News Story

Managing the Flow in Radiology

Smart Move: Transition to Web-based PACS
Open Source PACS System Is Now OSO Flexible!
$200K RIS Prize Is on the Line

Smart Move: Transition to Web-based PACS

Film- and chemistry-based imaging is still perceived as inexpensive by many entities, but when officials at the University of Oklahoma Health Sciences Center took a closer look, they thought differently. With the help of eRAD Inc, they ultimately transitioned to a Web-based PACS system, a move that fostered distributed reading access for referring physicians.

Seth Koeppel, MBA, senior vice president at eRAD, worked closely with officials to successfully integrate the Web-based PACS, a process that is slowly but surely creeping across the nation. Koeppel and his colleagues in the industry acknowledge that there is still a long way to go since approximately 50% of all institutions still print film. “Millions of dollars of film still get sold every year, and we know this because one particular national distributor still sells lots of sheets of film, which can range in cost up to $2 a sheet,” said Koeppel, who works for the Greenville, SC-based company. “Large academic hospitals have converted to digital, but some rural hospitals, such as one I learned about the other day out in California, are still printing film—about 15,000 studies a year. That is a minimum of two to three sheets of film for every study.”

Loyalty to film stems from what Koeppel says is a misguided calculation of the actual costs. “You often hear people say a sheet of film only costs them a dollar, but that is not true,” explains Koeppel. “You have processor maintenance, chemicals, film jackets, storage space, people who must file and pull them back—plus human labor costs. People rarely stop and figure all the true costs that it takes to run in a film environment.”

Taking heed of the evolution, clinicians at the University of Oklahoma are now able to access images and reports via the Web without the need for virtual private networks (VPNs) to ensure secure connections between PCs and servers. Thanks to eRAD’s native Web-based system, radiologists can access the same system regardless of where they log in—home, office, Internet cafe, or library. Wherever there is Internet and a browser, they have full access.

Koeppel started building a relationship with Oklahoma officials about a year ago. MR and CT are native digital to begin with, but x-ray requires a conversion strategy. “Either you need to buy computed radiography (CR), which allows you to take the similar plate technology—and instead of putting film in the plate, you put a phosphorus plate that can be reused,” said Koeppel. “So you have this [CR] reader, which allows you to use the same x-ray tube and equipment; you just now switch out the plates. Or you do what is called a forklift upgrade where you have to take out your whole x-ray unit and put in a native digital system or what is referred to as digital radiography (DR). Over the last couple of years, native digital has come down in price so rapidly that now it is that much harder for people to justify computed radiography, although that has come down in price as well.”

eRAD sells the workflow management, viewing, storing, and archiving—all elements that university officials coveted. As the years go by, the university will eventually get out of the film environment altogether, and all archives will be digital. “By having a Web server, we create an online archive for the referring community,” adds Koeppel. “They can look up a patient anytime. As they move from office to office and clinic to clinic, they have access to the central repository. So, Web is really the only way to go. Same for the reading doctors. They don’t have to come in and read. They can be at other institutions, at home, or wherever.”

—Greg Thompson

$200K RIS Prize Is on the Line

When Randall Swearingen, MBA, decided to give away an expensive radiology information system (RIS) to a facility in need, he knew it would be tough to decide which organization ultimately deserved the expensive prize. The contest started on November 2, 2009, and early on two hospitals had stated their case and put in their application. But the contest remained open until December 31, 2009, and several more applicants were expected at the time this article was written.

Randall Swearingen, MBA

For those who have long dreamed about a state-of-the-art RIS, the $200K prize could provide a crucial boost in a time of dire need. “To be eligible, officials from a health care facility just need to be able to describe why they are a hardship case, and why their facility would be a good candidate because of their financial situation,” said Swearingen, founder of Houston-based Swearingen Software Inc. “If they can demonstrate how a RIS would significantly impact the facility and improve patient care, they will be in the running. A group of five or six people will review the cases and try to select a winner. Just from the two that I’ve seen so far, it looks like it is going to be very difficult to pick one, and the contest is not over.”

While acknowledging the inevitable good PR for the company, Swearingen says he offered the prize because it was the right thing to do. “We have been running this business for 25 years, and we have been successful with really good years and some harder years, but we have run into many hospitals over the years that just can’t afford a top-notch RIS,” said Swearingen. “I have always felt blessed and wanted to find some way to give something back. This can hopefully help some facility to stay in business, because I know there are a lot of them that are right on the verge of going out. We are hoping to find that candidate for whom having a RIS—with the productivity and efficiency it brings—can help them stay in the black. If our act of giving can help that one facility, we can help a lot of people in the surrounding community, and for me that is a big deal.”

The idea for the contest started while Swearingen and his wife watched the reality TV show Extreme Makeover: Home, the program that builds homes for needy families. The families in need reminded Swearingen of the countless radiology departments that could benefit from the right technology. Perhaps they did 50,000 exams a year, or closer to 70,000, but when it came down to the money, these organizations just did not have it.

How much is the prize worth? Swearingen’s pricing structure has a range based on the number of exams per year, so the final value depends on the size of the facility that wins. “It could be about $100,000 in value all the way up to $250,000,” said Swearingen. “But I’m anticipating that the facility that will win is going to be a larger site rather than a smaller site. A larger site needs a RIS a whole lot more than a smaller site.”

Swearingen Software agrees to provide the RISynergy software to the winner, Pervasive database software, installation, on-site training, and 1 year of standard software support for free. No hardware is included with this prize, and the winning facility must provide its own working network, fileserver, fileserver O/S, workstations, workstation O/S, printers, backup functionality, and antivirus software.

The number of days on-site and the number of Pervasive seats will depend on the annual procedure volume of the winning facility. “The hardware is really a minimal cost when you factor in the prize,” said Swearingen. “If you are a large facility and let’s say you invest $25,000 in hardware and you are going to get a complete $200,000 RIS, I think that is a pretty good win-win situation.”

Company officials call the prize “our way of helping with the American Recovery and Reinvestment Act.” After all, Swearingen points out that these systems are not inexpensive and the current economic climate has made these types of large purchases difficult for many facilities.

The winner of the Hardship RIS Give-Away contest will be announced on February 1, 2010, with implementation and training to follow soon after.

—Greg Thompson