Ideas in Hospital-Based Imaging

“Rental PACS” Brings Digital Imaging to Rural Hospital
Siemens Launches Wireless Equipment Tracking Service
GI Radiology: Less Pains, Big Gains

“Rental PACS” Brings Digital Imaging to Rural Hospital

7 Medical Systems’ 7i Web viewer displays the diagnostic image adjacent to the radiologist’s report.

On April 23, 7 Medical Systems LLC, Minneapolis, announced it had won eight new contracts for its on-demand PACS and EMR offerings, which remove economic barriers to entry for small hospitals, imaging centers, radiology groups, and ambulatory clinics. One such new client, Ruby Valley Hospital of Sheridan, Mont, had been searching for a small, affordable PACS solution for 2 years before committing to 7 Medical’s on-demand PACS within a month.

“We had to come up with some kind of digital radiology solution because the radiologist who was reading our film was going to start reading from home,” explained Dennis Holschbach, CFO, director of human resources and compliance officer at Ruby Valley. The hospital has no on-site radiologist, Holschbach explained; instead, Ruby Valley was delivering films to its reading radiologist via US mail or, in emergencies, messenger.

“We were literally mailing the films and waiting for them to be returned by mail,” said Linda Parsons, Ruby Valley’s radiology department manager. “Whenever we had suspect x-rays, we had to send people 45 miles or farther to deliver them to the radiologist,” added Roman Hendrickson, MD, medical director of the clinic. “In winter in Montana, that’s no mean feat.”

That’s why the team jumped at the prospect of a PACS system that required no upfront capital outlay. “Right away, everybody was interested,” Holschbach said. “We asked for more information, everybody liked what they saw, and we started moving forward fast. By February 22, we’d decided we wanted to go with this program, and we actually went live by the end of March.”

Having that new layer of efficiency was particularly important to the team at Ruby Valley because of the hospital’s remote location. “We’re a critical access hospital, so we’re basically a frontier hospital,” Holschbach said. “We need to be able to say to our citizens and anybody coming to a small rural hospital that it’s not a mistake coming here for treatment. They’re going to get the best care here, like they’d get anywhere else. We can do a high-quality image, and nobody has to apologize for being seen at a rural hospital.”

Implementation went smoothly, according to Parsons. “The training was just great,” she said. “We found it really easy to use. They were so patient with us, and explained everything so carefully, that we felt very comfortable.”

And Ruby Valley’s radiologist is extremely pleased with the efficiency of the system—even comparing it favorably to some of its larger-scale competitors. “He’s told us more than once that he can’t believe how much better our PACS system is than the fancy-pants system at his other hospital,” Hendrickson said, laughing.

The “leasing” method of pricing offered by 7 Medical means that Ruby Valley could see ROI almost immediately. “We’re talking months instead of years,” Holschbach said. “We’re more than able to pay for the ongoing cost of the PACS by the savings we’re recouping from the old film study system.”

And in the meantime, patient care is constantly improving thanks to the rapid turnaround made possible by implementation. “Our repeats are going to be next to nothing,” Parsons said. “It’s really going to save the patient from excess radiation.”

—Cat Vasko

Siemens Launches Wireless Equipment Tracking Service

Business research and consulting firm Frost & Sullivan estimates that between 5% and 15% of hospital and imaging center inventory is written off each year because it cannot be located or serviced. In response to that dilemma, Siemens Medical Solutions, Malvern, Pa, announced the launch of its new Asset Management and Tracking (AMT) service designed to help hospitals monitor the location of expensive equipment in real time.

“We’ve found that 38% of clinical engineers’ time is spent looking for equipment,” said Tom Pagurek, technical manager for Siemens’ integrated service management division. “It’s a significant problem in hospitals.”

Part of the issue, according to Gerhard Kschwendt of Siemens’ integrated service division, is the ease with which equipment can be stolen or misplaced. “The utilization rate of mobile equipment in hospitals is only 45%,” he said. “So hospitals have twice as much equipment as they really need. And you have to wonder, when you look at eBay, where all these pumps are coming from.”

Siemens solves the problem by integrating asset tracking over customers’ existing wireless networks into the company’s service and asset-management software, eliminating the need to learn two different types of software. “It’s purely software driven,” Pagurek explained. “It doesn’t require any hardware except the tags that attach to the equipment. You work from one interface, and you can find out exactly where a piece of equipment is.”

The tags come in three varieties: a T201 with a rechargeable lithium ion battery pack; a T301, which is slightly smaller and uses two lithium ion batteries; and a T310b, which comes with biodirectional messaging and has an 8-day battery life on a full charge. The tags can be set to transmit according to highly customizable protocols, enabling a facility to group its portable equipment into categories and track it accordingly.

“You can program each of the tags separately,” Pagurek explained. “You can program them to transmit every 10 seconds while the item is moving. But then items like an infusion pump, you want to know where it is when it stops. So you tell the tag, ‘Five minutes before you come to a full stop, send back your location.’ ” The tags are bidirectional, meaning they can be programmed over the air.

Furthermore, if a facility is having trouble with a particular type of equipment, it can set up “alarm areas.” “Say you had a problem with theft of wheelchairs,” Pagurek said. “You could set up the front lobby area of the hospital to turn on an audible alert when a wheelchair enters. If it goes out the door, the system sends an e-mail alert to security or whoever you like.”

It’s all made possible by the magic of Ekahau WiFi Real-Time Location System tags and Siemens’ ARCHIBUS suite of applications. When the Ekahau tags transmit information over the facility’s wireless network, the ARCHIBUS information system creates a 360° view of the facility’s equipment and maintains historical use records.

“Every hospital administrator should be aware of how much equipment they lose each year, but there are very few people who are doing anything about it,” Kschwendt said. “This technology allows hospitals to save a lot of money in a short period of time. Usually with IT investments, the payback is questionable. But this technology is relatively inexpensive, and you can see the benefits right away.”

—C. Vasko

GI Radiology: Less Pains, Big Gains

Much of the focus on GI radiology has been placed on UGI exams and barium studies.

However, gastroenterologists also use ultrasound for endoscopic ultrasound examinations and standard x-ray equipment for procedures like endoscopic retrograde cholangiopancreatography (ERCP), used to diagnose conditions causing jaundice as well as abdominal pain.

Steven A. Edmundowicz, MD, chief of endoscopy in the Division of Gastroenterology at Washington University School of Medicine in St Louis, had possessed an interest in endoscopic ultrasound ever since the modality was first available in the United States. Furthermore, he has been involved in research dealing with ERCP and pancreaticobiliary endoscopy, including a study on the endoscopic management of gallbladder stones and pancreatic duct stones.

These days, he has been investigating the benefits of CO2EFFICIENT, a product now offered by Princeton, NJ-based Bracco Diagnostics since its acquisition of manufacturer E-Z-Em. CO2EFFICIENT is what its name suggests—it utilizes CO2 gas instead of room air during endoscopy.

“We have learned from previous work that CO2 can be used to distend the lumen, but because it is absorbed by the bloodstream so rapidly, it does not cause the bloating and discomfort of air insufflation,” Edmundowicz said. “We could also use CO2 for small intestinal endoscopy to cause less pain and not lengthen the small bowel so we can examine more of it. CO2 has been shown to reduce discomfort after screening colonoscopy as well.”

After more than a year in progress at Washington University, Edmundowicz and fellow researchers recently finished a study that compared the use of regular room insufflation versus CO2EFFICIENT’s CO2 gas during ERCP examinations. The team performed a subgrouped randomization of 100 patients, measuring pain levels exhibited before, immediately after, and 24 hours after the procedure. The group discovered that patients with CO2 infusion reported significantly lower pain scores 1 hour after their procedures than their counterparts who had been examined using room air. The study was presented at the ASGE Plenary Session during Digestive Disease Week in San Diego.

Now, Edmundowicz has replaced room air with CO2Efficient gas for all of his patients at Barnes Jewish Hospital, where he performs about 1,200 ERCP procedures per year. Numerous benefits have since arisen, in addition to reducing patient discomfort from bloating and cramping, he said.

“You can discharge people slightly earlier from the area,” he pointed out. “Also, you don’t confuse pain felt after the procedure with other, potentially more serious complications. It can theoretically help us identify the patients who really have a problem.”

Researchers involved in the study include lead author John Maple, MD, along with coauthors Mark Hovis, CRNA; Raj Keswani, MD; Larry Waldbaum, MD; Steven Edmundowicz, MD; Sreeni Jonnalagadda, MD; Riad Azar, MD; and Esmadt Sadeddin, MD.

—Elaine Sanchez