Although technical systems for the digital creation, storage, and viewing of images and reports have matured, image and report data streams often remain segregated in the medical record throughout their lifecycle. The reader may misunderstand the meaning of a text report without knowledge of image interpretation. The process of correlating the findings described in a text report to the findings in the source images requires expertise and effort on the part of the reader. Pathologists often show histologic images of biopsy or resection specimens to colleagues during multidisciplinary conferences/tumor boards.
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A primary care doctor may review a photograph taken by a dermatologist to assess the change in a skin lesion. An oncologist may review a positron emission tomography (PET) scan to show a patient how the disease burden has changed. A surgeon may wish to review images of computed tomography (CT) scan for surgical planning. However, in other specialties, the source images are increasingly available for review. In some specialties, the text report may be the only available documentation of the image findings.
The report is transmitted to the electronic health record (EHR), where the report guides patient management. Image-centric specialists create a report of their findings by either typing a narrative description of findings, dictating a report for subsequent transcription, or using a voice recognition application.
An image is evaluated on a computer screen, video monitor, or microscope. Īt a conceptual level, reporting workflow is similar for most image-centric specialists.
“Despite the clear importance of the imaging report and despite radiologists’ daily work in a field defined by rapid progression of new techniques and innovative digital tools, most radiologists continue to create reports in a manner strikingly similar to that of their predecessors practicing 100 years ago”. Many authors have documented the somewhat primitive means through which these image-centric specialists document their findings: Diagnostic radiology and pathology are two prototypical image-centric specialties. Many medical specialists review images while diagnosing and treating diseases. These efforts have led toward the development of an Integrating the Healthcare Enterprise (IHE) profile that will serve as a foundation for interoperable interactive multimedia reporting. This paper describes the standard-based infrastructure and communications to fulfill recently defined clinical requirements through a consensus from an international workgroup of multidisciplinary medical specialists, informaticists, and industry participants. Lessons learned in the digital transformation of radiology and pathology can serve as a basis for interactive multimedia reporting (IMR) across image-centric medical specialties. These provide the foundation to discuss enhanced reporting. International standards have enabled the digitization of image acquisition, storage, viewing, and structured reporting. Most of these solutions rely on proprietary single-vendor systems for viewing and reporting in the absence of any encompassing industry standards to facilitate interoperability with the electronic health record (EHR) and other systems. Forward-thinking centers and early adopters have created interactive reports with multimedia elements and embedded hyperlinks in reports that connect the narrative text with the related source images and measurements.
Images and reports often reside in separate silos in the medical record throughout the process of image viewing, report authoring, and report consumption. Despite technological advances in the analysis of digital images for medical consultations, many health information systems lack the ability to correlate textual descriptions of image findings linked to the actual images.
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