POCUS Image Archiving in Emergency Medicine: A Systematic Review of Clinical and Financial Impacts.

Point-of-care ultrasound (POCUS) has become an essential diagnostic tool in emergency medicine, providing rapid bedside information that supports clinical decision-making. However, the full potential of POCUS may extend beyond image acquisition, with effective documentation and integration into electronic health record (EHR) systems potentially contributing to improved clinical and operational outcomes. This systematic review evaluated the clinical, operational, and financial impacts of POCUS image archiving within EHRs in emergency department settings. Following PRISMA guidelines, a comprehensive search was performed in PubMed/MEDLINE, Embase, and Web of Science, eligible studies included emergency department-based research reporting original data on POCUS image storage or archiving within EHR systems, whereas studies without specific archiving outcomes were excluded. Two independent reviewers conducted study selection and data extraction, with risk of bias assessed using an adapted NIH quality assessment tool. A total of 225 records were identified, and 11 studies met the inclusion criteria. The included studies demonstrated that structured POCUS image archiving improved documentation completeness, image quality, accessibility to prior examinations, and clinical review processes. Implementation of automated or semi-automated workflows was consistently associated with improved compliance, enhanced organization of ultrasound services, and more efficient resource management. Financial outcomes were also positively affected, with reported increases in billing compliance, reimbursement, and institutional revenue after workflow integration. Despite these benefits, substantial heterogeneity among studies and limitations regarding study design, confounding factors, and generalizability remain. Future research should focus on standardized implementation strategies, cost-effectiveness analyses, and adoption models applicable to diverse health care settings, including low-resource environments.