A web implementation: the good and the not-so-good.

E-commerce, e-mail, e-greeting, e-this, and e-that everywhere you turn there is a new "e" word for an internet or Web application. We, at the Cleveland Clinic Foundation, have been "e-nlightened" and will discuss in this report the implementation of a web-based radiology information system (RIS) in our radiology division or "e-radiology" division. The application, IDXRad Version 10.0 from IDX Corp, Burlington, VT, is in use at the Cleveland Clinic Foundation and has both intranet (for use in Radiology) and internet (referring physician viewing) modules. We will concentrate on the features of using a web browser for the application's front-end, including easy prototyping for screen review, easier mock-ups of demonstrations by vendors and developers, and easier training as more people become web-addicted. Project communication can be facilitated with an internal project web page, and use of the web browser can accommodate quicker turnaround of software upgrades as the software code is centrally located. Compared with other technologies, including client/server, there is a smaller roll out cost when using a standard web browser. However, the new technology requires a change and changes are never implemented without challenges. A seasoned technologist using a legacy system can enter data quicker using function keys than using a graphical user interface and pointing and clicking through a series of pop-up windows. Also, effective use of a web browser depends on intuitive design for it to be easily implemented and accepted by the user. Some software packages will not work on both of the popular web browsers and then are tailored to specific release levels. As computer-based patient records become a standard, patient confidentiality must be enforced. The technical design and application security features that support the web-based software package will be discussed. Also web technologies have their own implementation issues.

Impact of digital radiography on clinical workflow and patient satisfaction.

Compared to traditional film radiography, digital radiography is believed to improve workflow and patient throughput. Digital radiography permits the technologist to immediately view the quality of the film directly at the modality. Additional workflow improvements, therefore, should be achieved with the integration of the radiology information system (RIS). To learn more about this proposed efficacy, a study was performed at The Cleveland Clinic Foundation (Cleveland, OH) comparing timings in three groups: traditional film radiography; digital radiography; and digital radiography with RIS integration. Our data validated a timesaving of digital radiography over traditional or standard films and an even greater timesaving in a digital radiography/RIS environment.