Productivity gains enabled by digital imaging and PACS have come at the cost of sterilizing relationships to radiologists and clinicians. Consultations have dropped by as much as 80% when going from a film-based environment to a digital one. Miscommunication is now the most frequent cause of sentinel medical error according to the Joint Commission, and lack of communication is currently the single largest cause of malpractice in Radiology.

Pathology has been used as an alternate means for diagnosis, with interpretation concentrating on frank tissue diagnosis and discerning aggressive vs non-aggressive processes. Radiology concentrates on similar areas in a macroscopic scale. Our goal was to evaluate a platform that: (1) could bridge the findings within radiology and pathology, (2) could provide a level of image access and interpretation that would alleviate problems with mis-diagnosis, and (3) could provide open dialogue and visual interaction with a radiologist and pathologist.

Desired features of the collaborative environment where formulated and applicable solutions were evaluated included: web video-conferencing with screen sharing capability, digital whiteboards, interactive chatting, collaborative session archival, and a content management system to wrap around these services. Other considerations included medical/legal issues regarding privacy of PHI (patient health information), infrastucture needs (PC versus MAC and associated peripherals), internet bandwidth, client side firewall and security issues, and evaluation of deployment. The platform was tested for ease of use, ease of training, and metholodology to deployment within a medical institution. The platform was also measured on clinical effectiveness, and radiologists and pathologists’ willingness to use the environment. Although two platforms were initially evaluated, we chose to concentrate on the Adobe Acrobat Connect platform from Adobe Systems.

Primary participants in the medical collaborative evaluation included radiologists, pathologists, and pulmonologists. IT resources from system administration, clinical support, and development evaluated the commercial software, infrastructure needs, and deployment. Various models of interactivity were then developed, with participant feedback used to further shape the experience. Scenarios included, one-on-one with a radiologist and pathologist, multiple radiologists from different geographical locations, speed and connectivity at the local LAN level within a single institution, and speed and throughput with distances greater than one thousand miles. The platform had varying strengths and weaknesses in the different areas evaluated.

The benefits of a technology platform can bridge radiology and pathology, and can improvement diagnostic capabilities with multiple resource availability. Can a platform designed to bridge be easily adaptable, deployable, and possibly scaleable? Collaborative platforms represent significant advances in the utlization of technology to aid in teaching and medical diagnosis. How well did this platform fit the needs of a pathologist or radiologist? Did they find the system accessible versus a hindrance? Finally, what role did the evaluation of this platform have in improving the interpretation of findings for the patient?

The platform is robust internet caching, which provides near real-time collaboration and is extremely promising. Connect is also a teaching solution, offering interactive audience response and measurement, which educational institutions can take advantage of. The platform represents a unique bridge of many technologies, including web conferencing, online chat, teaching “pods,” and audience response measurement. Its limitations are in HIPAA and PHI concerns. Although the platform offers web based SSL encryption, there are legal implications in the broadcast of PHI. Deployment of the platform presented challenges at the local infrastructure level, including managing bandwidth concerns, power, and flexibility of PC versus Mac, and throughput when the online audience was greater than the solutions limitations (licensing, and interactivity).