Apart, they are four rural New England hospitals that for decades happened to share a radiology group. Together, they are demonstrating how a group of hospitals—each independently owned—can conquer technical challenges and create a common PACS.

While PACS have grown in popularity in recent years, the systems are generally installed within a single hospital or medical group. But in setting up a common system, the four hospitals have done something different—share medical images and reports across a wide area and between hospitals with different ways of managing patient data.

At the same time, their experiment is part of a larger trend, coming at a time when many community hospitals across the nation are obtaining their own PACS.

“It’s a very complex system that we put in place, and we’re changing how the work is done in each hospital dramatically,” said Charles Randall, medical imaging manager and PACS administrator at Valley Regional Medical Center in Claremont, NH.

The other three hospitals that joined on to a common PACS are Alice Peck Day Memorial Hospital in Lebanon, NH; Mount Ascutney Hospital and Health Center in Windsor, Vt; and New London Hospital in New London, NH.

The four critical access hospitals bought the Web-based Vision Series PACS from Boston-based Amicas Inc, which more than 10 years ago came out with the nation’s first Web-based PACS and has been improving the system ever since.

“I’ll tell you, at the end of the day, moving data around from point A to point B is inherently much more simple with a Web-based system than a non-Web-based system,” said Paul Merrild, vice president of marketing for Amicas.

The hospital officials said relying on a Web-based PACS has saved them money on hardware, and because of the ease of connecting to the system, it also allows doctors and administrators to work from home.

Setting up a Web-based PACS cost about $600,000 per hospital, including hardware, software, and consultant services, hospital officials said. Each hospital saved between $200,000 and $300,000 by creating a common PACS instead of installing its own system.

The hospitals do not use their common PACS to centralize billing operations, because each hospital is an independent operator, but they do rely on it to better parcel out work for their radiologists.

“We’re completely unrelated hospitals, other than the fact that we share the same radiologists,” said John Rousseau, director of radiology and PACS administrator at Alice Peck Day Memorial Hospital.

For more than 30 years, the hospitals have shared the services of Valley Radiologists Professional Associates of Claremont, NH, which has five radiologists who rotate between the different hospitals.

Each of the radiologists has a different specialty, and when a hospital has a special case, it uses the PACS to send the images to the radiologist who is best suited to review it.

Before the hospitals obtained a common PACS, a case needing to be reviewed by a particular radiologist could sit for a week until the radiologist arrived at that hospital to review the film, representatives of the hospitals said. But with the PACS a review can happen the same day.

And since each hospital generally has only one radiologist on-site at any one time, the radiologists use the PACS to share the workload.

“What this allows now is a hospital that’s slower to help out a hospital that’s busier,” said Mark Hansberry, MD, radiologist with the group.

“It isn’t that we actually were able to have staffing change in the hospital, but we were able to have a staffing change in that we have more expertise that is able to be transferred across more hospitals,” he said.

So, if a skier is injured near Mount Ascutney Hospital and Health Center in Vermont, and a medical image from that patient needs to be sent to a radiologist who specializes in orthopedics at Alice Peck Day Memorial Hospital in New Hampshire, the PACS system can be used to do that, Hansberry said.

Also, the patient’s record stays in the PACS, so if the injured skier happens to live in Claremont, NH, they can visit Valley Regional Medical Center and doctors will have access to the medical imaging reports.

If the hospitals had separate PACS solutions, the radiologists would have to learn how each system works, never knowing how to fully use each system, Hansberry said.

Setting up a common PACS for the hospitals was the result of 2 years of planning.

Alice Peck Day Memorial Hospital was the first to launch with the system in September 2007, and the other three hospitals took turns joining the system over the next 5 months.

The hospitals invested in a Wide Area Network (WAN), which is a communications network for computers to span a large distance, Rousseau said. The system has a hub-and-spoke setup, with a central server housed at Alice Peck Day Memorial Hospital, and the other three hospitals each having their own less powerful servers, he said.

If the central server went down, each hospital could continue operating with its own server, Rousseau said.

The system uses JPEG 2000 images, and all the images are stored in the original Digital Imaging and Communications in Medicine (DICOM) format on the archive. When the hospitals need to buy more hardware for data storage, they meet and decide how much to invest. The group has also discussed improving connectivity with an investment in its network.

“With this enterprise, we have proven that if you have a cooperative, common goal in mind, you can work together as a group,” said Randall.

The hospitals are spread across the Upper Valley region of Vermont and New Hampshire. By road, 10 miles separate the two closest hospitals, and the two hospitals furthest apart are more than 40 miles from each other.

Alice Peck Day is the biggest of the four hospitals, with more than 400 employees and more than 30 specialties and clinical areas.

Because it is Web-based, the Amicas Vision Series PACS that the hospitals bought allows them to overcome distance by accessing the system on any computer equipped with the required software and connected to the Internet.

The system can even be accessed from a wireless network, from home, or at another location.

The system has privacy safeguards in place to protect patients’ privacy under the Health Insurance Portability and Accountability Act (HIPAA). Accessing the system requires a user name and a password, and the system uses encryption technology as another security measure.

Four independently owned critical access hospitals teamed up to purchase the Web-based Vision Series PACS from Amicas Inc, allowing them to better support one another and improve patient care.

Also, PACS administrators rely on system audits to ensure patient privacy, allowing them to see everything that a particular radiologist or physician has been accessing on the system. The system can also be set up to restrict physicians’ access to only their own patients.

To manage workflow, the Amicas Vision Series PACS has instant messenger-type technology to track patient reports and images with a real-time worklist, showing what has been done and what remains to be done on an exam, said Merrild, the Amicas representative.

The system can also alert the referring physician via e-mail when a radiologist has completed a report on a patient, Merrild said. The auditing system records that the physician has seen the report.

When Amicas worked with the four New England hospitals to set up a common PACS, each hospital had a hospital information system (HIS) from a different company. Amicas and the hospitals created a standard notation system for sending medical data, so that patient IDs were not mixed up, Merrild said.

Amicas and the hospitals said their partnership to create a common PACS across four separately owned hospitals is unlike the standard approach of each hospital setting up its own system.

But what makes the example of the four New England hospitals similar to what other hospitals have gone through in acquiring a PACS is the role of the radiology group in the process, Merrild said.

“We see increasingly the radiology group playing a more and more important role in helping hospitals choose their technology,” he said.

The four New England hospitals also are part of a larger trend of community hospitals switching from film to digital record keeping by acquiring a PACS.

In a November 2007 report called “Community Hospital PACS,” the Utah-based independent medical research firm KLAS found that community hospitals are finding it increasingly difficult to stay competitive without a PACS, and that several factors have made it easier for community hospitals to get a PACS.

The systems have become more affordable with the entrance of new vendors into the marketplace, driving down prices, according to KLAS. And creative ways of financing the systems have emerged, including fee-per-study and leasing options, according to KLAS.

“Some theorize that PACS has become a mature, commodity market,” the report stated. “However, there is still significant dissatisfaction with service, and only half of respondents say that their PACS has all the functionality that they need today.”

Representatives from the four New England hospitals said Amicas worked with them to resolve kinks with the system, including bandwidth limitations.

And the hospital officials said they are also pleased with the collaboration they have shown among themselves.

“What we were trying to do was bring more efficient health care to our patients and to our physicians who use our service by having one place to go, instead of several,” said Rousseau. “That was the driving goal behind the project, and that was what kept us together and on track.”

Alex Dobuzinskis is a contributing writer for Axis Imaging News. For more information, contact .