· VHA Embraces PACS and Teleradiology
· Learn to Share at RSNA


VHA Embraces PACS and Teleradiology

With a shortage of radiologists in the health care industry, many medical facilities—particularly smaller community-based hospitals and imaging centers—are embracing an approach that optimizes manpower and links resources: teleradiology.

Supporting the increasingly affordable trend toward electronic synchronization, eight hospitals in the country’s Northeast region are in the process of implementing a fully featured PACS platform, complete with a regional archive system and other health care IT solutions.

The facilities, located in Connecticut, Massachusetts, New Hampshire, Vermont, Maine, and Rhode Island, are part of the New England Region of the Veterans Health Administration (VHA), which worked out the multimillion-dollar order with Rochester, NY-based Carestream Health Inc.

As part of the package, Carestream will equip the hospitals with a Kodak Carestream PACS, a regional archive, data migration from existing PACS, network integration, and other professional IT services. The PACS at each hospital is capable of image storage for up to 3 years.

Drew Miller, district manager for the Healthcare Information Solutions Group at Carestream, said the installation is beneficial for the hospitals’ patients—military veterans who potentially travel often.

The centralized imaging archive allows physicians to have access to all their previous exams from any facility in the network, he continued.

“With our system, they’re allowed to leverage radiology resources at any of the locations, regardless of where the primary study was actually performed at,” Miller said, adding that patient records will be easier to track.

Carestream will collect scheduling information from existing radiology information systems, in addition to creating a regional worklist to integrate patient information with each diagnostic imaging exam. Furthermore, it will create a central regional archive that has a 5-year image-storage capacity, managed by Kodak Carestream Information Management Solutions.

A virtual desktop environment will allow authorized users to access a variety of applications, such as 3D processing, from any computer, regardless of whether it is located inside or outside the organization. Dynamic streaming capabilities reduce the need for large-bandwidth network connections, even when viewing 3D, cardiac CT, and other large image files.

Also available are optional features, such as integrated voice dictation, orthopedic surgical templates, and native 3D viewing of imaging exams. Native capabilities eliminate the need for a separate unit to process the 3D rendering, thereby facilitating workflow.

Integration with PowerScribe and the VistA Imaging system used by the New England Region, or Veterans Integrated Service Network 1, was already very familiar to Carestream. About 5 years ago the company had established its PACS in VA-West Haven, one of VISN-1’s affiliated hospitals in Connecticut.

As a result of the recent order, VISN-1’s smaller centers will be able to reduce costs by tossing aside films and going the digital route, Miller said. He also pointed out that the issue of understaffing would be resolved because radiologists in a specific location, even at home, could work with a facility in another city.

“They weren’t getting all the advantages both financially and from a diagnostic perspective,” Miller said. “We’re giving them a comprehensive radiology solution.”

—Elaine Sanchez

Learn to Share at RSNA

IHE offers demos on cross-enterprise sharing of imaging documents

The Integrating the Healthcare Enterprise (IHE) initiative, established a decade ago by the Radiological Society of North America (RSNA) and the Healthcare Information and Management Systems Society (HIMSS), will again demonstrate at the 2007 RSNA meeting this month. To learn about what IHE has in store for attendees this year, Medical Imaging turned to David Avrin, MD, PhD, chair of the RSNA Radiology Informatics Committee and vice chair for informatics in the radiology department at the University of California, San Francisco.

“The most important thing we’re demonstrating is the concept of cross-enterprise sharing of imaging documents,” Avrin said. The idea is simple enough: If a patient goes to a hospital across town or across the country that isn’t part of an affiliated enterprise, their prior imaging studies will be retrievable—with their permission—in a HIPAA-compliant manner.

But as everyone knows, such sharing of data is easier said than done. “There are a few obstacles,” Avrin noted. “One is that we don’t have a nationalized health care system; we have a bunch of independent entities, and even within the same enterprise some hospitals function independently. We don’t tend to use our social security numbers as identifiers, for several reasons. So the first issue is correctly identifying the patient, and then there’s the permission and privacy layer, and then there’s the actual transmission, which is not a big trick.”

Hence the development of the XDS-i standard, which, Avrin explained, uses a “broker” to confirm two separate institutions are referring to the same patient. “We’re kind of schizophrenic in this country about things like this,” he said. “We tried it about 10 or 15 years ago, and people went nuts because of privacy issues. We either need a national health identifier number, a regional one, or a third-party broker in each region. What XDS provides in general is offering such a broker to institutions within the enterprise who want to cooperate.”

Avrin explained that the government’s contributions also play a large role in making such large-scale implementation possible. “This is all against the background of the White House,” he noted. “Bush allocated money to look at this issue. The secretary of Health and Human Services is very tech-savvy; he’s expanded on the president’s initiative to mandate we’ll be able to do things like that. We’ll have EMRs with imaging studies and reports, and the ability to move them around confidentially.”

Another exciting development in the IHE demonstration is the Teaching File and Clinical Trial Export (TCE) profile. Developed with vendors in response to the challenge of harvesting interesting case files from PACS and collecting studies for large-scale clinical trials, the TCE profile enables a standardized method of getting specific images and studies from the PACS system to a server, with patient identifier information scrubbed or anonymized en route. So far, approximately six of the major PACS vendors are writing software to the TCE profile, Avrin said, and where that many go, the rest generally follow.

“We’re very proud of it,” he said. “Basically, we want to get this to a point where you can order this option from your vendor. And they’ll be demonstrating their own implementations of these profiles in their own booths. Soon the TCE profile will be offered as an option on their products.”

But, Avrin said, in the end the real question is, will the public cooperate with the government’s renewed initiative toward health record portability? “HIPAA’s been around for 10 years, and we’re finally starting to get there,” he said. “Go back to the first Community Health Information Network attempts. We saw then that there was an outcry over privacy. The question is, will our attempts at ensuring privacy be believable by the public this time?”

Stay tuned to find out—and visit the Lakeside Learning Center during this year’s meeting to see the new profiles in action.

—Cat Vasko