How Do Images Get Stored for Documentation and Billing?

Image storage is more essential than ever. Proliferation of these units brings increasing danger of “phantom scans” (scans that are never recorded or documented), leaving users open to medico-legal liability, particularly if an error is made. The latest devices allow easier storage options than previous portable units, with wireless image transmission and patient work-list retrieval. Local device storage is not ideal given space limitations and the possibility of theft. Images can be set to upload to hospital servers for archiving, a necessary step for documentation and linkage to electronic medical records. However, companies that transmit images to the cloud (eg, Butterfly) require careful consideration.

Most tech giants are data mining our online searches to develop their own products and market strategies. Images sent to cloud-based services are accessible by those companies, who could use them to develop other products for profit. Since users pay subscription fees to access cloud storage, are we then paying to provide data that will later be used for proprietary reasons? Who owns the data? Who consents for data use? Many business and ethics questions arise, further validating that hospital purchase with the backing of IT security and risk management is important. Some institutions have discovered ways to retrieve cloud information for permanent local storage onto hospital servers, but this is not an easy process.

If units are hospital-purchased, reimbursement claims could be submitted for both the professional and technical components. However, if units are personally bought or bought by academic departments separate from the hospital, then the technical fee would not apply and could potentially cause billing confusion.

The Bottom Line

Pocket ultrasounds will change the accessibility of imaging in patient care and point-of-care ultrasound education. Their imaging is good enough to cover emergent applications and procedures, such as the core applications listed in the ACEP Ultrasound Guidelines (except for transvaginal pelvic ultrasound), but they are not as robust as cart-based systems. Their color flow Doppler is limited, and they cannot offer more advanced features such as spectral Doppler. For security and risk management purposes, investing the time to involve hospital or group IT early on can avoid a lot of headaches later. 

(click for larger image) Comparison of Pocket Ultrasound Machines
Definitions: AI = artificial intelligence; CMOS = complementary metal–oxide–semiconductor; CMUT = capacitive micromachined ultrasonic transducer; DICOM = digital imaging and communications in medicine; PACS = picture archiving and communication system; REACTS = Remote Education, Augmented Communication, Training and Supervision