Web-based PACS Powers the Enterprise

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 brief, non-diagnostic viewing, but initial primary reads require a 3 megapixel (MP) display, says Richman. 

Boosting referring physician satisfaction

Tristan Associates in Harrisburg, Penn., a six-site imaging center practice, first deployed Amicas Inc.’s Vision Series PACS in 2004. The web-based PACS delivers a number of benefits, says Systems Administrator Meghan Engler. For starters, it allows radiologists at satellite offices to read from any worklist. For example, radiologists at any office can read studies acquired at the main office, which helps balance workflow. “Web-based PACS is the way to go,” adds Brian Bloom, MD, radiologist. Web-based systems eliminate the link between licenses and specific machines. In addition, proprietary hardware is not required, and sites can put other applications on workstations, which increases flexibility and reduces costs.

Tristan Associates hopes to stand out in the competitive imaging center arena with the addition of Amicas Vision Reach solution, which it deployed in November 2006. The web-based program proactively emails images and reports to referring physicians. Engler believes Vision Reach will improve the practice’s turn-around time of two to four hours. “Physicians can read preliminary reports as soon as they are transcribed, and they can view studies from any location.”

Vision Reach improves efficiency for the radiology practice and referring physicians, says Engler, as practices that use Vision Reach no longer call Tristan Associates to request faxed reports. The system can help accelerate the patient care process as well. A family physician can grant a specialist access to a specific patient’s reports and images, thus eliminating the inefficiency of a middleman.

Infrastructure requirements on the referring physician side are light. Vision Reach runs on Microsoft Windows and Internet Explorer. A client download is necessary only for physicians who require full image viewing capabilities. If a referring physician only wants to view key images and reports, the web-based program suffices. What’s more, tech-savvy physicians on the go can access reports and key images on PDA devices such as Treos or BlackBerrys.

Universal access

Evanston Northwestern Healthcare in Chicago provides both radiologists and referring physicians online access to images on GE Healthcare’s Centricity PACS. The referring physician solution is two-fold. Physicians located in the hospital or networked clinics use the internal network to view images. A browser-based SSL connection provides access for offsite physicians. Radiologists require a more rapid response time, says Mary Ann Cardello, senior IS consultant. The health system ensures rapid access for radiologists with two web servers dedicated to radiology. The two server configuration also serves as a back-up system. Evanston Northwestern Healthcare maintains sufficient response for the referring physicians by load balancing other web servers.

“The web extends the benefits of PACS by making it more convenient for radiologists and referring physicians,” notes Cardello. For example, if a patient comes to the ER in the middle of the night, the referring physician can view images from home, which can translate into accelerated clinical decision-making and treatment.

Cardello admits, “It’s difficult to give physicians hands-on instruction for online viewing because the web opens the system to large numbers of physicians.” The answer at Evanston Northwestern Healthcare is online training via the intranet, providing physicians an anytime/anywhere online image viewing course.

Virtual advantages

Web-based PACS delivers multiple benefits. The results run the gamut from increased convenience to decreased hardware costs, accelerated decision-making and enhanced satisfaction among referring physicians. What’s more, sites can go beyond the basics and turn to web-based PACS as the foundation for state-of-the-art initiatives such as e-ICUs.


Peripheral Power
PACS represents a hefty investment in servers, hardware and software. But maximizing the gain from the investment may require additional solutions in the form of peripherals. Peripherals are especially essential in phased implementations as sites combine analog and digital processes. Consider the example of York Hospital (in York, Penn. The 466-bed community teaching hospital completed multiple flow analyses when it transitioned to digital image management in 2004.

Document and multimedia connectivity software from PACSGear. The goal, says PACS/RIS Coordinator John Zimmerman, was to determine what was needed to replicate or improve analog processes. The hospital deployed a range of peripherals to streamline workflow. Solutions include PACSGear PacsSCAN Film with Vidar DiagnosticPRO Advantage to digitize mammography film priors and reduce read times; PacsSCAN to scan documents into PACS; PacsSCAN + MediaImport to import JPEGs and external DICOM CDs and DVDs; DatCard PACSCube CD burner to create CDs and a Kodak laser imager to produce necessary hard copies.

The peripheral process can be tricky and requires a fair amount of research and legwork. It’s important to understand the capabilities of various peripherals, says Zimmerman. Some CD burners don’t burn DICOM images, which could lead to repeat procedures and treatment delays. The CD burner also should be appropriately sized to meet current and future image volume.

“Talk to your customers. Find out how they run their businesses and what their needs are,” advises Zimmerman. For example, when York Hospital shared its CD labeler with customers, they helped the hospital determine appropriate information to include on the label. Sharing information about new processes with customers also helps them prepare; some may require new systems or software to accept CDs.

York Hospital tackled the transition phase by first focusing on the most voracious film consumers such as orthopedic and surgical practices. This approach yielded a fairly rapid reduction in film, and the hospital gained several success stories to share with other practices.

Zimmerman also recommends training in-house staff. “If film library staff take calls from physicians transitioning from film to CD, they need to understand the system and provide good customer service. Otherwise, customers may be left with a bad first impression.”

Peripherals represent an essential component in the PACS deployment process. Selecting appropriate equipment and communicating its functions and benefits to referring practices can boost the success of the PACS deployment by cutting film use and enhancing service.