The usage of mobile devices for radiology purposes increased in the last few years with the availability of smartphones. The first mobile app used for radiology purposes was approved by FDA in 2011 after an initial rejection in 2010.
A mobile device with smart phone capabilities can be used as an alternative medical device with limited features that can accessed from anywhere without depending on a desktop client. However, it’s not a complete replacement for desktop pc but still need a desktop pc to perform some complex tasks.
A Radiology information system (RIS) is an integrated suite of various software components responsible for patient management, workflows, reports, orders and billing, authorisation, image storage (PACS) etc. The main purpose of RIS is to manage radiology activities from referral request to scanning to report. The patient management module is either internal or external integrating with hospital information system or EHR.
In this comparison study, range of functionalities implemented in mobile apps to access radiology based information by each RIS vendor will be compared and discussed. The scope of comparison was limited to 3 Australian based RIS vendors namely Kestral karisma, GE Centricity, I-MED.
Kestral computing is an Australian operated organisation developing radiology and pathology solutions. Its flagship product karisma is a web based RIS application with features accounting, reporting, dictation etc. It developed a mobile app Karisma mobile to access its RIS server from iOS and Android platforms based devices.
GE healthcare is a unit of GE Australia providing medical technologies and services. GE centricity RIS-IC is RIS web application developed by GE healthcare. It’s integrated with GE Centricity PACS solution to implement patient centric workflow management in radiology. It developed a mobile app AccessNow to enable limited functionality of its integrated RIS server accessed on iOS and Android platform based mobile devices.
I-MED Network radiology, an Australian network of medical imaging clinics providing radiology services. It developed I-MED mobile app to access its RIS/PACS server on iOS and Android based devices.
The purpose of any radiology mobile app is to share the reports and images and to perform complex radiology tasks with an easy interface on a range of mobile devices. The following criteria were used for comparison as most of the mobile RIS functionalities falls in one of this criteria.
This criteria discusses the functionalities specific to usability. It measures the easiness of interaction to perform an action on a mobile device when compared to that of a desktop pc.
Usability is more important and is a key efficiency factor when interacting with a complex system. For example adding annotations in image areas with hand writing or sketching. This enables the user to use this functionality instead of writing detailed descriptions in the report and can be quickly completed and easy to interpret by others.
This criteria discusses the functionalities that enable data sharing and workflows. Sharing is a key data quality factor. For example in radiology, patient reports and images are shared among the users as part of the workflow for documenting first or second opinion.
This criteria discusses the functionalities that can be accessed from various types of mobile platforms. Most of the vendors were having mobile apps specific to one or two mobile platform(s) I.e. IPhone and Android. Mobility may be possible indirectly with a mobile web browser for other platforms if RIS application is a web based.
The following is table listing the range of functionalities categorized by the above criteria that are possible in every mobile RIS/PACS app at minimum
|1.||Search for patient with demographic details||Usability|
|2.||View Images from radiology server||Sharing|
|3.||View Reports from radiology server||Sharing|
|4.||Image activities (Zoom, Pan, Rotate etc.), annotation||Usability|
|5.||Report dictation with voice recognition||Usability|
|6.||Access from web, cloud, smart phones and tablets of various platforms||Mobility|
|7.||Search for patient history and reports||Usability|
|8.||Comparing with prior images/studies||Usability|
|9.||Upload images||Usability, Sharing|
Findings from comparison
The following table shows range of functionalities available in the compared mobile apps categorised by criteria.
|Criteria||Kestral Karisma||GE Centricity AccessNow||I-MED|
|Mobility||Available on iPhone, iPad, but not on android and windows phone. Web based system with limited features can be accessed from tablets.||Available on Android and IPhone phones.
A Web based system. Accessed from any mobile web browser.
If accessed from web, dependent native functionality like sensors may not be possible.
|Available on Android and IPhone apps, IPad, A web based system. Accessed from any mobile web browser in other platforms.
If accessed from web, dependent native functionality like sensors may not be possible.
|Usability||Simple to use, Minimum UI and features.
Notifications, Badge numbers, Report lists navigation
No image viewing
No search functionality, users work on only notified reports.
Dictation and Authorisation support.
|Simple to operate, Minimum UI and features.
Search functionality with patient demographics. Supports imaging activities zoom, pan, scroll, W/L
No dictation support, split screen comparison with prior images, No Authorisation.
|Simple to use, Minimum UI and features.
Search functionality with in the history of visits.
Image functions zoom, pan.
No dictation support or compare with prior images or reports, functionality, No authorisation.
|Sharing||Reports and Images shared between users, Workflows
Users can view and edit reports, dictate, and send voice files to server. Ability to authorise reports
|Reports and images shared between users
No specific workflows
Users can view reports and images.
|Reports and Images sharing.
Retrieve reports and images of referred patients.
Retrieve recent examination requests.
The following table shows range of functionalities available in the compared mobile without any categorisation.
|Functionality||Kestral karisma||GE centricity AccessNow||I-MED|
|Retrieve images from server||No||Yes||Yes|
|Image functions( zoom ,pan, scroll)||No||Yes, supports zoom, pan, and scroll.||Yes, supports zoom and pan only|
|2D/3D, MIPR capabilities||No||Yes||No|
|Retrieve reports from server||Yes||Yes||Yes|
|Retrieve tasks from server||Yes, with the help of push notifications of reports to work||No||Yes, only examination requests|
|Search||No functionality offered||Yes, Search referred patients with demographic details||Yes, Search only visited histories.|
|Comparison||No comparison offered.||Yes, comparison with prior images||No comparison|
In all the compared apps, it was observed that the minimum functionality implemented was reporting (with or without imaging).
Karisma notifications is a good usability feature which informs a user about the reports that requires user authorisation without opening the app and display badge numbers on top of mobile app icon. Without this, the user has to open the app, manual check for new reports and close the app. On opening app, reports that require authorisation are displayed in a list view and users can quickly open a report and edit and send back to radiology clinic. Users were able to dictate using mobile integrate voice system.
Karisma mobile supports work flow management from referral to report generation. The limitations are there was no support for images and search functionality in the mobile apps. Users need to work only the notified reports (work list) but a web based system available that can accessed from any web browser.
GE Centricity AccessNow has some good usability features around images. Users can view images with 2D, 3D, MIP/MPR capabilities and perform image related functions like zoom, pan, scroll etc. The most interesting feature was split screen comparison with prior images. It helps users a lot in decision making. The other feature is search functionality with patient demographics (Patient Id, name, access number, modality, date range). Everyone who has access to this mobile app can search for any patient and not sure how the privacy concerns were addressed.
I-Med radiology app has some good usability features similar to that of GE Centricity AccessNow app. Users can view images without 2D/3D but can perform image functions zoom and pan. It has different view styles (screen orientation, resolution) in iPad when compared on iPhone. It’s a good usability feature of adjusting to surroundings (responsive design). Users can search their visit history, retrieve referred reports and access recent examination requests.
Karisma mobile app adopts task based approach with modalities. It enables the users to perform pre allocated tasks only and a search for referral patient is not possible. However, GE centricity Accessnow and I-Med adopts query based approaches. It includes querying the patient information and reports with image analysis.
There’s a scope for providing more functionality and improvement in these mobile apps as outlined below.
|Karisma||GE Centricity AccessNow||I-Med|
Retrieve, Zoom, Pan.
Search functionality patient and reports
|Workflow based approach.
Modalities(Work lists), Dictation
All the compared mobile apps were not close to each other in terms of functionalities and their functionalities were dependent on the vendor and were restricted to specific needs. There were no specific design guidelines that specifies what a RIS mobile app is and what features it should contain at minimum. The range of functionality varied from vendor to vendor. Some vendors implemented workflows and others implemented image related extra activities such as panning, zooming etc. However most of the vendors developed apps for IOS and Android platforms only but not for Windows phone.