Expanding Access: Fantastic growth with web-based PACS

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It doesn't matter whether PACS are installed for use in a single department, an imaging center, or a large health system. With their web capabilities, current web-based PACS are helping facilities greatly increase their referring physician user base, creating speedier in-house operations to boot, and providing greater patient care. To put it simply, they're fantastic.

Imaging Centers with big PACS reach

Epic Imaging
Portland, Oregan

As John Griffith, CRA, CIO of Epic Imaging, sees it, when it comes to web capability there are really two PACS camps. "You've got web-based PACS and then there are web-enabled PACS. Web-enabled [systems] allow you to at least distribute and update via the web but aren't truly web-based."

Truly web-based PACS provide users off-site with the same access and tools via a web interface that they have sitting at the PACS workstation within a hospital or imaging center.

Epic Imaging is a two campus facility, which Griffith says with a laugh, is "cutting edge" because it's already in the replacement cycle for PACS having already owned one previous system that was not web-enabled.

In January, they installed Dynamic Imaging's IntegradWeb PACS which is fully web-based, and it is now used both by the clinic's own in-house physicians and radiologists as well as their outside user base of physicians which is 1,000+ strong, and growing. All told, they currently log about 125,000 procedures a year.

"We have a very diverse referral base because we are freestanding," Griffith says. "Everything is outside of our walls. The bottom line with web-based PACS is that it doesn't matter whether you're logging in from home or from your office or wherever. If you're a radiologist looking at images on a diagnostic workstation, you also can get the same tool sets at home."

The ability to access the full tool set, including such advanced functions as multi-planar reformatting, 3D functionality, and ortho CAD templating, is a huge advantage from a user support perspective.

"If one of our radiologists gets a call from a referring physician who wants to look at a case," says Griffith, "or needs to navigate through the system and has a question, the radiologist doesn't have to think, 'well OK, what type of system are you looking on?' It's the same system the radiologist is looking on, so it makes it easy from that regard."

When a referring physician first logs into the system with the URL that Epic Imaging provides them, they are required to install a basic ActiveX viewer applet. So, though the applet itself is very robust, it is also "componentized" and allows a user to load the functionality from the server on an as-needed basis so as not to bog down your PC the first time you use it, Griffith says.

That's the nice thing about fully web-based systems. Once you are established as a user, it makes no difference what PC you are using because the data remain on the system's server, not on your PC.

"A physician's worklist is configurable and all of the changes are stored on the server, not on the client side PC. So, the settings travel with you if you use multiple machines," Griffith says.

Epic Imaging uses a storage area network (SAN) with clustered servers equipped with web server software to serve up the images very quickly. IntegradWeb uses JPEG 2000 which is a newer DICOM standard for storing images in a compressed format, Griffith says. He adds that as a result they are able to keep "all of our images online 100 percent of the time."

So who gets access to images? Like many healthcare organizations, Epic Imaging has a set process for setting up user accounts, either through a faxed form (in this case a HIPAA agreement) or email which gives the radiology department a chance to check the credentials of a physician to guarantee he or she should in fact have access to the PACS and network. Users are given how-to instructions and a username and password, which in this case expires every 45 days, though some facilities set expiration at 90 days.

Griffith says that although he can grant access "at the drop of a bucket," different levels of access are set depending on the situation. For example, specialists who might be dealing with a number of patients get access to the entire database; primary-care physicians are often only allowed access on a patient-by-patient basis. Access also can be organized by groups of physicians. Perhaps most vitally, emergency temporary access can be granted instantly.

Rockwood Clinic
Spokane, Wash.