The challenge: Denver Health needed accurate and timely images from multiple hospitals across state lines in order to treat trauma patients.

The Rocky Mountain West is a sportsman?s paradise. Among its steep hills and vast prairies lie some of the world?s greatest adventures. But there, too, lie some of the greatest risks. When risk turns to traumatic injury, less than a handful of level I trauma centers exist in the four-state region, and that presents a challenge to get the right care?at the right time?to the critically injured. Denver Health, a 477-bed medical center in Colorado?s capital affiliated with the University of Colorado medical school, receives many of those trauma patients. But over the last couple of years, they have begun to streamline and expedite care. In some cases, they have even turned away trauma patients, but only doing so secure in the knowledge that the patient will be best served by staying put in one of the dozens of small hospitals that it has connected with using a specially designed tool that permits same-time radiology reads. The result has been more efficient care and, often, cost-savings to the patient.

It?s ski season in world-famous Vail and someone has fallen, causing a pelvis injury requiring surgery. The physician has done a CT scan, but wants to talk to the orthopedic specialist who can look at those films and consult on the spot. It wasn?t an option because proprietary technology simply could not communicate with a different proprietary technology. The standard had been to stabilize and capture images of the patient at the local hospital, and then transport them by ground or air, depending on the severity of the injury, to a trauma center along with a CD of the imaging. ?Patients were arriving and we didn?t have the CD. It was left in the helicopter or dropped out of an envelope in the referring hospital, or got stuck in the ED under a pile of paper,? recalled Debra Carpenter, RN, administrative director of surgery and trauma for Denver Health. That had created huge issues for the hospital system, celebrating its 150th anniversary this year. For the patient, it meant delaying treatment while the CD was located and read on an appropriate workstation. In some cases, when the CD could not be found, additional imaging studies were recorded, adding to the expense of care and exposing the patient to unnecessary radiation. For the hospital, it meant keeping up with all those incoming CDs, figuring out a way to store the information on their PACS, and making sure the right information went with the right patient.

?We wanted to import CDs, make sure the information matched up and that worked well, but it was still a big manual process; a lot of hands grabbed the CD, if it came from trauma or orthopedics,? said Vince Doyle, imaging informatics manager for Denver Health. ?Debra came to me and said the CD imports are nice but they?re not timely. Is there something we can do to make this process easier for our physicians?? Doyle?s background was in teleradiology, so the hospital tried a few ways of image sharing. But none of the outlying hospitals Denver Health dealt with on a regular basis was directly affiliated, so it became technically cumbersome to get all the different kinds of technologies to talk with each other. With so many obstacles, it seemed as if the solution had to be one that could move mountains.

Finding a Gateway

?We wanted to streamline where the doctors got their information, how we were going to present the images from different facilities,? Doyle recalled. ?We went to various PACS vendors asking, ?Do you have any sort of solution close to what we want to see?? and 95% said they could do auto-routing but they had nothing for storage or DICOM tag-morphing.? Emageon, now a part of Boston-based AMICAS, also had nothing of the scope Denver Health wanted, but they came up with a solution, called Gateway, which provides a standardized solution for importing outside studies and patient information and enables health care facilities to directly and securely transmit a copy of the patient?s images and information from location to location. With Gateway in place, the medical staff can help reduce the number of instances when they need to burn images onto CDs and cut down on the times they need to rescan patients because their images are stored in a format that is proprietary to a particular PACS vendor. And the software permits short-term storage solutions that allow the medical center to keep imported information separate from the 175,000 radiology studies alone conducted each year. ?None of that is new to the medical imaging industry, but no one had put it all together.?

?We receive patients from tons of facilities, so everybody has a different system,? Carpenter said. Physicians at an outlying hospital call in and want a live review of an imaging study they?ve conducted. ?We couldn?t do that before. They didn?t have a way to import those pictures into our PACS system.?

One of those facilities is Vail Valley Medical Center. Located about 100 miles west of Denver, the hospital is the second-busiest level III trauma center in Colorado. The medical center has had a long-term relationship with Denver Health. But if they were faced with a critically injured patient, they would have to delay transporting until a CD of the CT scan was created. Using the Gateway, that is no longer the case. But it doesn?t mean patients are scanned and immediately dispatched to Denver, said Anne Wardrop, trauma program manager at Vail. ?Our CT scans can be read by their physicians while the patient is still here. They can start to determine if the patient needs to go straight into surgery or can bypass the ED and go to the ICU, or whether the patient can stay here. It makes transports more appropriate.?

The trauma surgeons at Vail all came from Denver Health within the last decade. The neurosurgeons at Denver Health can look at the digital films and say the patient is fine at the remote location or make specific preparations if they decide the patient needs to be brought in. ?It?s keeping us from transporting people down to Denver, taking up a bed, incurring that additional expense,? Wardrop said, adding that flying a patient into Denver can cost as much as $10,000. ?You can imagine a lot of our patients come from around the world, and then to be disrupted to go to Denver and get their families there, or have some of them here and some of them there. If you need to do that for patient care, you do it?it?s not an issue. But when you don?t need to and the patient care is maintained, I think we need to be fiscally responsible for our patients.?

Saving Lives, Saving Money

Denver Health, a level 1 trauma center, implemented a specially designed tool from AMICAS that permits same-time radiology reads with hospitals it serves from surrounding areas.

The real-time image sharing has multiple benefits, as Carpenter sees it, but none of them relate to filling a bed in Denver. ?You?d think our drive is to have patients sent to us, but it?s more than that. If you don?t need to transport that patient and we wouldn?t do anything a level II or III can?t do, why do it? It is an inappropriate use of resources. But if you do have a really critical patient, we study them before they arrive; we have a plan of action before they even get here. We don?t need to waste time in the ED; they go right to surgery. Our care is going to be more timely.?

Doyle said Denver Health piloted its Gateway reading with nine hospitals. Today, they work consistently with 24 facilities in four states. ?We have the capability of taking direct DICOM send. There was more involvement in creating a CD than this.?

And, Carpenter adds, there?s instant communication. ?In terms of those patients who do come here, we?re able to make much more rapid decisions on the care, we really know what?s coming in the door. You?re not able to visualize the patient, but if we?re looking at films with the doctors at some remote facility, we?re all on the same page. Our doctor knows exactly what to expect when the patient rolls in the door here, and we know the urgency?or lack of urgency. You can ground the patient and not fly the patient.? That could mean the difference between a $10,000 airplane trip from New Mexico, a $5,000 helicopter flight from Wyoming, or a relatively inexpensive ambulance ride. ?When you talk about health care?and our cost increases every single year?if we can remove some of the burden from these insurers by removing some of these expensive and unnecessary things, we?re doing our part to keep those costs down.?

Carpenter and Doyle look to every one of the outlying facilities they work with as a partner, even though they?re not affiliated with Denver Health. Doyle said the ?trust factor? is paramount. ?You have to have buy-in and support. We?ve got that. Last year, through this solution, we have over 2,500 studies that would have been on CD. That almost doubled from the previous year. That?s encouraging for us as well as other facilities.? One cost-saver is having a flat fee for PACS images. Some vendors will charge per-image, making this kind of volume inconceivable. ?It?s going to cost some money regardless. But it comes down to a facility that looks at patient care as the thing of utmost importance.?

Dan Anderson is a contributing writer for Axis Imaging News.