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Sun Jan 11 14:34:21 GMT 2009

The issue is far from clear to most people, there are nuances, legal and otherwise which have not been elaborated in this discussion.

There are many considerations when reviewing images performed at another hospital. Some are clinical, some are medicolegal, some are legal. radiologists have to assure that we are HIPPA compliant. we have to assure that the images do belong to the correct patient, They must reach our own standards for quality, and we must record our impressions in our own medical record.

1. there is always some concern regarding whether the images belong to this patient. We do not have any way to verify this in a pacs environment because all the demographic data is digital and is not on the image when it is taken,

2. The images must be read in the context of our own standards: contrast bolus given appropriately or at all? coverage of area of interest sufficient? etc

3. "hallway" consults are not satisfactory or standard of care.?radiologists are legally?at risk for any hearsay comments the surgeon writes about the curbside consult. ?A documented reading by a radiologists must occur for his or her own protection. ?Many electronic radiology departments report via voice recognition into fields in the electronic medical record. That means , in our system, that someone must put an order for the test into the system. The system is so intertwined with billinlg that reporting risks being re-billed and that is problemlatic and potentially fraudulent. Sometimes an order is placed in a system and someone in radiology actually performs the test.? I resolve this issue by writing a consult in the EMR rather than creating a radiology report. Problem is, many times the referring physician looks in the radiology part of the record and never finds my opinions. (neither does risk management). 

4. some insurers will not insure for curbside consults.

5. "peeking" into another hospital's electronic medical record is possible just as it is possible to break into someone's home and read their email. We create firewalls etc to protect ourselves. so do hospitals try to protect themselves and their patients. Most "peeks" between hospitals that writers have discussed? are based upon written agreements WITHIN a medical enterprise, not between medical enterprises. 

In new york state, we are trying to create consortia of hospitals that will share medical records. We are some distance from the finish line

sal

sal

-----Original Message-----
From: Fiona Wallace <tielserrath at yahoo.co.uk>
To: 'Trauma &amp; Critical Care mailing list' <trauma-list at trauma.org>
Sent: Sat, 10 Jan 2009 11:05 pm
Subject: RE: reimaging transfer patients

We are electronically linked to our nearest referral hospital and they can
view all our radiology.
For referral elsewhere we email the relevant images. 

Our imaging department is in the process of moving to a web-based system
which can be accessed from anywhere; this will be the logical answer in the
future as all you need then is a fast internet connection.

The CTs I have seen on CDs carry a small software program that loads first
to enable you to read them. The main problem is when an officious IT
department puts an administrator block on the computers so the software
can't load.

If there are going to be serious issues we download as .jpegs, which are an
utter pain to read I know, but better than nothing at all, especially if
sent with a note highlighting which slices match with the major pathology.

Could OSIRIX get round this?

Fiona Wallace
Tasmania

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Joe Nemeth, Mr
Sent: Saturday, 10 January 2009 9:41 AM
To: trauma-list at trauma.org
Subject: RE: reimaging transfer patients

Happy New year to all!

A quick one:

What do people do regarding transferred patients coming in with imaging on
CD and radiology refusing to read (cannot double dip, hence no pay, hence no
read)...

Do you rescan the patient only to have it now read by the happy
radiologist?...
Read the imaging yourself?...
Do you have a system in place where imaging from outside can be accessed by
your own radiologist, i.e. function on a same database system?...

thanks,

Joe 

Joe Nemeth MD CCFP EM
Director,
Dept. of Emergency Medicine
Montreal General Hospital
Assistant Professor
Pediatrics
Montreal Children's Hospital
McGill University Health Centre

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reimaging transfer patients