Inside a RHIO: Maine Health System Spreads the Imaging Wealth

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

 Small, rural hospitals often have trouble supporting their own PACS and full-time radiology coverage. By offering its radiology, RIS and PACS resources to others on an outsourcing basis, Eastern Maine Medical Center has prevented unnecessary transfers, duplicate studies and enabled the faster commencement of critical treatment.

Eastern Maine Medical Center (EMMC) in Bangor has leveraged its radiology RIS and PACS equipment into the infrastructure of a regional health information organization (RHIO). EMMC is the tertiary referral center and hub of the six-hospital Eastern Maine Healthcare System (EMHS). EMMC went live with RIS in 1998 and PACS in June 2002, and started rolling it out to other sites in June 2004, says Deborah Sanford, RN, MS, patient care administrator. Beyond those six hospitals, Sanford says that the majority of the organizations in the RHIO are nonaffiliated. The RHIO facilities extend more than 200 miles from Presque Isle in the north to Waterville, southwest of Bangor.

One RIS that EMMC uses is the Agfa HealthCare IMPAX Radiology Information System and IMPAX Master Patient Index, which are integrated with the IMPAX PACS. Agfa assisted the facility in setting up the imaging RHIO which included supplying staff to help with implementation and “setting up regional architecture to best meet the needs of the patients and institutions participating,” Sanford says.

Facilities came on board as they were ready with more hospitals on schedule for later this year. Each hospital has to have the IT structures in place, financing and CR to enable digital images. “Most didn’t have CR and that was the largest cost for the organizations,” Sanford says. Sanford’s IT team and IT professionals from Agfa conducted both a network and a technology review to determine exactly what was required. Each hospital needed a server with which to pull DICOM images so they didn’t have to retrieve images over a T1 line. EMMC built everything up to a hospital, and then that hospital was responsible for building its internal network and ongoing management. Sanford also worked with each hospital’s imaging equipment vendors to help the facility get DICOM ready. In some cases, her team worked hand-in-hand with the facility and in others, the facility took care of the changes more independently.

Expanding radiology coverage

The RHIO was initiated to address the unique needs of a rural, sparsely populated region. EMHS’s referral area is the upper two-thirds of the state and includes 434,000 covered lives. Over the past two-and-a-half years, EMMC has enabled several smaller hospitals — 20-, 30-, and 40-bed facilities — that cannot afford their own PACS to take advantage of its system.

“A majority [of the facilities] are critical-access hospitals so they can’t support a full-time radiologist,” explains Sanford. “A lot are looking at not having radiology coverage.” Since beginning to share the PACS, the hospitals can support 24/7 imaging with timely interpretations and delivery of patient care. “We also have seen a decrease in unnecessary transfers to tertiary care centers because basic diagnostic imaging services are now available around the clock,” she says. The smaller hospitals have “hopped onto our PACS. We’ve been able to leverage our infrastructure and provide them with local caching and image management at their local site. They don’t have to have full-time information technology staff there.”

EMMC signed on with Agfa in October 2001, implemented its PACS solution in 2002 and its RIS in 2006. “We fell into this RHIO by accident,” Sanford says. The hospital’s radiologists are fairly progressive, she says, and realized that the benefits of the RIS and PACS at EMMC did not exist at the other hospitals they covered. “They said, ‘The smaller sites can’t afford this, but we should be able to leverage what we’re doing here.’” That turned into a centralized communication and support system. “People think you have just a centralized archive, but what we really have is a communication system of imaging results,” she says. Because both images and reports are accessible, providers around the state can see what’s happening with their patients, wherever they are.

Saving time, money, travel

People no longer have to make overnight trips to Bangor for imaging procedures because they can have the exams done locally and transmitted for interpretation. The referring doctors can access the images and reports anytime, anywhere. Conversely, if the patient