MINNEAPOLIS - Successful importing of patient images from CDs into PACS requires careful attention to quality control, according to a presentation at the Society for Imaging Informatics in Medicine (SIIM) annual meeting.
Developing a process that ensures data integrity is crucial to prevent errors from entering the system, according to Bradley Erickson, MD, PhD, of the Mayo Clinic in Rochester, MN. He shared tips on handling patient images from digital media during a Saturday morning session at the Minneapolis conference.
Staff members at the Mayo Clinic regularly come across data integrity issues when importing images from CDs. In 1.2% of the cases, CDs have data from the correct patient but with different forms of their name or identifiers. CDs are also unreadable in 0.6% of the cases, Erickson said.
Even worse, data for the wrong patient are found on 0.1% of CDs and include information for more than one patient on 0.1%. At the volume the Mayo Clinic experiences, a 0.2% error rate represents four cases a week, Erickson said.
Non-DICOM images (including all types of images) represent about 4% of the facility's total image volume. As a policy, non-DICOM data are not imported, Erickson said.
To import or not to import?
Importing images into a PACS network allows for centralized management of data, Erickson said. An alternate practice of "distributing the CD" approach (i.e., having the patient carry a CD to each visit instead of importing the images into PACS) comes with risks.
Without a process designed to ensure a high level of data integrity, errors may be missed. That's why desk staff trained in the CD import process handles this task at the Mayo Clinic, avoiding the possibility of a busy physician failing to catch an error, Erickson said.
Even if one physician would detect the error, the next physician who looks at the CD might not. This "distribute the CD" model is also prone to filmlike problems, such as being lost or damaged, Erickson said.
"So we want to get that CD into the system right at the very start and not let bad things happen," he said. "You're best off trying to get that CD imported up front into the system and then distribute the images around."
This requires setting up a process to prevent data integrity problems, however. Staff members need to understand the error modes that come up during importing and be meticulous about identifying the patient.
"If you're not careful, and now you import and distribute all of these errant images, you've got a bigger problem," he said.
How Mayo does it
At the Mayo Clinic, trained desk personnel accept each CD from patients and begin the import process. Approximately 90% of CDs are loaded by staff outside the radiology department.
A Mayo-developed electronic medical record (EMR) module scans the CD for viruses and then looks for DICOM images, Erickson said. If DICOM images are present, it then parses the header to look for patient information.
The outside digital media (ODM) processor can automatically detect a removable drive, and it also allows the drive to be selected when media is inserted. The operator enters the patient ID and last name; this patient information is validated with the enterprise registration system, Erickson said.
In the application, the left side of the screen displays patient information from the enterprise registration system, while the right side shows the names and dates of birth found on the CD. If there's a mismatch, it will be highlighted in yellow, Erickson said.
In some cases, the CD is simply not readable. When this happens, the staff tries another disk drive. They've also been trained to wipe the disk radially or use a disk cleaner, he said.
Erickson noted that the average size per exam is 211 MB (based on 346,000 exams parsed at the Mayo Clinic); the average CD has 2.3 exams.
"It seems like they basically fit to the size of the media," he said. "So now we're starting to see DVDs being used. Every once in a while we'll see a patient that comes in with a couple of CDs, but I haven't seen too much more than about 10 GB per patient."
Erickson recommends creating a process that promotes data validation when importing exams.
"Get the patients involved, if you can, because they clearly have a vested interest in having the right information there," he said.
It also makes sense to import the images into an EMR viewing application and PACS, he said.
As for exporting image data on CDs, strive to use a process that promotes high-quality CDs, Erickson said. It should be impossible to select more than one patient to import images onto a CD, and there also should be a confirmation that the selected patient is indeed the correct patient, he said.
Finally, it's important to be a respectful member of the community and adhere to standards, he said.
"I still can't entirely figure out why somebody would be making a non-DICOM CD in this day and age," he said.
By Erik L. Ridley
AuntMinnie.com staff writer
June 7, 2010
Related Reading
Analysis of imported images reveals key lessons, June 4, 2010
RIS/PACS integration with personal EHR can be a tough task, April 5, 2010
CDs may come up short in long-term storage reliability, July 2, 2009
IHE's XDS-I profile may help with CD import dilemma, April 14, 2009
Testing procedure improves usability of DICOM CDs, January 22, 2007
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