DICOM helps integrate images into multimedia EMR

One of the nation's most advanced digital medical systems can easily integrate a variety of medical images into the patient's electronic medical record (EMR), and DICOM has been the key.

DICOM uses a structured representation of image data and a communication mechanism that allows the VA to acquire images from multiple sources and store them directly into the online patient record, said Peter M. Kuzmak of the Maryland Department of Veterans Affairs in Baltimore.

Using DICOM, the VA can obtain both radiology and nonradiology images and can display them on low-cost clinician workstations throughout the medical center, he said. High-resolution gray-scale diagnostic-quality multimonitor workstations with specialized viewing software are used for reading radiology images.

"The VA has been working on the multimedia online patient record for over 10 years," Kuzmak said. "There have been other research projects related to the development of multimedia online patient records, but no other multispecialty multimedia patient record systems are in widespread use."

The EMR developed by the VA is an example of the functionality that can be provided with today's technology. In addition to serving VA patients, the VA model may benefit other hospitals in the future. User interface to the EMR can be enhanced to present data in ways not possible with paper charts or other physical image media.

"The VA's DICOM capabilities interface six different commercial PACS and more than 20 different image acquisition modalities," Kuzmak said. "The VA is advancing its use of DICOM beyond radiology. For instance, new color imaging applications for gastrointestinal endoscopy and ophthalmology using DICOM are under development."

It is essential to have all this data available from every workstation so clinicians will use the system widely, he said. Users must be able to capture patient data in their procedure room and view their patients' online multimedia record on a single workstation anywhere in the medical center.

The availability of a full range of patient data from a single source - the clinical workstation - is a key factor in system efficiency, usability, and user acceptance, according to Kuzmak. Because the system is integrated, data that are entered into any part of it serve all users, resulting in a system that contains a "critical mass" of information.

Because users are likely to find what they need from the system, they look there first and also find it cost-effective to add information to it, he said.

"Reaching this critical mass is essential to achieving the maximum benefits from an integrated patient record system. The ultimate goal is to increase clinician productivity, facilitate medical decision-making, and improve quality of care," Kuzmak said.