As COVID-19 approached one large health system it quickly installed at-home PACS workstations—here’s how

As the pandemic swept across the United States and into the southeast, one large health system moved quickly to enable social distancing by installing at-home picture archiving and communication system workstations.

The University of Alabama at Birmingham Health System is one of the largest academic medical centers in the country and among the state’s largest employers. While the organization has been hesitant to implement widespread remote interpretations in the past, the decision was made in order to protect its radiologists.

It’s been a success thus far, deploying more than two dozen remote PACS stations for nearly all the institution’s radiologists. Srini Tridandapani, and colleagues at UAB’s Department of Radiology shared their process May 20 in the American Journal of Roentgenology, in hopes of educating other organizations considering the same approach.

One of the initial challenges the team faced was securing funding for the stations. Standardizing the hardware and software was essential, the researchers noted. Traditionally the on-site systems use high-end monitors, but the team decided to build a number of new PACS with standard display monitors, purchasing 44 of these less expensive displays. Importantly, UAB maintained a handful of high-end monitors for viewing radiographs.

In order to ensure the off-site stations functioned just like the on-site PACS, the group used a virtual private network solution and all radiologists were required to have an internet connection speed of at least 100 megabits per second. Much of the financial support went toward this VPN system, with another large chunk set aside for monitors.

Another major hurdle to the process was choosing which radiologists received the at-home setup.

“Because we did not have the funding to equip all of our radiologists with remote PACS workstations, we had to make difficult choices regarding who would benefit the most from these workstations, and conversely who, if equipped with these workstations, could benefit the department the most,” Tridandapani said.

Emergency radiology already had five of its nine doctors working out of state, so the “easiest” part of their decision was to assign four new workstations to four emergency-section members (one already had an at-home PACS). Also, the authors noted, these physicians can read a wide range of studies, ensuring services run smoothly if on-site rads at Birmingham became infected.

Section chiefs in abdominal, cardiothoracic, musculoskeletal, and neuroradiology were asked to choose who received workstations based on production and protecting at-risk readers. Most chose either older division members or those with preexisting conditions more susceptible to COVID-19. PACS stations weren’t provided to mammography due to required quality standards and an overall drop in outpatient imaging. Nuclear medicine doctors were offered a separate remote solution.

Redesigning imaging workflow to achieve social distancing now means the department has three or fewer rads per reading room, depending on the size of the area. Each section has at least one doctor in-house to help technologists. And during evening or weekend calls, radiologists must also be on-site.

Teleradiology, especially home workstation installation, has jumped dramatically during the pandemic. One recent study of more than 170 institutions reported a 65.2% increase in such at-home setups. That same research found that many practices that have made the move saw enough benefit from their experience that they plan to continue after the pandemic has passed.