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● Tactical Operations sidesof 2 Clinical users

By Gorkem Sevinc, MS, CIIP, and Paras Khandheria, M.D.


ne of the biggest drivers for telemedicine has been ra- diology. Radiology was the fi rst department in most hospitals to go electronic with the implementation of dictation through speech recognition software,

PACS (picture archiving and communications system) and RIS (radiology information system). T is helped to lead the change to digitize records in healthcare by going from printed images to elec- tronic images. Nowadays, a radiologist typically spends most of his or her day in front of a PACS workstation, working off an electronic list of patients managed by the RIS and reviewing and dictating digital images using speech recognition software. Radiology private practices were among the fi rst to implement telemedicine. In fact, a small hospital that needs a group of 24/7 ra- diologists may hire an off -site radiology private practice. T e hospital acquires images from on-site MRI/CT scanners, sends the images electronically to the private practice and the private practice sends the fi nalized report back to the hospital. T ere has been tremendous progress on the initial headaches of integrating multiple modalities and IT systems by the introduction of HL7 and DICOM standards. One of the recent advancements in telemedicine has been image sharing in radiology. T e Radiological Society of North America (RSNA), supported by an NIBIB (National Institute of Biomedical Imaging and Bioengineering) grant, has led the implementation of an Image Share network to enable radiologists and hospital personnel to share medical images with patients and between institutions. T e image-sharing network has been a tremendous success, integrating tens of vendors to work together as personal health record (PHR) systems, and is currently in place at several large health systems: Mayo Clinic, Mount Sinai Medical Center, University of California San Francisco, University of Chicago Medical Center and University of Maryland Medical Center. Additionally, several startups are push- ing the technology to “upload images” further by enabling patients to get second opinions on their medical images from the doctors of their choosing online.

Getting personal

It is apparent that the future is bright for personalized medicine, which may serve as the primary driver of technological advances in telemedicine. EMR systems are making progress on making their

20 January 2014

systems more available for a diff erent kind of end-consumer: the patient. Epic’s myChart is a great example of how a patient can be better kept in the loop and have access to their health data. Another angle set to play an increasing role in personalized medi- cine is the ability for patients to feed personal health data directly into the EMR. For example, some EMR systems are starting to enable fi tness tracking devices to electronically submit information into the patient’s digital record, and there are emerging start-up companies that are enabling patients to submit information via their mobile devices. T ere are a number of companies that are part of these mHealth (mobile health) initiatives and accomplishing various goals, from reminding patients to take their pills to taking videos of patients as part of social work assessments. Lastly, telemedicine is transforming the internal and external communications in healthcare environments. Critical result manage- ment systems (CRMS) enable physicians within a hospital to better communicate life-threatening and incidental fi ndings and ensure follow-up. It is natural for these systems to go outside a hospital and be part of a healthcare information exchange (HIE) or more. Video teleconsultation systems such as REACH, displayed by Johns Hop- kins at the RSNA 2013 conference, enable any two parties, such as a radiologist and a clinician, or a radiologist and patient, to have a face-to-face conversation with each other while looking at the same stack of images. Such state-of-the-art systems are spreading rapidly throughout academic institutions and appear poised to expand more broadly in healthcare in the near future. T e future for telemedicine and personalized medicine is excit- ing, with empowered patients that have better access to their health information and advanced technologies that enable better collabora- tion between physicians – and with the ultimate goal of enhancing patient safety and outcomes by delivering more effi cient and better quality healthcare.

Gorkem Sevinc, MS, CIIP, is systems development manag- er and research associate, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, and CTO, Radiology Response.

g- nt ns

matics fellow, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions.


Paras Khandheria, M.D., is resident physician, clinical infori

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