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Case Study #4: Digital Management in Medical Radiography

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Over the past decades, the role of Radiologists has been essential in the clinical-

therapeutic management of patients. Therefore Radiologists' responsibilities and duties, and

liabilities for patient care continue increasing. The increase in liabilities and duties exposes the

radiologist professional to higher risks of legal claims that may arise from the interventional

procedures. Studies show that errors in radiology practices are very high. However, the common

errors, which amount to about 5%, are related to the radiologists' interpretations, most of which

are minor and are resolved before harming the patients (Seeram, 2019). Nevertheless, many

radiologist errors have harmed the patients and have resulted in medical malpractice lawsuits.

Such as the cases presented of the 38-years old emergency medical physician (Berlin, 2017), the

case presents major challenges such as ethics on data and professional practices, security, and

breach of practice policies.

Although the department of radiology is among the pioneer clinical department to

implement electronic systems, the Picture Archiving and Communications System (PACS) and

radiology information system (RIS) that have enhanced patient care (Seeram, 2019), the

increased malpractice lawsuits indicates the urgency to address the efficiency of the Radiologist's

practices. The application of modern advanced information technology techniques can be

essential in reducing the error and enhances the ethics and flow of communication, boosting

patient care significantly reducing problems of the physician-patient relationship and

inappropriate medical care errors.

In the provided cases, the emergency department physician experienced mild chest

discomforts, which led him to request a chest radiograph while he was on his shift at the hospital.

The physician ignored the patient registration process, in which the radiograph technologies

allowed him to as a collogue (Berlin, 2017). The physician interpreted his radiograph and did not
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consult the Radiologist and took with him the radiograph. The process was unnoticed by the

radiologists and the hospital management as the physician was not billed for the services.

However, after seventeen months, the physician was diagnosed with lung cancer that has at

incurable stages. The small tumor was detected during the first radiograph that the emergency

physician interpreted without the help of a Radiologist. If the Radiologist's interpretation were

provided in the first radiograph, the emergency physician tumor would have been cured. This act

triggered the emergency physician to file a lawsuit against the Radiologist and the hospital for

malpractice (Berlin, 2009). Although the emergency doctor died and the family won the case, the

whole process would have been avoided if the hospital had an existing mechanism to enhance

ethics and protocols among the employees and even the care practices. Although the emergency

physician may have only been a single case that resulted in a lawsuit, the audacity of not

registering the radiograph seems to be the norm in the facility.

The case presents a working healthcare environment prone to much legal malpractice. An

employee can move from one department and gain access to vital data and tools without

following the proper procedure and authority. The facility's leadership should embrace a

management information system that would drive an ethical-based working culture in the

organization. The informatics system, such as the electronic health records systems (EHRs),

provides a monitoring strategy to ensure that the proper procedure is followed (Langer et al.,

2018). The integration of the radiography tools with the EHRs will ensure that every image or

any process in the radiology department is captured and follows proper authentication

procedures.

Every user of the EHRs has designated functionality matching their professionalism

while accessing the system authentication such as personal passwords, or biometric is required.
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When all the facilities system are integrated into the EHRs, such as the reimbursement system,

reception system, the RIS system, the authentication and hierarchy of authority is followed

(Nance et al., 2017). For example, if EHRs, the system was functional in the care facility, the

Radiologist would be the one to authorize the radiograph technologist to take the emergency

physician radiograph and would be presented with the data for proper interpretation. However, it

is not the case as the technologist was only required to work under their capacity and provide the

radiologist data, which are in print form for interpretation. Furthermore, the ERHs capture every

department data stored in a central position, where it is easily accessible and available (Langer et

al., 2018). Therefore, the Radiologist could have logged in to the system, retrieved the data

captured from the emergency physician radiograph, and provided a professional interpretation

that would have resulted in the early treatment of lung cancer.

The proper registration of patients is a requirement in the EHRs, where the facility

does not provide care to unregistered patients. The capturing of the patient information is

necessary for proper filling of the patient's records and the availability of these records in future

treatment, and the patient records also are important for a physician-patient relationship as the

physician can effectively diagnose the patient, provide proper intervention and avoid any

medical errors (Berlin, 2017). The patient registration also captures the patients' billing methods

and demographic information essential for other departments such as the finance department. In

our case, the hospital seems to have a system that captures patient information, but the

emergency physician uses the loophole and accesses the service, which results in substandard.

The failure of the technologist to capture the patient's information shows the disadvantage of the

facility system, as EHRs required the patient to register at the reception and are directed to the

respective department for the care. The system also allows the patients to schedule a meeting
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with a physician, in our case, the Radiologist. The registration and availability of patients'

information would have been easy proof of the physician-patient relationship, which took much

energy from the plaintiff attorneys to prove its existence. In the real sense, under EHRs, the

physician-patient relationship rare results in malpractices (Seeram, 2019).

According to Langer et al. (2018), the information management system addresses data

loss and misplacement issues. The emergency physician took the radiograph with him after the

interpretation, leaving no copy at the radiology department. Hence, the Radiologist would not

have been in a position to offer his/her professional review of the data. The capturing and storing

of data is essential to retrieve the data and reanalyze or collaborate with other physicians for

more analysis. This was not the case with the emergency physician; he took the data, and there

were no records in the system. The Radiologist was aware of the existence of data after 17

months (Berlin, 2009). The emergency physician acted on his capacity as a physician and trusted

his interpretations, which resulted in the wrong, thus highlighting the major issues that the EHRs

were designed to address, the availability of data, and the reduction of medical error through

physician collaboration. The Radiologist would have shared the interpretation with the

emergency physician in a physician- to patient capacity and at a physician-to-physician

collaboration to have involved other medical physicians in prescribing the effective treatment

intervention (Seeram, 2019). Nevertheless, this would only be possible under the EHRs.

The healthcare facility's accountability is also questionable in the provided case, and all

the involved parties were failed in performing the diligence duties. The technologist failed to

capture the patient information. The Radiologist was not available during the radiography and

did not bother about what happened on his area of jurisdiction when he was away. The

emergency physician acted on the capacity of his collogue and performed the procedure
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unauthorized (Berlin,2009). He left with vital data, which would have been of help to his health

condition if the right procedure would have been followed. All three parties played a role in the

error, resulting in a malpractice lawsuit and the patient's death. In the EHRs, all the system users

are provided with the work scope and monitor the activities on the system. The system utilizes

modern emerging technologies such as the Internet of things and data mining. The (IoT) allows

the system to integrate with other electronic devices such as the mobile phone, embedded

systems necessary to enhance patient care (Nance et al., 2017).

The new technologies allow the users to access the system at any convenient place, and

they can perform their duties while in a different location. For instance, the Radiologist would

have been able to interpret the radiography even if he was not on the hospital premises. Most of

all, the hierarchy and the system's authentication ensure that all the policies in place are enforced.

These would reduce errors such as those presented in these cases, resulting in reduced lawsuits

and increased healthcare services quality.

References

Berlin, L. (2017). Radiologic errors and malpractice: a blurry distinction. American Journal of

Roentgenology, 189(3), 517-522.

Berlin, L.MD, FACR. (2009, April 6). Patient registration and processing. Radiology

TodayMagazine. https://www.radiologytoday.net/archive/rt_040609p27.shtml#sthash.39

u5dtgg.dpuf

Langer, S. G., Ramthun, S., & Bender, C. (2018). Introduction to digital medical image

management: departmental concerns. American Journal of Roentgenology, 198(4), 746-

753.

Nance Jr, J. W., Meenan, C., & Nagy, P. G. (2017). The future of the radiology information

system. American Journal of Roentgenology, 200(5), 1064-1070.

Seeram, E. (2019). Digital Radiography: Physical Principles and Quality Control. Springer.