Sharing medical data easily using interdigital mobile communication

Introduction

Modern medicine increasingly depends on digital image exchange for diagnosing, representing in 2D, and reconstructing pathological entities in 3D. With the diffusion of the Internet, a major limitation of free and widespread sharing of data between physicians has been the size of the files, which are often too large to be transferred easily. For example, a chest CT may be 420 MByte in size, and a coronary angiogram may be 200 MByte. A recent patient with unstable angina was operated on following a coronary angiogram exchanged through a smartphone application (app) for multimedia instant messaging. This prompted the present case report.

Case report

A 74-year-old male with three-vessel coronary artery disease and unstable angina was transferred to our institution from a peripheral hospital to undergo surgical revascularization. On arrival, the file with the coronary angiogram was found to be corrupted. Because of the distance between the sites (90 km) and the lack of a PACS image sharing service, and no Internet VPN connection between them, a new copy could not be delivered in time. Because of the patient’s clinical instability, we decided to transfer the angiography data through a popular mobile phone app, called WhatsApp (WhatsApp Inc., Mountain View, California, USA). This is a free cross-platform application that allows users to share multimedia data immediately, such as images or short videos. It has been used in other medical subspecialities. ¹

The referring cardiologist played selected sequences of the coronary angiogram on his computer monitor, filmed them with his smartphone camera and shared the relevant content instantly with the surgeon via WhatsApp. Care was taken to limit the size of each series of frames to 1 MByte, and to erase any sensitive data, such as the patient's name and date of birth. The images reproduced on the receiving smartphone were judged to be of satisfactory quality (Figure 1 a, b) for formulating a surgical plan, and the patient underwent a successful three-vessel bypass. The postoperative course was uneventful. OPEN IN VIEWER

Discussion

Despite the fact that telemedicine has been shown to work in many fields, such as teleradiology, teledermatology and telepsychiatry, some applications are considered to be immature, and remain in the early stages of adoption. ² A telemedicine system should be easy to use, facilitate rapid communication and information exchange, and be cost-effective, if it is to become widely used among physicians. ³ Mobile applications allow the possibility of sharing multimedia content. ⁴ WhatsApp, for example, is widely available and is used by 350 million people per month for non-healthcare purposes. ⁵ This could allow rapid consultations between emergency room physicians, cardiac and thoracic surgeons, neurosurgeons or other specialists, by sending critical CT images of the chest, brain or abdomen, even where a conventional computer network connection is not available. There are potential benefits from better and faster diagnosis and therapy. Finally, while the WhatsApp mobile application allows for instant communication between two or more doctors, the patient’s identity must be always protected to avoid the possibility that sensitive data (name, date of birth, social security number) are exposed.