Low complexity, adaptable, image -capable solution for inter-clinician communication.

摘要

Communication among clinicians about patients, such as referrals, reports, or informal "curbside consults" is vital to health care. Yet traditional methods that rely on telephones, fax machines, or face-to-face consultation are becoming inefficient in the face of growing fragmentation in the health system, which requires more collaboration among a wider circle of clinicians. New methods such as e-mail, Internet discussion groups, electronic medical records, and picture archive communication systems are either too unstructured or too costly, particularly in smaller clinics where most clinicians practice.;EyePACS is a system designed and tested in this dissertation that resolves these problems in eye care, but is generalizable to any clinical domain. EyePACS is an open source, open access system that builds on simple familiar components, including the problem-based exam record and standard Web browsers. It eliminates barriers to access and use and operates smoothly with relevant health care systems and diagnostic devices.;Since images are crucial for eye care, EyePACS also includes image processing tools that are specific for ocular images. Current imaging applications in eye care use general-purpose algorithms not optimized for ocular imaging. A new image processing algorithm, Multiscale Retinex with Color Restoration, was adapted for ocular imaging. Field tests showed that clinicians preferred viewing enhanced images, but enhancement did not significantly improve their clinical performance.;31 Clinicians were recruited from a wide range of clinical settings to use EyePACS over 2.5 years. They generated 1,122 cases, successfully adapting EyePACS for referrals, reports, teaching, rural telemedicine, and diabetic retinopathy screening. EyePACS was also used to study a new approach to glaucoma screening that uses communication between screening sites and treating clinicians to replace standalone screening devices. Glaucoma screening using EyePACS showed specificity of 86% and sensitivity of 78% in detecting the need for glaucoma treatment in a population of individuals at risk for glaucoma. This compares favorably with the performance of screening devices, thus showing that EyePACS could significantly improve accuracy of glaucoma referrals in practice.;Flexible, powerful, freely accessible, standards-compliant, image-capable communication among healthcare providers can be realized by simple means, empowering clinicians to meet their communication needs.