Facilitating image sharing for patients transferred to a tertiary care center through process assessment and identification of quality indicators.

From the 2018 HVPAA National Conference

Roshni Patel (University of Texas Southwestern Medical Center, Dallas, TX;), Cecelia Brewington (University of Texas Southwestern Medical Center, Dallas, TX;)


Imaging studies play an integral role in diagnosing, documenting, and managing disease across specialties. Image availability during inter-hospital transfers remains a barrier of care. Cloud-based sharing, rather than CD transfer, provides an important opportunity to improve patient care. Even when available, the use of cloud-based sharing (lifeIMAGE) remains poorly understood.


The aim of this study was to assess the current state of imaging transfers via lifeIMAGE in order to identify barriers to imaging handovers for patients transferred from outside hospitals to UTSW’s tertiary care center, Clements University Hospital (CUH).


Internal Medicine residents were surveyed to shed light on the current state of image transfers. The process for uploading imaging from CDs was highly variable: 34% of surveyed residents directly import images from the CDs into lifeIMAGE. 30% send CDs to radiology, 25% view images but do not import. 72.7% of residents expressed repeat imaging was required in at least half of the patients because they were transferred without imaging. We then sought to identify the current state of imaging handoff.

We conducted a retrospective study of patients transferred to CUH ED from outside hospitals. 4,256 transfer logs spanning 9 months were sorted. Charts from the two non-UTSW facilities that transferred the highest volume of patients were reviewed to determine: 1) If outside imaging and/or interpretation was uploaded, 2) If the patient was re-imaged, 3) If diagnosis was changed for patients who were re-imaged, and 4) the time that the re-imaging was completed.



lifeIMAGE analytics showed 96% of the exams that were received were from CDs, whereas 4% were from cloud. Average time for patient arrival to CD import was 133 hours. 38.8% of patients had re-imaging done at CUH after transfer. Diagnosis was changed for 2% of the patients after reimaging. The average length of time from the time of transfer request to time of repeat image after transfer was 24.6 hours. Of the transferred patients with images uploaded, 10% were reimaged, in contrast to the 56.7% of patients transferred without images uploaded who were reimaged.


Reimaging is an important consequence of inability to access images in a timely manner. Our study was unique in that it evaluated non-trauma patients, yet it was consistent with studies in trauma patients that found 50-60% reimaging rate after transfer. The process map we developed improved documentation and understanding of the current state of imaging transfers. Ideally, lifeIMAGE would facilitate image sharing such that a patient’s imaging would be available in the EMR for immediate use upon patient arrival, yet our data shows that the capability of cloud-based transfer is widely under used.

Implications for the Patient

Despite the growing importance of imaging, accessing and distributing these images continue to pose barriers to patient care, especially when patients are transferred between facilities. Patient safety, treatment delays, and increased healthcare costs are implications of ineffective transfers.

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