Managing the Flow in Radiology

A ?Meaningful? System Pays Off for Hospital
Easy Image Sharing!
CoActiv Takes to the Clouds
Software Upgrades Mean Better Cardiac Images

A ?Meaningful? System Pays Off for Hospital

Hospitals looking to capitalize on the American Recovery and Reinvestment Act plan incentives in 2010 are increasingly looking for electronic health record (EHR) solutions. When officials from Virginia-based Twin County Regional Hospital (TCRH) went searching, they ultimately decided to expand their existing McKesson Paragon? hospital information system to increase efficiency and improve patient safety.

As one of many health care technology solutions within McKesson, Paragon is a fully integrated hospital information system specifically designed for community hospitals, based on Microsoft technology, and using a single database. So far, the technology has bolstered TCRH?s integrated plans for inpatient and outpatient EHRs through better patient histories, physician orders, and test results immediately available anywhere a patient goes for care.

Walter Reid, RPh

Walter Reid, RPh, vice president, Product Strategy and Marketing for Paragon, reports that TCRH?a 141-bed acute care hospital?also purchased McKesson?s Practice Partner? Patient Records ambulatory care EMR solution. Integration with Paragon allows physicians to seamlessly refer patients from their office to the hospital for care. ?From that, we automatically create a preregistered visit, grant the orders, and the patient simply has to present at the hospital,? said Reid. ?The patient?s information for that referred service is already on file. That has saved TCRH a lot of time in terms of managing their referral business, but it also helps them secure their referral business.?

Improved patient workflow inevitably leads to better cash flow, which is always a welcome by-product of increased efficiency. ?We have eliminated the faxing, and the associated costs that go along with that,? added Reid. ?We have worked with TCRH?s executive management team to develop a road map to get them to what we call stimulus or meaningful use readiness. TCRH is an institution that sees the value in IT, and they are making the correct decisions to move forward, primarily to protect the institution?s current revenue streams. They are doing what they can do now in anticipation of being at the appropriate functionality levels that they will have to demonstrate to obtain meaningful use.?

The stimulus package passed last year under the Obama Administration mentions ?meaningful use? as a necessity for health care providers who wish to avoid penalties that are sure to materialize after incentives have been drawn down. Essentially, the government will help hospitals to adapt, but the alternative is to face financial repercussions that could come in the form of negative ?adjustments? to fee schedules.

Part of that meaningful use threshold includes digitizing records so that hospital officials can hand them to patients, who can then take them home. ?TCRH administrators are not waiting for the final [meaningful use] criteria to come out,? said Reid. ?I applaud them for that.?

?Over the past 18 months, we?ve provided practitioners in our hospital and clinics with more timely access to critical clinical information,? added Jon Applebaum, president and CEO of TCRH. ?Now the stage is set to make even larger strides in improving the quality and safety of the care we provide. We expect the additional clinical solutions to help us realize an almost three-to-one return on investment in information technology.?

TCRH is building on a prior deployment of the Paragon integrated clinical and financial system, which is tailored to meet the needs of community hospitals, and McKesson?s Practice Partner CCHIT-certified outpatient medical record. The integrated systems create a single EHR, enabling physician practices to electronically send orders to the hospital, with results flowing back to the physician offices. Physicians at six clinics currently use the Practice Partner system, while physicians at four affiliated practices are gearing up to install it. ?With an EHR, we can share information among our clinics and with the hospital, preventing duplicate procedures, cutting costs, and increasing the continuity of care for patients,? said Chastity McGrady, manager of the TCRH Family Care Centers. ?The Practice Partner system?s ability to electronically submit prescriptions to a patient?s pharmacy also significantly improves patient safety.?

TCRH?s ability to reduce report turnaround times from 24 hours to minutes, and then provide immediate access to those results (from lab results in the emergency department to radiology images and reports in the clinic), has improved patient care. ?We have 12 hospitals within a 1-hour drive of our facility, but patients say that for an emergency department visit, TCRH is the place to go because our new ED system helps us care for patients so quickly,? said Jack Roberts, director of information systems, TCRH. ?Our technology partnership with McKesson gives us a single-vendor offering with everything we need for our hospital and clinic community.?

?Greg Thompson

Easy Image Sharing!

Sharing radiology studies over the Internet can be technologically complex and expensive for small departments and imaging centers. But, because of ?cloud? computing technology, going digital is now in the reach of any organization.

Viztek?s Opal PACS solutions for radiology and orthopedic departments utilize cloud-based technology to give access to authorized users. The cloud technology eliminates the need to connect to a facility?s on-site server and, also, the complexities of establishing a virtual private network or VPN. This approach has several advantages for clinicians and their patients. It provides cross-enterprise sharing of images at a faster, more efficient, less expensive rate and, consequently, brings the goal of a true, integrated electronic patient record closer to everyday reality.

The Opal PACS is a particularly attractive option for organizations making the move from analog to digital technologies, according to Steve Deaton, Viztek?s vice president of sales. ?The IT needs for the Opal are small,? he said. ?This is often a large barrier to entry into a digital environment; the group needs another IT person. We don?t provide total IT support, but we do provide the IT support that?s needed [for the Opal].?

The Opal PACS solutions are completely scalable to the organization?s needs. This includes both the amount of server space and the speed of the connection. Because Viztek has large server resources, the Raleigh-based company can give radiology departments and imaging centers ?room to grow and breathe,? said Deaton.

One of the biggest advantages cloud computing offers radiologists and other clinicians is the ability to send (or receive) images from outside of the enterprise to referral sources and to other colleagues. While the PACS may need to be accessed by only five users internally, these referral and consulting sources may number in the dozens, meaning that they need access, which may be a difficult technological issue to solve. Viztek handles all of this for their customers, eliminating the need for additional personnel, and making communication with those outside the facility as easy as possible.

Security of patient images and data is at the forefront of Viztek?s technological strategy, while, at the same time, preserving functionality. Opal security includes user passwords and strong encryption on par with those used by credit card companies and the US government. However, Deaton notes that what differentiates Opal from some other systems is that it is easy to manage for outsiders. ?[You have to have] that to successfully launch into the cloud,? he said.

Much of this is handled through permissions. For instance, an individual or group outside the facility may have access limited to only certain images from a particular patient or from a particular series of DICOM tags, or only certain types of exams such as CT or x-ray.

In these cash-strapped days, the Opal brings another significant advantage to the table?a pay-as-you-go fee schedule, which shifts image management expenses from the capital to the operating budget. The Opal is scalable to grow with a facility?s needs, and system upgrades and maintenance are built into the fee schedule.

?C.A. Wolski

CoActiv Takes to the Clouds

The phrase ?being on cloud nine? has just gotten a radical new meaning thanks to CoActiv?s launch of its EXAM-PACS, a cloud-based option that will enable secure, anytime, anywhere live access to PACS images and data over the Internet.

At the same time, it is launching mobile Apple iPhone/iPad technology that can connect via a virtual private network in the clouds using an airline?s WiFi connection to enable secure medical image review on an aircraft cruising at 30,000 feet.

CoActiv CEO Ed Heere discovered the effectiveness of stratospheric viewing on his iPhone during a trip he was taking on an airline that offered in-flight WiFi connections. Whipping out his iPhone, he was able to download 350 images from CoActiv?s test server in about 5 minutes.

And just because the images are sent to an iPhone or iPad doesn?t mean they lose any functionality. In fact, except for the image size, there is no difference between the capabilities of the EXAM-PACS on the iPhone or iPad and on a full-scale workstation. This is particularly convenient for the radiologist who may be reviewing an image up in the clouds or in their home. The EXAM-PACS has a number of features that are becoming crucial in today?s imaging environment, such as full-color, 3D reconstruction.

MRI brain?coronal series?full resolution with sample linear measurement.

The new, cloud-based EXAM-PACS can be accessed using any Internet connection. All CoActiv-supported images are archived on its EXAM-VAULT QUAD-REDUNDANT ARCHIVE, a cloud-based, vendor-neutral server with ultrasecure and reliable mirrored storage in four geographically distinct locations. The iPhone/iPad accessibility will allow travelers to review images on airplanes flying high above the earth (or anywhere on the ground) thanks to EXAM-PACS? bidirectional compatibility with the OsiriX Mobile viewer, which runs the iPhone and the recently released iPad. There is no special software needed to take advantage of this functionality.

Although CoActiv writes all of its own software, Heere said that using Apple?s OsiriX Mobile viewer allowed the company to take advantage of the iPhone/iPad revolution by getting the EXAM-PACS to market very quickly. ?It would have been a mistake to develop our own [iPhone] viewer,? he said.

Heere, an admitted IBM PC user, said that he initially didn?t have much interest in leveraging the Apple iPhone technology. That was until he noticed that many of his employees had begun using iPhones, making them a ubiquitous part of their lives. ?I saw the iPhone, then I saw the apps, and I saw this is where [communications] was going for radiologists and other clinicians to see reports anytime and any place,? he said.

While the EXAM-PACS app proved successful, it was originally limited by the size of the iPhone?s screen. Heere says that the iPhone is ideal for second opinions and not for making diagnoses. The iPad?s larger screen should help solve this problem.

The system is extremely flexible and scalable. It can be set up in any configuration that a hospital or imaging center would like and for any modality, including cardiology and BSGI. ?We haven?t met a modality yet that?s DICOM that we can?t interface with,? Heere quipped.

Expanding the system is as simple as adding server space. According to Heere, an expansion is completely seamless. The only additional costs are for new licenses or any extra hardware, such as workstations.

Heere added that the company has no facility size requirements to use EXAM-PACS.

In the event of any problems or service issues, CoActiv technicians?all of them PACS engineers?are available on the company?s help line around the clock every calendar day. These technicians can even enter the system remotely to help diagnose a problem or train new personnel.

And best of all, EXAM-PACS is easy to get for an iPhone or iPad. The EXAM-PACS app is available for download from Apple?s iTunes store for $20.

?C.A. Wolski

Software Upgrades Mean Better Cardiac Images

For many years, radiology was more of an art than a science. And while the tools have improved, in some cases, it hasn?t changed that much. This is particularly true in cardiac imaging, which is often at the mercy of numerous variables.

However, Toshiba America Medical Systems has recently introduced software improvements to its Aquilion ONE and Aquilion Premium CT systems that promise to take any ?artistic? approximation out of cardiac imaging and give it the kind of precision that improves diagnoses.

In addition to delivering a more precise image, the new ONE Beat Prospective Reconstruction shortens the interval window. The Real Time Beat Control calculates the running real-time average heart rate to precisely predict the next heartbeat for a more accurate scan, which is particularly useful for patients with arrhythmia or unstable heart rates. The SUREStart feature can determine contrast uptake for more accurate imaging, which improves image quality and lowers the contrast dose.

Toshiba now offers software improvements for cardiac imaging to its Aquilion ONE and Aquilion Premium CT systems.

Robb Young, acting director for Toshiba?s CT Business Unit, notes that because the ONE Beat is able to image the entire heart more precisely and in one ?panoramic? pass, scans can be finished more quickly and the need for retakes is drastically reduced. And, unlike helical scans, which can require two to three scans to capture the same information, the ONE Beat?s single scan also means more efficient use of resources and reduces the radiation dose by about 21%.

While reducing radiation exposure has become a clarion call throughout the halls of government and elsewhere, Toshiba has been working to limit doses since the late 1990s and has been doing so incrementally since then, noted Young. ?It?s always something that we?ve planned,? he said. ?We have always looked at the ability to image faster with less radiation dose.?

Toshiba?s Aquilion ONE dynamic volume CT features 320-detector rows and is able to scan an entire organ in a single pass and produce 4D videos showing an organ?s structure, movement, and blood flow. The Aquilion Premium is designed for clinical accuracy and safety, according to the company. It features 160-detector rows to image up to 8 cm of anatomy in a single gantry rotation and can accommodate patients up to 660 pounds. It also comes standard with the 72 kW generator and advanced features like iStation display and 8 cm dynamic scanning capability.

The ONE Beat upgrade has been made available to all Toshiba Aquilion ONE and Aquilion Premium users, and is being loaded into all of the models currently on the assembly line.

Toshiba users typically get one or two updates per year, which is provided as part of the regular service plan. According to Young, one of the advantages that Toshiba brings to the table is that its medical imaging hardware is much more advanced and long-lived than that of many of its competitors, and is designed to be upgraded. ?[Our systems] are introduced knowing that the software will be updated,? he said.

Because these updates are regularly planned, they can be implemented precisely and at the convenience of the users.

?C.A. Wolski