Mayo teleradiology offers healthcare for the virtual patient

Teleradiology activity at the Mayo Clinic in Rochester, MN, has widened its borders from the Midwest to the Middle East.

The U.S. version is primarily for internal, though long-distance, evaluation of echocardiograms. This system allows the transmission of echoes from Mayo Health System sites in the upper Midwest to their cardiac echolab in Rochester.

"This is a physician-to-physician consultation that allows remote echoes to be read in hours rather than days," said Marvin P. Mitchell, administrator of the Mayo Clinic TeleHealthcare Center.

The echolab handles 10 or 12 echoes of this type every day. Since these are Mayo patients and the echoes would be read by Mayo physicians regardless, there is no additional charge to the patient for this service.

A more innovative telemedicine/teleradiology application has been installed between Mayo in Rochester and two hospitals in the United Arab Emirates. A store-and-forward system uses custom software that allows the UAE referring physician to package radiographs, scanned paper documents, video, and angiograms and echocardiograms (in motion), and send them securely over the Internet to Rochester for a second opinion.

"This system is also capable of inputting and transmitting any DICOM-compliant image," Mitchell said. "The unique part of the system is its integration into the normal workflow at Mayo."

Mayo has created a "virtual patient" environment that allows the electronic patient to travel through the Mayo internal systems as if that patient were physically present in the halls of the Rochester clinic.

Once the radiographs are received in Rochester, for example, they are electronically routed into the existing PACS and show up in the normal radiology workflow. Angiograms and echoes are routed to the cardiologist for reading, radiographs to radiology, and so forth.

When reports come back from the diagnostic areas, the assigned clinician can review the electronic history on any workstation, view medium-resolution versions of the radiographs, and make treatment recommendations.

At this point, if the physician needs to do a face-to-face consultation with either the referring physician or the patient, a desktop videoconference can be arranged. In the past year, however, videoconferencing has not been necessary in any of the 50 cases, Mitchell said.

"Radiology plays an important part in the process, although it has been one of the more difficult areas to integrate from a process perspective," he said. "We see anywhere from one to 20 images for each case. We have not, and will not, promote use of the system for remote teleradiology. The radiology portion is only for use within a full second-opinion consultation."