Integrating dictation and PACS: It's about time

Digital report dictation is essential to a fully digital radiology department. Researchers at the University of Pittsburgh Medical Center - with the help of commercially available microphones and a small amount of software - have integrated their PACS with their dictation system. They hope to increase clinician satisfaction.

Radiology departments that migrate to PACS often discover their reliance on paper tracking forms for clinical history and dictation continues to hobble their practice.

"A common misconception that 'all you need is PACS' is just not true," said Dr. Thomas E. Warfel, a fellow in the radiology department at UPMC.

PACS merely shifts the delay from waiting for film to waiting for paper, he said. To reap the full benefits of PACS, radiology departments also need to get rid of paperwork delays.

Digital report dictation by itself isn't new.

"What's worthy is the recognition of its role as one of the three key pieces needed to do productive work: images, clinical history/patient assessment, and reporting tool," Warfel said.

The university began to see an increase in clinician dissatisfaction with the radiology department after the installation of PACS. Clinicians could now see the images on their PCs minutes after completion of the imaging study. They couldn't understand why radiology hadn't produced the report.

At risk was radiology's clinical relevance. Since studies appeared at clinician PCs long before requisition forms reached reading rooms, clinicians would simply do their own interpretations, relying on radiology to call if something life-threatening was later seen.

"Clinicians figured why wait for our interpretation if they could see the images before we read them," Warfel said.

Radiology wasted even more time performing two reads for many exams: one radiologist issuing a wet read over the phone for the clinician, followed by another radiologist doing the real read later when the paper tracking form arrived.

UPMC integrated PACS with the existing dictation infrastructure, which now allows a single sign-on for both PACS and dictation authentication, guaranteeing the study being viewed is the study being dictated. Warfel's paper on this implementation was published in the February issue of the Journal of Digital Imaging.

The integration of dictation with PACS has increased radiologist efficiency and reduced errors caused by dictating the wrong study.

"We're gaining between 30 and 50 minutes per day of radiologist work time through the elimination of manual data entry into the legacy dictation system," he said.

Integrating dictation into a PACS system requires:
? an audio input device
? a means of signaling dictation control to the system (i.e., record, play, rewind)
? software for performing the audio capture
? software for communicating the captured audio to a transcription infrastructure

Security and reliability are key issues for integrating dictation and PACS. If the dictation system fails, the system grinds to a halt.

"A combination of early error detection and critical component redundancy enhances reliability," Warfel said. "This combination allows us to improve dictation efficiency while minimizing downtime despite increased technical complexity."