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Mon Jan 12 14:39:08 GMT 2009

> From: Ronald.Gross at bhs.org
> To: trauma-list at trauma.org
> Date: Mon, 12 Jan 2009 06:57:51 -0500
> Subject: RE: reimaging transfer patients
> 
> This is the way our guys handle these things as well.  We need only give them the disc so that they can (1) load the images onto the PACS and (2) put in an "official" order for radiology re-read of outside images.  When necessary, they will let us know when we need to re-scan or image the patient.
> 
> Ron

Speaking from the computer side, but recognizing the absolute needs here, were I responsible for your PACS, I'd want to be very sure that it had appropriate "infection control" for pathogenic software. If the disks are coming from an affiliated institution, and there is a chain of custody from trusted professionals much as there would be for medical supplies or even transplanted organs, the risk is low.

If the disk was from a remote hospital, with which you don't routinely work, think in terms of the software equivalent of universal precautions.

While I can't give you the exact citation without research, there is an unsolved computer safety issue with JCAHO. On the one hand, they want traceability of software of critical medical equipment back to the responsible manufacturer. On the other hand, especially with Windows-based software, there are frequent and appropriate security and reliability updates that should be applied, but, if they are not by the vendor, you lose a certain auditability.  FDA Part 510(k) medical device approvals also touch on this. Personally, I much prefer to have any life-critical* applications running on the much more controllablle LINUX/UNIX systems, where it is far less likely someone might install personal software. I have had some very frightening experiences when the general-purpose PC, supposedly dedicated to a piece of portable imaging equipment or patient monitors, had some irrelevant personal software installed, which jeopardized its reliability.  It's wise to have safeguards on all patient care computers, which make it difficult for anyone except the IT people, or designated qualified medical personnel,install or change software.

*I must share this: in one presentation, I was discussing life-critical systems. A colleague knew that I've worked on a number of military systems, and asked if those were death-critical. There wasn't a really good answer!

Howard
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr.
> Sent: Saturday, January 10, 2009 12:16 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: reimaging transfer patients
> 
> Our radiologist are happy to read them. Not sure if they dictate a
> report but the important thing is that they discuss it with us on the
> spot so the surgeon knows what is there ( in addition to the surgeons
> own impression, of course)
> 
> Norman
> 
> Norman McSwain Jr, MD FACS
> Trauma Director Charity Hospital
> Professor of Surgery
> Tulane University School of Medicine
> 504 988 5111
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Joe Nemeth, Mr
> Sent: Friday, January 09, 2009 4:41 PM
> 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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> Sent: Fri 1/9/2009 10:00 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 67, Issue 9
> 
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