title: Implementation of an image sharing system significantly reduced repeat computed tomographic imaging in a regional trauma system.
abstract: BACKGROUND
  The practice of repeating computed tomography (re-CT) is common among trauma patients transferred between hospitals incurring additional cost and radiation exposure. This study sought to evaluate the effectiveness of implementing modern cloud-based technology (lifeIMAGE) across a regional trauma system to reduce the incidence of re-CT imaging.
  
  
  METHODS
  This is a prospective interventional study to evaluate outcomes after implementation of lifeIMAGE in January 2012. Key outcomes were rates of CT imaging, including the rates and costs of re-CT from January 2009 through December 2012.
  
  
  RESULTS
  There were 1,081 trauma patients transferred from participating hospitals during the study period (657 patients before and 425 patients after implementation), with the overall re-CT rate of 20.5%. Rates of any CT imaging at referring hospitals decreased (62% vs. 55%, p < 0.05) and also decreased at the accepting regional Level I center (58% vs. 52%, p < 0.05) following system implementation. There were 639 patients (59%) who had CT imaging performed before transfer (404 patients before and 235 patients after implementation). Of these patients, the overall re-CT rate decreased from 38.4% to 28.1% (p = 0.01). Rates of re-CT of the head (21% vs. 11%, p = 0.002), chest (7% vs. 3%, p = 0.05), as well as abdomen and pelvis (12% vs. 5%, p = 0.007) were significantly reduced following system implementation. The cost of repeat imaging per patient was significantly lower following system implementation (mean charges, $1,046 vs. $589; p < 0.001). These results were more pronounced in a subgroup of patients with an Injury Severity Score (ISS) of greater than 14, with a reduction in overall re-CT rate from 51% to 30% (p = 0.03).
  
  
  CONCLUSIONS
  The implementation of modern cloud-based technology across the regional trauma system resulted in significant reductions in re-CT imaging and cost.
  
  
  METHODS
  Therapeutic/care management study, level IV; economic analysis, level IV.
authors.affiliation: From the Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Metro Health Medical Center (A.B., B.M.Z., D.A., P.A.W., R.F., J.A.C.), Case Western Reserve University; and Cleveland Clinic Regional Hospitals (D.A.), Cleveland, Ohio.
authors.forename: Aman
authors.initials: A
authors.lastname: Banerjee
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Zosa
authors.forename: Debra
authors.initials: D
authors.lastname: Allen
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Wilczewski
authors.forename: Robert
authors.initials: R
authors.lastname: Ferguson
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
mesh_terms: D000328:Adult; D000067917:Cloud Computing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010360:Patient Transfer; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*