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

Open Source PACS System Is Now OSO Flexible!

In the early days of PACS, it was necessary to purchase the system as part of a package along with the modality from an imaging vendor. Not any longer. Thanks to companies such as ClearCanvas, Toronto, which offers an open source RIS/PACS solution, radiologists and radiology administrators are no longer locked into a single-vendor-dependent solution.

ClearCanvas recently partnered with Oso Healthcare, which will provide a pay-as-you-go user support system for RIS/PACS customers.

But eliminating the need to invest in a single imaging vendor is only one of the advantages that ClearCanvas’ open source RIS/PACS delivers. There are several others, including the elimination of licensing fees; a transparent, high-quality software development process; and a passionate, vocal user community that gives real-world feedback to the company. Of the latter, ClearCanvas president and CEO Norman Young notes that the user community’s feedback can be acted on immediately and any perceived or real issues can be addressed and corrected right away to the benefit of both users and their patients.

The ClearCanvas system is virtual, so the PACS can be installed on a single server but appears to be on several thanks to its strict separation of data. The system has a high level of customization and can be specifically tailored to the user’s needs.

The system is straightforward to install, according to Young. The installation is handled through ClearCanvas’ Web site. He said that the company is planning a Web-based solution within the next year.

All of ClearCanvas’ software is Windows based and easy to use. “What we’ve heard from users is that it’s extremely intuitive,” said Young, adding that most users can be up to speed within a few minutes after downloading and accessing the software.

Conversely, if a department underestimates the number of “tickets” it needed, it can “top up,” that is, purchase additional ones. These tickets can be purchased using everything from a traditional purchase order to a credit card to a PayPal account. While the pay-as-you-go model isn’t completely new to the health care scene, it’s a revolutionary way to pay for PACS support. “I’m pretty confident that the pay-as-you-go model is a viable option [for PACS support],” said Oso Healthcare president John Adziovsky.

Of course, while ClearCanvas’ open-source PACS and Oso’s advanced support are attractive for their convenience, in these days of rampant ID and data theft, security is likely high among the priorities of administrators, radiologists, and patients. Adziovsky says that both ClearCanvas and Oso have implemented full data security protocols, including the use of permissions, data encryption, and auditing functions—this last acts somewhat like electronic fingerprints pointing to who accessed the data. He also noted that the systems are HIPAA compliant. But he points to the very fact that the ClearCanvas PACS is based on an open-source model that heightens its security, noting that large computer and data corporations, such as IBM, rely on open-source systems in order to conduct their business.

Making ClearCanvas’ PACS even more user friendly, the company recently partnered with Toronto-based Oso Healthcare to provide implementation and user support. Unlike a typical service contract, Oso offers a per-use, pay-as-you-go system that can be bought in service bundles and varying levels of support. These “support tickets” can be mixed and matched based on the level of needed service. For instance, an urgent request could be made using an “Elite” ticket, which triggers a faster response time of a few hours. A more routine or “Basic” ticket will have a response time of up to a day or more. Pricing is based on level of service and tickets don’t expire. In addition, there are no licensing fees nor is there a set, locked period for the service contract. Users aren’t required to continue buying tickets or use Oso’s support service for a set period of time.

—C.A. Wolski

$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