With the modernization of radiology departments, there is an increasing need for a better means of communication. Radiologists are now more likely to be clustered by modality or by organ systems, which provides advantages of being closer to patients, scanners, and technologists, but raises barriers to communication. Similarly, there is less likely to be one central reading room where clinicians can consult radiologists. Teleradiology has become an integral part of night and weekend coverage for many departments. Finally, with the increasing availability of web-based image viewing, clients and fully functional radiologist-grade PACS applications, clinicians are understandably less motivated to consult radiologists in person. Lack of communication is frequently cited by the Joint Commission as a major contributor to sentinel events(1), so it is incumbent upon radiology departments to provide channels for improved communication in today’s clinical environment.

Many new forms of communication exist today, including technology which allows real-time communication over the Internet, as best exemplified by Google Talk(2). However, because of the sensitive nature of medical communication, which includes patient identifying information and the need to be HIPAA-compliant, outside technologies are not suitable for the clinical environment. Also, these outside technologies do not provide integration into PACS or other hospital information systems. Fortunately, the same technologies are available as open standards and open-source software, such that a radiology department can easily implement a secure intra-departmental platform for communications.

To better incorporate the chat client into the radiologist workflow, an integration was created between the chat client and the PACS client using a Microsoft Component Object Model (COM)(7). A button is provided in the chat client that sends the context of the PACS to another user by sending a link that the receiving user can click on to automatically load the study in their PACS client. Study specific information is automatically sent when using one of the standard macros in cases where a user needs more information on a study, or otherwise needs to quickly send information such as the medical record number or accession number.

In very preliminary stages, we have logged 1,263 individual conversations from clinical users and our radiology IT department over the course of approximately two weeks.

Because existing open standards for message passing were used, other commercial and open-source applications such as Apple’s iChat(8) or Pidgin(9) are able to connect to the internal chat server. Though these third party clients do not provide PACS integration, they give the users the option of turning their existing chat clients into a HIPAA-compliant clinical tool. This also significantly lowers the barrier to entry in that a radiology department only needs to install a readily available open-source XMPP server, such as eJabberd, to implement a chat communication solution. Only configuration is required to implement the basic functionality; additional development is optional. Regardless of the client used to connect to the chat server, all messages can be stored and transmitted completely within the department intranet, thus maintaining HIPAA compliance. All chats and messages are logged to a granular level with timestamps to provide usage statistics for later analysis, as well as clinical documentation.