OrthoPACS: The Information Backbone of the Orthopedic Clinic
 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 can pull them into our system,” Kruc says.

Bennett notes that the ScImage PACS connects with their NextGen EMR. “Many of our physicians easily toggle between the two programs. Physicians can look at PACS studies through the EMR, but the images do not reside in the EMR,” he says. Also, a connection with their practice management software allows access to all demographic information within PACS, “so we’re not re-entering information,” he notes.

PACS in the OR  

Many of Rothman’s 44 physicians often access its Sectra PACS images in the two operating rooms that are remotely connected at Thomas Jefferson University Hospital and Nazareth Hospital, both located in Philadelphia. This feature frees the surgeons from having to carry film into the OR, Kruc notes.

Physicians access PACS remotely, having exactly the features available as they do in-house. “If there is only one person using the DX [workstation within the clinic], and multiple physicians using the web version, there is no problem,” Kruc says. The DX workstation also can utilize the templating software, which is particularly beneficial for hip replacement reconstruction with just a few mouse clicks.

“Within the OR, physicians have all the advantages of a PACS image. They can size and manipulate it. Some of our surgeons will make notes on the PACS, and then have those available in the OR when they view the image,” Bennett notes. “Also, an administrative advantage is that we used to have to shift the images around to wherever the physician was located, so that activity and those costs have gone away.”

“We also have direct connections into the OR, so the doctors do not have to carry CDs,” Bennett explains. He notes that the biggest advantage is “the efficiency of having all the benefits of PACS in the operating room with all its functionalities.” However, if a physician needs to pull up an image from within the hospital system, which utilizes a different PACS, he or she “can simply switch over from within the OR. As a result, our doctors have become familiar with using many different PACS.”

COG’s surgeons also access PACS images in the OR. However, Epperson says that because many of the physicians use wireless tablets in the office, they also save images on the tablet, and bring it the operating room for reference. The tablets can only be accessed through thumb-print recognition to ensure the safety of patient data.

Remote PACS access is key for large groups as well as small. Julie Johnson, x-ray department manager of the Alabama Orthopedic Center in Birmingham, which sees about 190 patients daily, notes that remote PACS access is beneficial for their one-radiologist facility. Remote access guarantees that their one onsite radiologist, who often reads images from home, can access images or his replacement can read images from down the road in Montgomery, Ala. Aspyra’s Orthopedic PACS allows the radiologists to login and access images through a secure VPN, and any changes they make remotely are fully integrated into the system.

PACS inhabits a specific, much-needed niche for the orthopedic clinic environment, Bennett says. He says PACS vendors in this space have a good understanding of imaging and IT connectivity and the needs for the current volume of images, as well as the needs for expanding volumes, as a clinic grows. Their support helps to keep the patient data backbone strong.