In a single breath, doctors can acquire more than 200 CT slices, but it seems as though they don't have much more time than that to interpret them. Patients, clinical colleagues, fellow radiologists, and staff don't want to wait more than the time they can hold their breath for answers to their questions-anytime, anyplace.
Radiologists are expected to have vast amounts of data at there fingertips just to get through the workday and, increasingly, even when they are away from work. It has become increasingly difficult to keep track of this store of ever-changing information.
Having to run to an office, to boot up the computer and enter or retrieve information sometimes is impractical. An increasing number of radiologists are instead purchasing personal digital assistants (PDAs). Many hospitals, for example, gives each member of its incoming staff a PDA, which gradually becomes indispensable for the daily routine. Have we reached the point at which the PDA has really become a practical solution for radiologists and other members of the imaging department, or is it still just another toy for gadget geeks?
The latest Compaq iPAQ Pocket PC seems to be the logical next step. It seems to do practically everything the desktop computer does and more. Plug it into its cradle in the office, and it begins to synchronize with Microsoft Outlook, updating the latest departmental calendar, contact list, and miscellaneous notes and sending out e-mail written on the Pocket PC and receiving new e-mail.
Want to input information or write an e-mail message? Just write in print or script anywhere on the screen, and the iPAQ recognizes your scribbling with amazing (but not perfect) accuracy. Want to type? Plug in the tiny foldable keyboard that also fits in your pocket. Microsoft Word and Excel come bundled with the operating system. Need a pocket digital dictating machine? Just press the button and begin recording. For $60 per month and about $300, you've got a wireless connection to the Internet, and you're online whenever you're in range. Ms. Smith's creatinine, Dr. McKenzie's phone number, your latest e-mail-they're all there on your PDA. You can even now read a CT scan on our PDA?
The portability of these devices allows healthcare workers to take them anywhere. Consequently, some have renamed them PCDs, or point-of-care devices. Physicians have the capability to load various databases into their PDAs, as with their personal computers. These databases can take a variety of forms: clinical data (vital signs, lab results, radiology reports), pharmacy, medical records (discharge summaries, H&P, operative notes), insurance information.
To see how these devices are used, we need to look no further than medical training programs, where new computer applications are often adopted early. Many medical training programs are encouraging residents to use PDAs instead of traditional texts. The Cleveland Clinic house staff find their PDAs take the place of traditional manuals, laminated cards, and index cards, lightening the load of overstuffed lab coats. PDA-based references theoretically have the advantage of reducing the potential for medical errors, while rendering the physician users more productive and time-efficient. A number of medical software programs are available for PDA use, and the following are some of the best known:
ePocrates of San Carlos, CA, offers a comprehensive pharmacy reference containing drug dosages, interactions, formularies, and related disease information. New users are reportedly signing up at a rate of 25,000 per month.
All Scripts Healthcare Solutions of Chicago offers a program that includes electronic prescriptions (sent directly to the pharmacy from the PDA), electronic "charting" of physician notes, drug dosages and interactions, and reference anatomy atlases.
Skyscape of Hudson, MA, provides software reference books for PDAs with hypertext links to pertinent clinical data. The paradigm promoted by the product is "think, refer, act."
One of the most interesting applications for these technologies for healthcare is the seamless integration of wireless technologies with a number of information resources within the medical setting. These would include PACS, and ultimately the EMR. All physicians, regardless of subspecialty, could access all medical data (textual, imaging, numerical, and graphical) at their fingertips, independent of location.The end result would be more timely and efficient distribution of medical data, with additional tools to enhance the diagnostic performance and productivity of radiologists.
This paradigm shift will not end with the healthcare practitioner but will extend in all directions within healthcare . Healthcare consumers including payers, referring clinicians, and patients themselves will have greater access to all forms of medical data. This will in turn produce heightened expectations for timeliness, accuracy, and portability of data.
Imagine the benefits of having anytime, anywhere access to patient image files; the ability to review an MRI or echocardiogram at the point of care with the patient or from a location across the globe.
With a handheld medical viewer, the physician can access and review DICOM 3 image files anytime, anywhere - eliminating the delays associated with current methods of data review.
Until recently, the review of patient image files took place at the source of acquisition, or on fixed view boxes or workstations. The PDA delivers the ability to view your patient's images at your fingertips.
No matter how far you are from your patient, PDA technology allows you to access imaging studies, EKG's, test reports and medical records without having to travel to the hospital or office. You wiil even be able to write prescriptions on your Pocket PC and fax them to the pharmacy!
The diagnostic accuracy attainable when viewing medical images on handheld devices and other new display technologies compares about evenly with that obtained when the same images are viewed on a conventional high-resolution, high-brightness desktop monitor, according to the results of an informal study at an infoRAD conference.
During the conference attendees were invited to interpret 10 to 12 images. and determine the comparative accuracy of the devices. Tracking and assessing image quality is important because many wireless and handheld applications are finding their way into medical processes.
The test attempted to determine what differences may exist between viewing images such as head CTs on a high-resolution black-and-white monitor versus a pocket PC or tablet-based PC.
Results of the study have been surprisingly even, even though the resolution on the pocket PCs is significantly less. Handheld devices are currently limited to 240 x 320-pixel resolution, compared with standard PACS monitors that feature 2048 x 2048-pixel resolution. The pocket PC rated slightly higher than the tablet PC, even though the tablet has better resolution