OrthoPACS: The Information Backbone of the Orthopedic Clinic

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  Columbia Orthopedic Group transitioned to their Viztek Opal-Ortho PACS in four days.

Due to growing imaging utilization and the push toward heightened integration between IT systems and imaging modalities, orthopedic clinics are increasingly appreciating the benefits of adopting PACS in their practices. However, communication remains key for the ease of workflow and the minimizing of user complications.

Smoothing connections

With the prospect of opening a new orthopedic facility, Columbia Orthopedic Group (COG) in Columbia, Mo., felt the time was right to invest in PACS. The group, which performs upwards of 45,000 radiography exams and 5,000 MRI exams annually, needed a PACS that would integrate with their practice management and EMR solutions. The administrators at this 26-physician practice spent two-and-a-half years planning for the PACS integration, and when they moved into the new facility in April 2008, they went digital with Viztek’s Opal-Ortho PACS over the course of a four-day weekend. “The integration from the IT perspective was actually very good with DICOM and HL7 standards,” says Duane Epperson, IT manager at COG. “Viztek has programmers who only focus on interfaces, so the various intricacies of this interface were worked out prior to purchasing the product.”

The interfacing with the group’s various modalities—including two DR systems, two CR systems and one MRI unit—also came online over that same four-day weekend, explains Radiology Director Todd Walker. “We were using film on Wednesday, and we opened the new facility on Monday and were up and running PACS. That Monday, we were able to see 300 patients.”

PACS integration also is smoothing imaging workflow at Rebound/Northwest Surgical Specialists, a 26-physician group in Vancouver, Wash. PACS interfaces with six digital x-ray systems and one MRI unit, according to CEO David Bennett. A ScImage PicomEnterprise PACS connects three offices, as well as with two local hospitals and an ambulatory surgery center. “Our images originate from the various modalities that can be accessed at any one of these facilities, allowing for a unified workflow,” he notes.


To gain PACS workflow efficiency benefits, the magic is in the interfacing of IT and imaging systems. COG struggled with the issue of populating the worklist at the modalities. For instance, as an orthopedic clinic, “we didn’t have the ability to schedule the patient for an [x-ray exam],” Epperson says. “We have physicians who see 45 to 50 patients a day, and there is not always enough time to input that each patient needs a procedure, such an x-ray, into the system. We struggled with how to populate the worklist at the various modalities, so the radiology staff did not have to re-key all that data.”

They solved the issue by interfacing with and streaming the data from the patient management system. “When the patient actually arrives, the practice management system marks his or her arrival, and sends the name to the various modalities, whether or not the patient needs a film,” he says. “So, we filter all the patients each day to every modality, and just select which patients need a film that day from the device itself.”

While COG cannot currently pull their PACS images into their EMR because they are made by separate vendors, Epperson says that the two vendors, Viztek and MED3000, are working to integrate the two systems to accomplish this next phase of interfacing. “We will eventually end up with the x-ray report and the MR report in both the PACS and the EMR. The URL link will appear in the EMR, so the user can click and bring up the patient’s PACS images. Both vendors have done it before. They don’t foresee it causing any problems.” If this plan comes to fruition, Walker notes that it will reduce the number of clicks from four to one.

The Rothman Institute in Philadelphia, which completes approximately 100,000 imaging studies annually, has interfaced its Sectra Orthopedic PACS with its SRS Software practice management software via an HL7 interface, according to Director of IT Jerry Kruc. The facility also is able to pull up PACS images on its SRS Software document management solution.

Each of Rothman’s eight centers also can now access HL7 data feeds from third-party vendors, which is convenient for scheduling, Kruc says. “Without this capability, the technologists would have to manually input each patient name, demographics and study type. As long as the third-party images are DICOM, we