Web Enabled: Distributing Images to Referring Physicians

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It's no secret that referring physicians drive the success of a PACS implementation. If they don't use PACS, the hospital will probably not meet its project goals. Successful hospitals balance technical and security challenges and demonstrate mastery of human relations and educational processes. The formula for securing buy-in among referring physicians boils down to:

  • Selecting the PACS
  • Providing fast and easy training for all users
  • Developing a HIPAA strategy
  • Planning for alternate image delivery methods


"Web-enabled PACS is absolutely the way to go," says Jeoff Will, physician liaison for Fairview Health System (Minneapolis). "I don't see system-wide PACS succeeding any other way."

With a web-enabled PACS, a small program is downloaded from a website, eliminating the need to individually load the client application. These hardware-independent solutions allow most users with access to Internet Explorer to view images.

Fairview Health System epitomizes the healthcare conglomerate. It includes seven hospitals, 41 primary-care clinics, 38 specialty clinics and 21 senior-care facilities. Fairview completes 500,000 imaging procedures annually and distributes images to 6,640 physicians.

The health system aimed for anytime/anywhere/any image distribution at the enterprise level with its IDX Imagecast PACS. "It's relatively easy to implement PACS in radiology," Will notes. "It's an entirely different animal to roll it out throughout the enterprise."

Currently, three Fairview hospitals have deployed PACS. Referring physicians within the system view images over an intranet. Physicians outside of the Fairview system primarily view images on CD, but Will aims to further improve access with a physician portal that will allow all physicians to access images over the internet. The SSL portal meets HIPAA requirements with password protection and encryption for each user. "We will continue to offer the CD option after the portal in implemented," Will says. "The whole goal is to improve - not hinder - access to images." (See chart)


Cedars-Sinai Medical Center (Los Angeles) is an 820-bed university-affiliated, not-for-profit medical center that performs 380,000-plus imaging procedures annually for a referral base of more than 2,000 physicians. When the medical center deployed its Kodak DirectView PACS four years ago, it identified image distribution to referring physicians as a major challenge. David E. Brown, manager of PACS/RIS at the S. Mark Taper Foundation Imaging Center at Cedars-Sinai, explains, "No one wanted to print film to distribute everywhere throughout the medical center once we were live on PACS. The solution was clear - a web server."

The medical center installed a Kodak DirectView Web Distribution System in conjunction with its Kodak DirectView PACS to provide image access to referring physicians within the hospital. Cedars interfaced the DirectView Web System to WebVS, an internally-developed web-based viewing system. WebVS enables access to Cedars' main clinical data repository and provides an integrated display of clinical data from over 20 information systems, including PACS.

"This is a solution for both employee and non-employee physicians," Brown explains. "They can view clinical data on WebVS and click on a link to access the DirectView Web System and look at images of the selected patient." WebVS supports security needs via confidentiality warnings, detailed logging of all accesses or attempted accesses to patient data and automatic daily surveillance reports.

Physicians can log on to WebVS from their office or home computer; however, only physicians connected with a secure VPN have access to PACS images. In the future, Cedars will turn on encryption on the DirectView Web System to allow for access to PACS images from anywhere on the Internet with proper authentication. (See chart)

Part of the reason behind Cedars-Sinai's success is Brown's willingness to maintain two generations of web servers to support all users. Newer web systems work well with state-of-the-art PCs, but do not always work well with older PCs. A first-generation web server interfaced to WebVS supports of older PCs with slower processors and less memory. Brown admits, "You can't tell referring doctors that they need to purchase a new PC to access images. It just doesn't carry over well."

This fall, Cedars-Sinai plans to upgrade to Kodak's System 5. The upgrade entails a single database for all users and