Trauma Injury Infection and Critical Care.
Electronic access to images eliminates these problems and also improves care coordination. A typical care coordination use case includes the following phases of care as described in a HIMSS/SIIM paper on image exchange for improved patient care:
A patient with a head injury arrives at the Emergency Department (ED) of a community hospital and care providers perform a CT scan. To access a neuroradiologist, the ED physician reaches out to a tertiary care facility.
The patient scan from the PACS is transferred to the tertiary care center within a few minutes and provided to the neuroradiologist. The neuroradiologist accesses the patient scan and then calls the ED physician to discuss the exam.
With simultaneous access to the patient scan, the neuroradiologist and ED physician are able to make care decisions together. Instead of transferring the patient and possibly performing another CT scan, the neuroradiologist can diagnose right away and make a determination if a transfer is needed or not. If, for example, the patient requires surgery and a transfer is necessary, the surgery team can prepare for the patient arrival during the transport, saving even more time and improving outcomes.
When this scenario includes mobile devices, efficiencies are even greater. For example, if the neuroradiologist is on call but not physically present at the tertiary care facility, he or she can access the patient scan and diagnose from any location.
Electronic image sharing is a key component of telehealth, which connects providers over long distances. “Electronic image sharing has really opened the doors to telehealth,” says Amy Vreeland, founder of Imaging Strategies of Waban, Mass., a consulting firm focused on enterprise imaging. With electronic access, specialists can view images from rural providers, providing expert diagnosis without requiring time for patient travel.
One area where telehealth and image access plays a key role in saving patient lives is stroke care, which is extremely time-sensitive. For stroke patients, minutes can mean the difference for patients between recovery and permanent disability, or even death. Patients in rural areas, or even city boroughs, who don’t have local access to a stroke specialist waste precious time getting transported to specialists’ care. With stroke care “time is brain.”
For the past 20 years, telestroke has offered a solution to this problem, linking local doctors via video conferencing systems with stroke specialists to consult on patient care. A 2013 study from the University of Arkansas for Medical Sciences concludes, “Stroke patients treated at telestroke hospitals had a significantly lower mortality rate than those treated at non-telestroke hospitals, with the same cost of care.”
Telestroke has been thoroughly studied and is now widely accepted as a standard of care. One area of telestroke that has been studied in depth is the use of mobile devices for stroke patient scan viewing, interpretation and diagnosis. This research provides evidence that stroke diagnosis on mobile devices is at least as effective as diagnosis using PACS workstations, enabling providers to use mobile devices from anywhere, anytime to provide critical patient care.
To make mobile access to images safe for patients and to maintain the security of patient information, mobile image viewers need to offer specific diagnostic and security features.
Providing users with access to patient data from outside enterprise firewalls requires careful and secure management of users and servers. User groups need to be defined and authenticated and servers need to be configured for safe and secure external connections. Cloud-based access provides one method for securely connecting multiple, approved users to patient data with a minimal amount of technical support.
Ensuring that users are who they say they are is the job of authentication systems. In large enterprise environment, users often have multiple accounts—each with its own login procedure—to access health information systems. Multiple sign-ons are not only confusing to users and can slow their access to information, but are also hard for IT departments to manage. They also open multiple points of network access to potential break-ins.
Single sign-ons for all enterprise network software, including mobile applications, offers the most secure user access. Using mobile applications that support standard authentication technology such as Lightweight Directory Access Protocol (LDAP), for example, ensures that new applications do not compromise user authentication safety and security.
Mobile devices make it simple to share and view electronic patient information from virtually any location at any time, which increases the amount of patient data traveling both inside and outside enterprise firewalls. Using data encryption with HTTPS protects data as it travels over networks making it a key component of network security.
Systems that provide mobile access to patient information and then transfer and store that data on mobile devices are unsafe. When devices are lost or stolen, that information then becomes available to the thief. High-level mobile security includes the ability to share and view information without transferring it permanently to a mobile device. These applications also purge all patient information from mobile devices at the close of a session.
In patient care settings, ensuring that a mobile image viewer has accreditation for diagnosis is critical for patient safety. Providers have neither the time nor expertise to interrupt their workflow to determine whether the application on their smartphone can be safely used for diagnosis.
Kyle Hall, telehealth coordinator for Nebraska Medicine located in Omaha, NE, is careful to acquire health IT that has FDA clearance in place. “When doctors have the information they need at their fingertips, they react by diagnosing first and think about the rest later,” explains Hall.
Another important point of consideration is clearance for both web and mobile use so that providers can be using a single image viewer across desktops, laptops, tablets and smartphones with diagnostic confidence.
In conclusion, mobile access to images can open doors to more efficient provider workflow and better patient care. The future points clearly towards the increasing use of mobile technology for delivering cost-effective, efficient and high-quality patient care.
To stay on top of this trend, health care institutions should begin the steps to embrace mobile technology and transform their health IT strategy to support mobile devices.
Jonathan Draper is the Director of Product Management, Healthcare at Calgary Scientific. Jonathan directs the product roadmap and works closely with healthcare partners and institutions globally to develop innovative solutions that address clinical needs and meet the technical requirements of healthcare enterprises.