Seven intake centers in the Immigration and Naturalization Service have gone online, the first to adopt a new reporting system that integrates images with patient demographics.

The network is able to transmit digital chest images, typically on the order of 10 MB in size, from INS service processing centers throughout the country to the University of Maryland Medical Center (UMMC) in Baltimore, where they are screened for infectious chest-related diseases.

UMMC can return a diagnostic reading to the INS processing centers in less than four hours, identifying infectious diseases 25 times faster than before the system went into effect.

INS processing centers in El Paso, Florence, AZ, San Pedro and El Centro, CA, New York City, and Miami house undocumented immigrants awaiting completion of the immigration process. All new arrivals receive tuberculosis screening by purified protein derivative (PPD) or chest x-ray. The PPD (Mantoux method) is the primary screening method unless contraindicated, in which case a chest x-ray is obtained.

The turnaround prior to the establishment of the new network was about five days, according to Dr. Geralyn Johnson, chief operating officer of Immigration Health Services in the Department of Public Health. IHS provides services to undocumented immigrants through an agreement between the Health Resources and Services Administration and the Department of Justice.

"The results of the PPD weren't available for 24 to 48 hours," Johnson said. "Then we had mobile imaging companies come out and set up on a Monday-Wednesday-Friday schedule, perform the x-ray on those patients with positive PPD, take the film back, develop it, give it to the radiologist who would read it, then overnight the report back to us. It could take five or six days before we got everything done, creating a hardship for the patient as well as the INS, which had to segregate screened and unscreened patients for several days at a time."

With the teleradiology network, radiologists at the University of Maryland receive digital chest images in minutes and return a diagnosis in four hours, sometimes less.

"Depending on the time of the day and how many people we have coming in, we've had results back from the university as fast as 20 minutes," Johnson said. "It's created a safer living and working environment for the people at the detention centers."

In the first three months of the new operation, more than 5500 x-rays have been transmitted to UMMC-approximately 60 per day.

WamNet Global Healthcare is providing the connectivity under guidance from Digital Imaging Acquisition Networking Associates (or DianAssociates), a Maryland company that provides turnkey telemedicine healthcare solutions, including teleradiology.

DianAssociates is the first company to adopt WamNet's new clinical reporting system, said CEO John S. Bremer. The system integrates patient records with diagnostic images, allowing demographic data — including name, ID number, and other pertinent patient record information — to be included with the medical images that are transmitted across the WamNet network. The traditional time-consuming, manual paper processes associated with the management of patient records and images are eliminated.