CDs: Friend or Foe?

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In a Saturday afternoon session on cross-enterprise image sharing and accessibility, most people seemed to be of presenter Bradley Erickson MD’s mind: “I’m happy to give them, but I am not happy to receive them.”

Erickson said 85% of all materials coming in from outside the Mayo Clinic are on CD, and an informal poll of the audience confirmed that many radiology departments across the US are awash in CDs. While the digital revolution appears to have been a success, this heir apparent to film for providing patients their studies has created a new set of issues with which to contend.

Consider these figures from the Mayo Clinic:

2% are for the wrong patient
1% has more than one patient on it
3% are unreadable
1% contain correct patient but different forms of name or ID
4% contain non-DICOM data

What is your workflow for accepting CDs produced at other institutions from patients?

“Do it well or it will come back to burn you in many ways,” Erickson advised. “Almost two patients each day are showing up with the wrong CD.”

Mayo was able to track this data as a result of instituting a new importation process for CDs (only about 30% of which are destined for radiology, with the rest going primarily to cardiology and orthopedics).

“Even if one person catches error, you have to have some way to flag it,” he said. “That’s why we decided we are not going to distribute them. We built a system to import once and get it right.”

Mayo built an EMR module that imports the CDs, and established an intake desk with dedicated personnel. When a CD is imported, a confirmation/verification screen is displayed, and the identity of the patient is matched with the information on the CD.

Aside from quality and safety issues are the HIPAA implications, Erickson added. While probably not a violation, the lack of an audit process for the distribution of CDs should be considered before JACHO visits next.

A plan to give radiologists the ability to import the CDs into the PACS was the victim of budget cuts, but for the time being, the outside studies can be accessed through the EMR displayed in a different color than native exams.

Next step? The Internet is the Holy Grail.