Abstract:
Systems and methods are provided for communicating abnormal or unexpected medical findings to a designated recipient, and documenting the succesful and correct communication to the recipient. One method includes: conducting a radiology examination of a patient and generating a machine radiology image; collecting information about the patient and designated recipient to permit correct communication to the recipient; an interpreter preparing an interpretation of the image, and applying a code to any interpretation classified as abnormal or unexpected; entering and storing in a computer the collected information for patients with an abnormal or unexpected code; a communicator accessing the collected information and communicating the abnormal or unexpected finding to a designated recipient; and entering and storing in a computer documentation of the successful and correct communication of the abnormal or unexpected interpretation.

Description:
CROSS-REFERENCE TO RELATED APPLICATION  
       [0001]    This application claims priority to copending U.S. provisional application entitled, “Process for Obtaining, Reporting and Storing Communication Documentation of Abnormal X-ray Exam Results from Information Systems,” having Serial No. 60/474,171, filed May 29, 2003, which is entirely incorporated herein by reference. 
     
    
     
       FIELD OF THE INVENTION  
         [0002]    The field of the invention is the reporting of abnormal or unusual medical findings from radiologic examinations and diagnostic tests to a designated recipient and documenting and storing the documentation in a computer for future reference.  
         BACKGROUND  
         [0003]    When a physician (e.g., radiologist) who interprets a radiologic image (e.g. X-ray, CAT scan, or MRI scan) finds an abnormal or unexpected result, medical standards require that he communicate this finding to the referring physician, healthcare provider, or other representative. A similar communication procedure is used by a physician who finds abnormal results in other diagnostic procedures, such a tissue biopsies or blood tests. It is important that the physician meet this standard of care, since failure to do so can result in medical malpractice liability. However, there are many obstacles that lie in the way of properly communicating abnormal results.  
           [0004]    One communication method used by interpreting physicians is to mail the report indicating an abnormal or unexpected result to the referring physician. There are several problems with this method. The report itself could be lost in the mail. The address for the referring physician could be incorrect or out-of-date. Even if the report reaches to the referring physician&#39;s office, it may not come to the attention of the referring physician.  
           [0005]    Instead of using the mail, the interpreting physician could call the referring physician to report the abnormal or unexpected result. But doctors are frequently difficult to reach on the phone. If the interpreting physician leaves a message requesting a return call, the interpreting physician might himself or herself be unreachable when the referring physician attempts to return the call. Leaving a voice mail is no guarantee that the physician actually receives the voice mail as it may never be opened or it may be opened by someone else in the physician&#39;s office and not conveyed to the physician.  
           [0006]    Faxing the abnormal results to the referring physician is another alternative, but this has its own set of problems. Fax numbers are often busy for long periods of time, or out of paper. A received fax is easily misplaced in the physician&#39;s office, so that the doctor may never see the fax.  
           [0007]    Finally, an interpreting physician who successfully contacts the referring physician can still be vulnerable to a malpractice claim. It is important that he have proof of a successful contact. Or, if the interpreting physician made a reasonable number of attempts to contact the referring physician but was ultimately unsuccessful, the interpreting physician should also have proof of this.  
           [0008]    There is a need for a reporting system and method that solves these and other problems.  
         SUMMARY  
         [0009]    Systems and methods are provided for communicating abnormal or unexpected medical findings to a designated recipient, and documenting the successful and correct communication to the recipient. One method includes: conducting a radiology examination of a patient and generating a machine radiology image; collecting information about the patient and designated recipient to permit correct communication to the recipient; an interpreter preparing an interpretation of the image, and applying a code to any interpretation classified as abnormal or unexpected; entering and storing in a computer the collected information for patients with an abnormal or unexpected code; a communicator accessing the collected information and communicating the abnormal or unexpected finding to a designated recipient; and entering and storing in a computer documentation of the successful and correct communication of the abnormal or unexpected interpretation. 
       
    
    
     DESCRIPTION OF THE DRAWINGS  
       [0010]    [0010]FIG. 1 is a data flow diagram of the method for communicating abnormal radiological findings.  
         [0011]    [0011]FIG. 2 illustrates an example of a general-purpose computer that can be used to implement an embodiment of the system for communicating abnormal medical findings.  
         [0012]    [0012]FIG. 3 is another view of the system for communicating abnormal medical findings from FIG. 1, focusing on the data produced by the various steps rather than the actors.  
         [0013]    [0013]FIG. 4 is a data flow diagram describing one embodiment of the system for communicating abnormal medical findings.  
         [0014]    [0014]FIG. 5 is a data flow diagram of a method for communicating abnormal or unexpected medical findings. 
     
    
     DETAILED DESCRIPTION  
       [0015]    [0015]FIG. 1 is a data flow diagram of the method for communicating abnormal radiological findings. The actors are: technician  101 ; radiologist  102 ; translator  103 ; communicator  104 ; and recipient  105 ;  
         [0016]    The technician  101  conducts a radiologic examination of a patient. The examination produces a machine-generated radiologic image of the patient. Many different radiologic modalities can be used to produce the image  106 . Examples are X-ray, CT scan, MRI, fluoroscope, PET scans, mammograms, ultrasounds, nuclear medicine studies and interventional exams, but the invention is not limited to only these examples. The image  106  may take the form of a physical film, or it may be a digital image. This image  106  is provided to the radiologist  102 , who is acting as the interpreting physician. The radiologist  102  examines the image  106 , interprets the image  106 , and produces a report  107  of his findings. The report  107  commonly takes the form of dictation, but the report may be prepared by other means, such as handwritten, entered into a computer, etc.  
         [0017]    If the radiologist  102  classifies the findings as abnormal or unexpected, he or she also applies an “abnormal” code to the report  107 , using a coding method appropriate to the report. In the case of a dictated report  107 , the radiologist  102  might say a special keyword such as “Abnormal.” In the case of a computer-entered report, the radiologist  102  might check a field on the screen labeled “Abnormal.” 
         [0018]    The translator  103  takes the report  107  as input and generates a report  108  as output. The report  108  is entered into the computer system  109 . The translation process is specific to the reporting method. A report  107  which was directly entered by radiologist  102  into a computer system would require little if any translation. Translation for a dictated report  107  would be transcription into a report  108  residing on a computer system  109 . The transcription process may involve humans, or may be done by voice recognition software.  
         [0019]    Multiple reports  108  on a number of patients are thus generated and stored in a computer system  109 . Some of these reports  108  contain the “abnormal” code indicating abnormal or unexpected findings. These abnormal findings will be communicated to the physician who referred the patient, or to another healthcare representative. The person receiving this communication is listed as the recipient  105 .  
         [0020]    The communicator  104  obtains from computer system  109  a list  110  of report contact records for all reports  108  with an abnormal code. Each report contact record contains sufficient information about the report  108  and about the recipient  105  to enable the communicator  104  to make contact with the recipient  105  and to report the fact that the patient&#39;s examination produced abnormal or unexpected results. In one embodiment, this information includes the name of the referring physician, his office telephone number, the patient name, and an identifier for the report  107 . In one embodiment, the information in the report contact record information is manually entered into computer system  109 . In another embodiment, the information is extracted from other records in computer system  109 , as described in detail later.  
         [0021]    Using the report contact records  302  on list  110 , the communicator  104  contacts each recipient  105  and reports the abnormal or unexpected results. In a preferred embodiment, this list  110  contains only those recipients  105  who have not yet been successfully contacted by the communicator  104 . In another preferred embodiment, this list  110  does not contain the full report  107 , and therefore the complete findings in the report  108  are not communicated. In example, the report may only state that abnormal or unexpected results were obtained and the patient is advised to contact his or her referring physician immediately or as soon as convenient, depending on the circumstances. Patient privacy is thus maintained.  
         [0022]    The communicator  104  documents a successful communication by entering into the computer system  109  a completed contact record containing details like the name of the party contacted, the time and date of the contact, the phone number where the party was reached, etc. In one embodiment, the computer system  109  stores any transmission verification report provided by the recipient&#39;s facsimile machine. In another embodiment, when a communicator  104  does not enter a completed contact record for a particular report contact record, the computer system  109  provides a reminder to the communicator  104  through an appropriate user interface mechanism such as a dialog box and a warning beep.  
         [0023]    In one embodiment, the computer system  109  automatically contacts each recipient  105  and reports the abnormal or unexpected results via a facsimile transmission. In this embodiment, computer system  109  documents a successful communication by storing any transmission verification report provided by the recipient&#39;s facsimile machine.  
         [0024]    Embodiments of the method and system for communicating abnormal medical findings described in as FIG. 1 can be implemented in software (e.g., firmware), hardware, or combinations thereof. Furthermore, the components of the system can reside on one computer system, or can be distributed among more than one computer system. In some embodiments, the system is implemented in software, as an executable program or programs, and is executed by a special or general-purpose digital computer, or combination of computers, such as a personal digital assistant or personal computer (PC).  
         [0025]    [0025]FIG. 2 illustrates an example of a general-purpose computer that can be used to implement an embodiment of the system for communicating abnormal medical findings. Generally, in terms of hardware architecture, as shown in FIG. 2 the computer  201  includes a processor  202 , memory  203 , and one or more input or output (I/O) devices or peripherals  204  that are communicatively coupled via a local interface  205 . The local interface  205  can be, for example but not limited to, one or more buses or other wired or wireless connections, as is known in the art. The local interface  205  may have additional elements (omitted for simplicity), such as controllers, buffers, drivers, repeaters, and receivers, to enable communications. Further, the local interface  205  may include address, control, and data connections to enable appropriate communications among the aforementioned components.  
         [0026]    The processor  202  is a hardware device for executing software, particularly that stored in memory  203 . The processor  202  can be any custom made or commercially available processor, a central processing unit (CPU), an auxiliary processor among several processors associated with the computer  201 , a semiconductor based microprocessor (in the form of a microchip or chip set), a microprocessor, or generally any device for executing software instructions.  
         [0027]    The memory  203  can include any one or combination of volatile memory elements (e.g., random access memory (RAM, such as DRAM, SRAM, SDRAM, etc.)) and nonvolatile memory elements (e.g., ROM, hard drive, tape, CDROM, etc.). Moreover, the memory  203  may incorporate electronic, magnetic, optical, or other types of storage media. Note that the memory  203  can have a distributed architecture, where various components are situated remote from one another, but can be accessed by the processor  202 .  
         [0028]    The software in memory  203  may include one or more separate programs, each of which comprises an ordered listing of executable instructions for implementing logical functions. In the example of FIG. 2, the software in the memory  203  includes one or more components of the system for communicating abnormal medical findings, and a suitable operating system  206 . The operating system  206  essentially controls the execution of other computer programs, such as the system for communicating abnormal medical findings, and provides scheduling, input-output control, file and data management, memory management, and communication control and related services.  
         [0029]    The system for communicating abnormal medical findings is a source program, executable program (object code), script, or any other entity comprising a set of instructions to be performed. When a source program, then the program needs to be translated via a compiler, assembler, interpreter, or the like, which may or may not be included within memory  203 , so as to operate properly in connection with the operating system  206 .  
         [0030]    The peripherals  204  may include input devices, for example but not limited to, a keyboard, mouse, scanner, microphone, etc. Furthermore, the peripherals  204  may also include output devices, for example but not limited to, a printer, display, facsimile device, etc. Finally, the peripherals  204  may further include devices that communicate both inputs and outputs, for instance but not limited to, a modulator/demodulator (modem; for accessing another device, system, or network), a radio frequency (RF) or other transceiver, a telephonic interface, a bridge, a router, etc.  
         [0031]    If the computer  201  is a PC, workstation, or the like, the software in the memory  203  may further include a basic input output system (BIOS). The BIOS is a set of essential software routines that initialize and test hardware at startup, start the operating system  206 , and support the transfer of data among the hardware devices. The BIOS is stored in the ROM so that the BIOS can be executed when the computer  201  is activated.  
         [0032]    When the computer  201  is in operation, the processor  202  is configured to execute software stored within the memory  203 , to communicate data to and from the memory  203 , and to generally control operations of the computer  201  pursuant to the software. The system for communicating abnormal medical findings and the operating system  206 , in whole or in part, but typically the latter, are read by the processor  202 , and perhaps buffered within the processor  202 , and then executed.  
         [0033]    When the system for communicating abnormal medical findings is implemented in software, as is shown in FIG. 2, it should be noted that the system for communicating abnormal medical findings can be stored on any computer readable medium for use by or in connection with any computer related system or method. In the context of this document, a “computer-readable medium” can be any means that can store, communicate, propagate, or transport the program for use by or in connection with the instruction execution system, system, or device. The computer-readable medium can be, for example but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, system, device, or propagation medium. A non-exhaustive example set of the computer-readable medium would include the following: an electrical connection having one or more wires, a portable computer diskette, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM, EEPROM, or Flash memory), and a portable compact disc read-only memory (CDROM). Note that the computer-readable medium could even be paper or another suitable medium upon which the program is printed, as the program can be electronically captured, via for instance optical scanning of the paper or other medium, then compiled, interpreted or otherwise processed in a suitable manner if necessary, and then stored in a computer memory.  
         [0034]    In an alternative embodiment, where the system for communicating abnormal medical findings is implemented in hardware, the system for communicating abnormal medical findings can be implemented with any or a combination of the following technologies, which are each well known in the art: a discrete logic circuit(s) having logic gates for implementing logic functions upon data signals, an application specific integrated circuit(s) (ASIC) having appropriate combinatorial logic gates, a programmable gate array(s) (PGA), a field programmable gate array(s) (FPGA), etc.  
         [0035]    [0035]FIG. 3 is another view of the system for communicating abnormal medical findings from FIG. 1, focusing on the data produced by the various steps rather than the actors. Radiologic images  106  of a patient are generated by a technician  101 . The radiologist  102  interprets each image  106  and produces a report  108 , which may include an abnormal result code. Multiple reports  108  for multiple patients are stored in a radiology report database  301 . In this example, the translation described in connection with FIG. 1 is shown as optional. Reports  108  with an abnormal code are extracted from radiology report database  301 , and a list  110  of report contact records  302  is produced using the extracted abnormal reports.  
         [0036]    Each report contact record  302  in the list  110  contains contact information for a recipient  105 , such as office telephone number, office fax number, office mailing address, emergency phone number, etc. In one embodiment, reports  108  contain this contact information, so that report contact records  302  are derived from radiology report database  301 . In another embodiment, report contact records  302  are stored in a separate database table. The two databases or tables are linked by a recipient identifier, which is common to both. The identifier may be a physician&#39;s name, identification number, or any other unique identifier. The recipient may be the patient or a designated representative.  
         [0037]    A separate table for report contact records  302  is especially advantageous when the radiology report database  301  is maintained by an entity such as a hospital which is not the entity using the system to report results. In this case, the radiology report database  301  is likely to contain out-of-date contact information. In this embodiment, the system also provides a mechanism for updating the report contact records  302 .  
         [0038]    On completion of a successful communication, a completed contact record  303  is generated, usually by the communicator  104 . The completed contact record  303  may contain details, such as the name of the party contacted, the time and date of the contact, the phone number where the party was reached, etc. Note that the name of the party contacted and the phone number are not necessarily the same as the recipient&#39;s name. While the recipient is usually the referring physician, the party contacted is often a nurse or receptionist. Similarly, there may be multiple contact phone numbers that are attempted, and a party is reached at one or more of these numbers.  
         [0039]    [0039]FIG. 4 is a data flow diagram describing one embodiment of the system for communicating abnormal medical findings  400  where the entity which maintains the radiology report database  301  is different than the entity that communicates the abnormal or unusual results. The hospital information system  401  is a collection of various computer system components residing in a hospital. The hospital information system  401  is divided into subsystems, such as billing  402 , pharmacy  403 , medical records transcription  404 , radiology  405 , etc. In this embodiment, the transcription subsystem  404  produces radiology reports  108 , which are added to the radiology report database  301 . The radiology report database  301  is part of the radiology information subsystem  405 . This subsystem also includes imaging subsystem  406 , the component that generates and stores the radiologic images  106  that are associated with reports  108 .  
         [0040]    In one embodiment, one or more of these subsystems uses the Health Level 7 (HL7) set of standards to communicate with each other. HL7 is a set of standards for exchanging healthcare information, such as patient registration, patient insurance, appointment scheduling, and clinical reports and results (e.g., laboratory, pharmacy, radiology, and other diagnostic services). HL7 specifies the format, structure, and sequence of that data between information providers and information clients. HL7 messages are based on activities in the healthcare arena, such as “admit a patient,”“order an x-ray,” and “report an x-ray result.” Messages are built of segments (e.g., header, patient id, order info, and result info), and segments are built of fields (e.g., sending application, patient name, ordering provider). The syntax of HL7 messages is based on Extensible Markup Language (XML), which is a metalanguage for defining other languages. HL7 will be well understood by one skilled in the art of healthcare information systems.  
         [0041]    The radiologist  102  (FIG. 1) who interprets images  106  to produce reports  108  is associated with hospital, but is not usually employed by that hospital. Typically, the radiologist  102  organizes with other radiologists into a practice group. Because the practice group is separate from the hospital, it has its own radiology practice information system  407 , which consists of various components for patient billing  408 , scheduling of appointments  409 , etc.  
         [0042]    When a report  108  for a particular patient contains an abnormal or unexpected finding, it is the responsibility of the radiologist  102 , rather than the hospital, to report the abnormal findings. The abnormal findings should be communicated to the physician who referred the patient to the radiologist, or to another healthcare representative whom the patient has designated.  
         [0043]    To enable the reporting of these findings, the radiology information subsystem  405  also contains the system for communicating abnormal medical findings  400 . The system logically consists of several components or modules, including a hospital radiology IS interface (HRIS)  410 , a contact information extracter  411 , and a completed contact documenter  412 . These three components are logically part of the radiology information subsystem  405 , but their physical locations may vary.  
         [0044]    In a preferred embodiment, the contact extracter  411  and completed contact documenter  412  are physically located at the practice group office with the other components of the system for communicating abnormal medical findings  400 , and HRIS interface  410  is physically located at the hospital. HRIS interface  410  communicates with the contact extracter  411  and completed contact documenter  412  through any mechanism which allows remote communications between computer components, such as a wide area network, a modem, etc.  
         [0045]    As explained in connection with previous figures, the system for communicating abnormal medical findings extracts reports  108  that contain abnormal results, and generates a list  110  of report contact records  302  containing contact information associated with the abnormal reports. In this embodiment, the hospital information system  401  and the radiology practice information system  407  are separate, so that the system for communicating abnormal medical findings does not have direct access to radiology report database  301  containing the reports  108 . HRIS interface  410  provides the interface between the two systems.  
         [0046]    In a preferred embodiment, HRIS interface  410  intercepts HL7 messages  413  indicating that reports  108  are being added to radiology report database  301 . HRIS interface  410  is capable of intercepting HL7 messages directed to radiology report database  301 , and of parsing the messages to determine which are of interest and should be further processed. For example, HRIS interface  410  sees report messages for all radiologists, but only reports those associated with a specific set of radiologists (those in the practice group that is operating the system  400 ) that need further processing. All others are filtered out. Additional filters may be used, for example, to include or exclude reports based on dates or date ranges, or to include or exclude based on a specific radiologist within the group. Finally, only report messages indicating an abnormal result are reported.  
         [0047]    When a report message of interest has been identified, the system for communicating abnormal medical findings extracts contact information from the report message to produce a report contact record  302 . In the embodiment of FIG. 4, this functionality is performed by contact extracter  411 , but this functionality could reside instead in HRIS interface  410 . If report message contains an identifier for the referring physician but does not contain sufficient contact information (e.g., no phone number), then contact extracter  411  utilizes the contact database  414  to determine additional contact information based on the identifier.  
         [0048]    The report contact records  302  produced by contact extracter  411  are provided as output and used by communicator  104  to contact a particular recipient and to report the abnormal result to that recipient. The communicator  104  then interacts with completed contact documenter  412  to record the details of a successful contact into a completed contact record  303 .  
         [0049]    [0049]FIG. 5 is a data flow diagram of a method for communicating abnormal or unexpected medical findings. This method is similar to the method of FIG. 1, but is used communicate abnormal results for medical tests rather than radiology reports. Tests may include: blood tests such as pregnancy and HIV; tissue cultures such as pap smears, biopsies, throat cultures, etc. The actors are: technician  501 ; physician  502 ; communicator  503 ; and recipient  504 ;  
         [0050]    The technician  501  performs a medical test on a patient, which involves taking a sample and producing a result  505 . This result  505  is provided to the interpreting physician  502 , who produces a report  506  of his or her findings. The report  506  commonly takes the form of dictation, but that report may be prepared by other means, such as handwritten, entered into a computer, etc.  
         [0051]    If the physician  502  classifies the findings as abnormal or unexpected, he or she also applies an “abnormal” code to the report  506 , using a coding method appropriate to the report. In the case of a dictated report  506 , the physician  502  might say a special keyword such as “Abnormal.” In the case of a computer-entered report, the physician  502  might check a field on the screen labeled “Abnormal.” The Report  506  may optionally undergo translation, such as from a dictated report to a report entered into the computer system  507 .  
         [0052]    Multiple reports  506  are thus generated and stored in computer system  507 . Some of these reports  505  contain the “abnormal” code indicating abnormal findings. These abnormal findings will be communicated to the physician who referred the patient, or to another healthcare representative. The person receiving this communication is the recipient  504 .  
         [0053]    The communicator  503  obtains from computer system  507  a list  508  of report contact records for all reports  506  with an abnormal code. Each report contact record contains sufficient information about the report  506  and about the recipient  504  to enable the communicator  503  to make contact with the recipient  504  and to report the fact that the patient has abnormal results. In one embodiment, this information includes the name of the referring physician, his office telephone number, the patient name, and an identifier for the report  506 . In another embodiment, the information in the report contact record is manually entered into computer system  507 . In another embodiment, the information is extracted from other records in computer system  507 , as described in detail later.  
         [0054]    Using the report contact records on list  508 , communicator  503  contacts each recipient  504  and reports the abnormal results. In a preferred embodiment, this list  508  contains only those recipients who have not yet been successfully contacted by communicator  503 . In a preferred embodiment, list  508  does not contain the full report  506 , and therefore the complete findings in the report  506  are not communicated. Patient privacy is thus maintained.  
         [0055]    The communicator  503  documents a successful communication by entering, into the computer system  507 , a completed contact record containing details like the name of the party contacted, the time and date of the contact, the phone number where the party was reached, etc.  
         [0056]    The foregoing description has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiments discussed, however, were chosen and described to illustrate the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications are suited as to the particular use contemplated. All such modifications and variation are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly and legally entitled.