EMR integration with PACS enhances information access

May 20, 2004

VANCOUVER - The integration of PACS workstations with electronic medical record (EMR) systems can enhance imaging interpretation workflow, and is of vital importance in maintaining the future clinical relevance of radiologists, according to researchers from the University of Texas M. D. Anderson Cancer Center in Houston.

"Radiologist workstations must evolve to include ancillary clinical data sources (that are) critical to the radiologist workstation's workstation functionality," said Dr. Kevin McEnery, who spoke Friday at the Society for Computer Applications in Radiology (SCAR) meeting. "Radiologists must transition into a role as a radiology consultant and not just as an interpreter of images."

While the prospect of integrating PACS workstations with RIS is drawing increased attention, most of these efforts have centered on providing access to prior radiology reports along with historical diagnostic examinations. This approach offers the radiologist only limited insight into the clinical presentation of a patient, McEnery said.

"Clinical histories of the requisitions (that) are the basis for these prior radiology reports in most situations are often incomplete or worse, inaccurate," he said. "Lack of complete clinical history limits the interpretation that the radiologist can render to morphologic descriptions of findings without clinical context."

Taking a different tack, the MDACC developed RadStation, which integrates a PACS workstation with a homegrown EMR called ClinicStation. This EMR provides enterprise distribution of images and clinical information, as well as access to patient vital signs, pathology and laboratory reports, transcribed clinical documents, and optically scanned paper documents.

To assess the utilization of clinical data by radiologists while they dictated on the system, the MDACC research team analyzed audit logs back to August 2003, examining the approximately 20.9 million audit log files recorded in the shared RadStation/ClinicStation audit repository. The audit records capture information such as the clinical data reviewed, user ID, date and time, and the IP address of the computer that accessed the information.

The researchers then determined radiologist accessions, aggregated from radiologists, radiology fellows, and radiology residents. Of the 4,850 total system users, 85 radiologists had signed on to the system; radiologists initiated 35,342 patient queries (4.47%) of the 791,105 total queries.

The top three data requests for radiologists were radiology reports (39,668, 40%), transcribed documents (28,680, 29%), and image reviews (18,591, 19%), McEnery said.

Gaining integrated EMR access allows radiologists to function as expert diagnostic consultants, and there is a greater likelihood of appropriately interpreting ambiguous imaging findings in the context of available clinical history, he said.

"Radiologist information needs are not just radiology reports," he said. "When given access to clinical information, in our experience, radiologists tend to use that information, albeit in a different proportion than the enterprise (users). Access to clinical information should be integrated into PACS workstations."

By Erik L. Ridley
AuntMinnie.com staff writer
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