Web-based PACS Powers the Enterprise

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Systems Administrator Meghan Engler at Tristán Associates in Harrisburg, Penn., instructs a colleague on Amicas’ Vision Reach PACS.PACS can transcend mere digital image management. Some facilities are tapping into web-based PACS solutions to power new business opportunities and maximize revenue. But the advantages of web-based PACS extend beyond the financial. Enhanced service to referring physicians and improved patient care are other key advantages.

“Many specialties live and breathe based on their abilities to view images, but hospitals often underestimate the need for physicians to view images across the enterprise,” says Katherine Richman, MD, director of Thornton Radiology, University of California San Diego Medical Center (UCSD). The tide, however, is turning. “We’re seeing a trend toward decentralized image viewing,” continues Richman. Web-based PACS decentralizes image management to improve workflow and patient care. With web-based systems, any workstation serves as a PACS viewing station so referring clinicians no longer need to stand in line at a lone PACS workstation to view images. Finally, on the IT side, web-based PACS can simplify system administration.

The process of optimizing web-based PACS depends on the unique needs of the enterprise, but as a variety of sites demonstrate here, web-based solutions can transform image viewing and delivery and patient care.

Maximum gain

When Aurora Health Care in Milwaukee, Wis., deployed Siemens Medical Solutions Magic Web PACS in 2001, the 13-hospital enterprise planned to squeeze every feature out of its investment. The healthcare system has met its objective and uses Magic Web for multiple purposes including radiology and cardiology image viewing. The system also serves as the foundation of e-ICU and tele-echocardiography programs.

The e-ICU model centralizes ICU resources. Although each Aurora hospital maintains a physical ICU, intensivists and offsite nurses work from a separate building where they monitor patients at all sites, communicating with site-based staff via intercom. Magic Web provides the image viewing platform for the project. Aurora Health Care has realized decreases in the average length of stay and morbidity rates since deploying the e-ICU model, says Tim Heniadis, supervisor of medical systems integration for information systems.

The tele-echo program relies on on-call cardiologists to read echocardiograms acquired in the ER. “The rapid rule out option provides a better direction for physicians,” Heniadis says. A clear, expert assessment of the patient paves the way for more effective protocols for the treating ER physician.

Magic Web, says Heniadis, is a cost-effective and network-friendly platform that enables the healthcare system’s virtual initiatives. Although Magic Web is engineered to make the most efficient use of the network, the project does require ongoing maintenance and regular updates that are driven by timing and priority.

The basic network structure at Aurora Health Care is simple. PACS hubs are the image management core. They are equipped with a group of servers and rely
on the main network, a DS3 connection, for transmission. Off-hub hospitals and imaging centers use DS3 or gigabit network depending on imaging volume. Finally, smaller remote clinics are connected via T1 lines.

“Web-based systems like Magic Web offer multiple advantages,” says Heniadis. “They aren’t too expensive, and they are easier to support because the administrator or engineer does not need to be on-site to respond to a problem.”

Extending the power of the web

UCSD aims to fully implement web-based PACS with an upgrade to Agfa HealthCare’s IMPAX 6.2 this month. The center currently relies on Agfa’s Web1000 to provide referring clinicians access to images, but it does not comprise a comprehensive platform. Richman explains, “Web1000 does not provide the full capabilities of IMPAX. The biggest issue is that physicians cannot scroll through images. Clicking every single image is problematic when it comes to the number of images in multislice CT or MR datasets.”

IMPAX 6.2 crosses that hurdle and delivers additional benefits. “Clinicians will be able to scroll through datasets and find the images they need quickly,” states Richman. The upgrade also will provide flexibility in image-intense areas like the ER. Currently, the ER houses a single PACS workstation, but with IMPAX 6.2 the department can convert any workstation with an appropriate monitor into a PACS viewing station. The department can turn to a simple rule of thumb for the conversion. An off-the-shelf monitor can suffice for