Digital case file system collects interdisciplinary 'intellectual capital'

In an effort to retain valuable patient information generated at interdisciplinary conferences, researchers at the Cincinnati Children's Hospital Medical Center have developed a simple method for creating teaching cases. It aggregates clinical data, radiologic images, surgical images, and images from pathologic slides that are presented at tumor board conferences.

The system was implemented to prevent the loss of "intellectual capital" that emerges as physicians from different specialties and perspectives review the cases of patients they share, according to the researchers. Their technique was reported in the February, 2004 issue of the American Journal of Roentgenology.

"The issue is particularly acute when the patient is transferred among clinics, the emergency department, and the wards. Each transfer increases the risk that critical pieces of historical and diagnostic information will be missed or misinterpreted," said Dr. Mark J. Halsted, cochief of informatics radiology core research at the medical center.

Halsted and colleagues adapted their radiology department digital teaching file so that the clinical, radiologic, and histopathologic data from each case would be permanently recorded, organized, and stored, making it instantly retrievable at any time from any location using the hospital intranet. Their teaching file is based on the MyPACS teaching file management software (Vivalog Technologies, Seattle).

Halsted said the method they use to create digital cases for presentation is quite simple: A template is created for the case so that the oncology fellow, radiologist, surgeon, and pathologist can each enter text and images independently at any time.

"The oncology fellow assigned to present the case prepares the text describing the clinical setting as before, except now the text is entered directly into teaching file data field," Halsted said.

The radiologist then uses a simple screen capture to add radiologic images to the presentation from the PACS. The surgeon and pathologist likewise add text and digital images.

Halsted cite the benefits of this system:
? more efficient preparation of cases
? more effective and less distracting presentation of cases
? a rapidly growing teaching file incorporating text and images providing clinical, radiologic, surgical, and histopathologic correlation
? rapid access to clinical information during subsequent care delivery for patients whose cases have been presented at the tumor board

"Our new approach has few if any disadvantages," Halsted said. "Case entry is no more time-consuming than the old way, and conferences have run more smoothly and efficiently since we implemented it."