The Surgical Path The following is Part I of a two-part blog.
Over the course of the last year, I had the opportunity to co-author a couple of HIMSS
& SIIM Enterprise Imaging White Papers
. Our team included various end users, industry solution experts, and DICOM/IHE committee members. Together we developed a number of specific use cases and workflows, however, it wasn’t until a recent personal
experience, that my eyes were opened to additional use cases that we hadn’t yet thought of. For me, and my wife, a frustrating series of medical events reinforced the need for seamless enterprise imaging and universal image sharing.
My wife has severe osteoarthritis and her most recent hip implant was quite painful. The pain was not resolving and it was clear the time had come for a second surgeon’s opinion. She had undergone a number of imaging exams over the preceding 18 months. The studies were scattered between the hospital where the hip replacement was done, the orthopedic practice, and another hospital which had a scanner that could do a better job of the metal suppressed MR study. So, we gathered up the CDs of imaging studies (CT, MR, Nuc, X-ray) and reports from three different institutions, and went in search of answers.
We arrived early to the appointment with the new surgeon and handed over the stack of CDs and reports for import to the PACS in preparation for the visit. At the time of the appointment, the images were still not available in that PACS and the other facilities did not have them available via an external enterprise viewer like iConnect® Access
, so the path was planned on the basis of the reports only.
The next procedure was ordered: aspiration and long culturing of the fluid around the hip. A week later, we received the news confirming that my wife had an infection.
At the next visit, all of the images were finally available for review (except the cultures and slides) and the two-stage surgery was planned: removal, temporary implant, and later, a permanent implant. My wife – an X-ray technologist who has worked in an orthopedic department for over 15 years – had vivid mental images of what the outcome could look like, as did I from my own internet research and field experience. Needless to say, we were concerned about what might lie ahead.
Surgery was performed and two days later, the surgeon stopped by to check on her progress and discuss next steps. Given her background, my wife wanted to see the images. The surgeon searched the floor for a way to get them printed, however the PACS’ lightweight viewer connected to the EMR was unable to print anywhere on the surgical floor. The laptop for the EMR was located up high on a cart for a standing user, but my wife (who was literally pinned down on the bed with multiple IVs, leads, and pressure cuffs on her legs) had no way of seeing the images.
At this point, the surgeon inventively reached for his cell phone and took a picture of the images from the screen of the laptop to show my wife. Luckily, she was pleased as the temporary implant looked good, and the femur didn’t need to be opened and wired shut. Unfortunately, no prior images were available in this PACS viewer since it had a relatively small server cache of recent studies only.
Further adding to the complexity of care is the fact that my wife is also allergic to the adhesives used in many tapes and dressings. As a result, when the first dressings were removed, pieces of skin came with it. Securing new dressings became more difficult, but she was eventually discharged and sent home with IV antibiotics. However, when the time came for the first dressing change, the entire area around the incision was inflamed and red, prompting calls to both the surgical physician’s assistant as well as the infectious disease specialist to try to describe what we were seeing. The decision was made to wait a couple of days to see if the infection improved rather than make the 60-90 minute drive back to the hospital. Thankfully, things did
improve, but the experience provided an excellent example of a case where cell phone photos as a documentation and communication tool would have helped.
As I reflect back on this ordeal, it is clear that a cohesive enterprise imaging strategy with a readily-available image viewer may have shortened the surgical process, potentially minimized the risk of infection, and ultimately caused fewer headaches. In Part 2 of this blog, I’ll delve into the benefits of enterprise imaging in relation to this eye-opening experience.
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