Peter M. Kuzmak

Frequently when patient and study identification information (patient name, patient identification, date of birth, sex, and accession number) are manually entered at a modality, typographical errors occur that have to be corrected before the acquired images can be matched to the proper patient and study on a picture archiving and communication system (PACS). The Digital Imaging and Communication in Medicine (DICOM) Modality Worklist service alleviates these problems by automatically transferring this data from the radiology information system (RIS) to the image acquisition modality. The technologist then does not have to manually re-enter the data to place it into the image files. With modality worklist, precise patient and study data are obtained and placed into the image headers with no typographical errors. When the images are sent to the PACS, they match the corresponding patient and study records, and are immediately incorporated into the electronic patient record. While modality worklist does replace the manual keying of the data and virtually eliminates typographical problems, it introduces a new source of human error: the incorrect selection of the patient and/or study from the computerized worklist, and the resultant mislabeling of the images. When these mislabeled images are sent to the PACS, they are immediately associated with the wrong patient and/or study, where they potentially may cause serious harm. The goal of this report is to raise awareness to this problem, to identify the major causes of these errors, and to offer some practical suggestions on how to minimize them.

The US Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the health care enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire images from multiple sources and store them directly into the online patient record. The VA can obtain both radiology and nonradiology images using DICOM, and can display them on low-cost clinican’s color workstations throughout the medical center. High-resolution gray-scale diagnostic-quality multimonitor workstations with specialized viewing software can be used for reading radiology images. The VA’s DICOM capabilities can interface six different commercial picture archiving and communication systems (PACS) and more than 20 different image acquisition modalities. The VA is advancing its use of DICOM beyond radiology. New color imaging applications for gastrointestinal endoscopy and ophthalmology using DICOM are under development. These are the first DICOM offerings for the vendors, who are planning to support the recently passed DICOM Visible Light and Structured Reporting service classes. Implementing these in VistA is a challenge because of the different workflow and software support for these disciplines within the VA hospital information system (HIS) environment.