Teleradiology as a Foundation for an Enterprise-wide Health Care Delivery System1
John David N. Dionisio, PhD,
Ricky K. Taira, PhD,
Usha Sinha, PhD,
David B. Johnson, MS,
Benjamin Y. Dai, MS,
Gregory H. Tashima, BS,
Stephen Blythe, DO,
Richard Johnson, MD and
Hooshang Kangarloo, MD
1 From the Departments of Radiological Sciences (J.D.N.D., U.S., B.Y.D., G.H.T., H.K.), Computer Science (D.B.J.), and Family Medicine (R.J.), University of California, Los Angeles, 924 Westwood Blvd, Suite 420, Los Angeles, CA 90024; the Department of Radiology, Children's Hospital and Regional Medical Center, University of Washington, Seattle (R.K.T.); and the Harris Family Medical Center, Melbourne, Fla (S.B.). Recipient of a Certificate of Merit award for an infoRAD exhibit at the 1998 RSNA scientific assembly. Received March 1, 1999; revision requested April 28; final revision received October 11; accepted October 21. Supported by grant RO1 CA 39063 from the National Cancer Institute. Address correspondence to J.D.N.D. (e-mail: dondi@itmedicine.net).
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Figure 1. Process model for an established teleradiology consultation process between generalists and specialists over a transcontinental, dedicated T1 line.
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Figure 2. Consultation process between PCPs and specialists, which includes initial patient participation in the home page, education, and online scheduling (upper part of diagram); PCP examination of data and request for consultation (left side of diagram); and specialist interaction (right side of diagram).
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Figure 3. Patient home page for a fictitious patient. The patient's picture, demographic data, and reminders appear in the upper left part of the screen. A brief history, entered in a structured format, is displayed in the lower part of the screen. Details of the "Library" and "Schedule" tabs are shown in Figures 4 and 5, respectively. AIDS = acquired immunodeficiency syndrome, Meds = medications, Std = standard.
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Figure 4a. Library of educational resources. (a) With body map navigation of resources, the patient selects the area of interest by clicking on a specific anatomic site (eg, the head). When such an area is selected, three resource lists become available to the patient: general education, risk assessment, and pain and symptom guides. (b) A resource (eg, osteoporosis risk assessment) appears after it is selected from a resource list and opened by the patient.
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Figure 4b. Library of educational resources. (a) With body map navigation of resources, the patient selects the area of interest by clicking on a specific anatomic site (eg, the head). When such an area is selected, three resource lists become available to the patient: general education, risk assessment, and pain and symptom guides. (b) A resource (eg, osteoporosis risk assessment) appears after it is selected from a resource list and opened by the patient.
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Figure 5. Initial assessment phase of the appointment scheduling process. After an inquiry into the patient's chief complaint, the initial assessment provides a series of online questions specific to that complaint. When the initial assessment is completed, the patient can select the date and time of the visit.
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Figure 6a. Consultation request and real-time talk windows. (a) In the PCP module, the consultation modes available to the PCP (talk, e-mail, or submit) appear in the lower right part of the screen. (b) In the consultant module, real-time discussion in the form of a "chat room" is displayed in the lower right part of the screen. Initial assessment data (lower left part of each screen) and the medical history and patient demographics (top part of each screen) are identical in both modules.
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Figure 6b. Consultation request and real-time talk windows. (a) In the PCP module, the consultation modes available to the PCP (talk, e-mail, or submit) appear in the lower right part of the screen. (b) In the consultant module, real-time discussion in the form of a "chat room" is displayed in the lower right part of the screen. Initial assessment data (lower left part of each screen) and the medical history and patient demographics (top part of each screen) are identical in both modules.
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Figure 7. Data model for patient information, which was generated during the data modeling phase of system integration. The patient, PCP, and consultant modules use this common model when retrieving, storing, or displaying patient information. id = identification.
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Figure 8. Technical aspect of the system's integration methods. Java and CORBA are used by the system to integrate its multiple modules. The modules shown may represent anything ranging from user-level patient, PCP, or specialist clients to agent or server processes.
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Figure 9. Overall system architecture, including components not visible to users. Components communicate by using the integration methods shown in Figure 8. Users interact only with their respective clients; clients interact only with their respective agents, which in turn exist only while the clients are logged in. The dynamic nature of these agents facilitates the customizability of the system.
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Copyright © 2000 by the Radiological Society of North America.
