New technologies are helping imaging centers better connect with referring physicians, save time, and capture more business.

As PACS technology continues to improve, imaging centers are maximizing service and performance like never before. Long gone are the days when patients had to hand-carry large film files from one doctor to another. Still, many medical practitioners continue to burn CDs and have their patients carry these around.

But times are changing. For example, Milwaukee-based Merge Healthcare has introduced a ?zero-client? PACS platform that overcomes some of today?s most significant challenges with radiology connectivity and interoperability. The zero-client approach will improve processes across health care enterprises?for radiologists, radiologic technologists, referring physicians, business executives, IT professionals, and even receptionists?by enabling new efficiencies for viewing, distributing, and manipulating radiology data, including images and associated information. Patients, as well, will have ready access to radiology images and reports.

?Think Google Maps,? said Tim Kulbago, general manager of Merge Healthcare?s Fusion medical imaging business. ?Just as anyone can secure an image of a neighborhood, then zoom in to see a neighbor?s pool using a PC or Mac with any browser, zero-client imaging enables clinicians to more quickly and cost-effectively access and manipulate images?at computers in medical offices, at home, even in the palm of the hand via iPhone. With a zero-client approach, diagnostic images can be readily included as part of a patient?s EHR regardless of browser type, operating platform, or security policies, and without the need to install or maintain subsequent visualization devices or software plug-ins such as Active X controls.?

?We see continued movement toward comprehensive PACS solutions,? said Kulbago. ?As such, PACS vendors must differentiate their solutions by extending their value beyond core functionality. Merge Healthcare?s Fusion Workstation (version 3.0) is the first PACS to deliver uncompromised interoperability between practice groups and referring physicians via our revolutionary ?zero-client? Clinician Access Portal. Using this dynamic EMR module (available on Fusion Workstation and Fusion RIS/PACS, in addition to use on non-Merge PACS), referring physicians can visualize patient studies from their favorite PC- or Mac-based Web browser, without having to download/install software or hardware of any kind. The rendering of images and all manipulation are securely managed and facilitated by server-side processing. Fusion Workstation also delivers robust 64-bit processing, a customizable enterprise worklist, and numerous workflow tools that provide unmatched peer-to-peer communication.?

Metro Imaging of St Louis, an independent imaging center that produces more than 100,000 images a year, is an early adopter of the zero-client platform. ?To us, zero client means zero hassle, and we?re very excited that there are no more firewalls, Active X controls, downloads, or browser upgrades to contend with,? said Metro?s chief financial officer, Christine Keefe. ?We?re certain this technology will bring our referring physician practices and our hospital partners the flexibility and accessibility to consolidate workflow, and to get through their day with much more efficiency.?

According to Keefe, ?We?ve used Merge?s RIS/PACS for several years and recently added the new FusionWeb Clinician Access Portal. Improving connectivity with our referring physicians is critically important to our marketing strategy. With our previous portal, security protocols at many hospitals and offices restricted physicians from using it. But Merge?s zero-client technology eliminates this challenge, making images more readily available to a larger base of referrers. We look forward to considerable cost savings via reduced CD burning and courier costs. Feedback has been awesome, including comments from scheduling staff at referring offices who report saving a lot of time by using the portal.?

Indeed, Keefe reports that 230 referring physicians have signed up with Metro Imaging in just the last month.

?The patients love it,? added Keefe. ?The on-site reporting gives patients their results before they leave the office. Plus, it gives us a huge marketing advantage and eliminates the need to employ a new radiologist for our five sites. With everyone securely logged on and able to interact with both worklists and images, our referring physicians? nurses have their daily cases prepared in advance, with minimal effort and little need of phone calls to coordinate efforts.?

More Efficiency, Better Business

Bradley Stevens, clinical coordinator of Alabama-based Precision Imaging, points out another advantage of today?s new technology?the ease of billing. ?We were a normal, small office imaging center that was trying to grow. We were experiencing staffing issues due to the amount of paperwork involved with remote reading and preliminary reports and time spent faxing. We didn?t have the reimbursement to justify more staff. In our attempt to grow, we invested in the Viztek PACS, RIS, and billing solution. This has become a lifesaver. We now can give remote facilities and referring physicians the ability to log in and see only the patients they are involved with. This really cuts down on us having to manually fax anything or spend time looking up reports. Now the facilities and referrers have the capability to handle this without the hassle of contacting us.?

The Viztek solution eases the burden on patients, too. ?If referring physicians need to send their patient to another facility after we complete their scan, they can burn the images to a CD and send it with that patient to their next physician office,? said Stevens. ?There is no more hassle in making the patient go back and pick up images or the expense in mailing out images. This move to Viztek has allowed us to grow even greater than we expected.?

Stevens noted how the system enhances the billing and reimbursement process, too. ?The information flows from the Viztek RIS to the Viztek billing solution and allows one to instantly send a claim out and track the reimbursement. The software allows us to see where our financials are at all times.? In addition, it?s user-friendly for referring clinicians. ?Referring physicians can log on for the first time, you have a quick download, and from that point forward you just log in and do your work. It?s a more robust system and much simpler,? said Stevens.

?We are currently in the process of trying to get one of our other centers online with VPN access to our PACS,? Stevens said. ?Currently, they are just mailing us CDs, which I then have to import into PACS studies and scan in the paperwork for our director to view. This process normally takes about a week! When they get their end straightened out and can send directly to our PACS server, this process will take less than 1 hour to get them a report.?

The Viztek solution is a business booster for Precision Imaging. ?With the new system up and running, we have the opportunity to expand and capture more business that used to be limited due to distance,? said Stevens. ?In the past, a radiologist had to drive to each facility in order to read the study. Now we can read a stat in California at 2 am with no problems, whether it is from the office or from home. We can log into the server over the Internet and complete the read.?

Addressing Multi-Modality Challenges

Running a busy multi-modality center is no easy task. Advanced Imaging of Port Charlotte, Fla, provides a wide array of imaging services including PET, PET-CT, MRI, nuclear medicine, biopsies, nuclear cardiology, ultrasound, echocardiology, and digital mammography. To keep pace with volume and stay efficient, the facility chose comprehensive PACS solutions from Thinking Systems of St Petersburg, Fla.

Aside from Web-based image review for conventional modalities like CR/DR, CT, and MRI, Thinking Systems offers PACS solutions for hybrid modalities and more. For example, the company provides archiving of all image types for nuclear medicine, PET/PET-CT, ultrasound, echocardiology, and cath lab. Image fusion between different modalities, such as PET-CT, PET-MR, SPECT-CT, and CT-MR, or among the same modalities, such as PET-PET, CT-CT, and MR-MR, is another key feature.

According to the company, its thin-client-based Web technology provides workstation functionality over the Web, allowing clinicians to view and manipulate images of all modalities, and perform PET-CT fusion, nuclear medicine processing, and quantitative analysis from any computer connected to the Internet. Most importantly, it means that clinicians?across town, or across the globe?can collaborate over the Web.

The system offers the advantage of centralized storage for both images and patient information and allows clinicians or staff members to perform key tasks such as patient registration, scheduling, exam tracking, staff and resource management, report generation, and distribution, etc, from any Windows computer on the network (intranet or Internet). ThinkingPACS? and ThinkingRIS? are based on an open architecture, using standard Microsoft Windows operating systems (Windows 2000, Windows XP, Windows 2003, etc) and off-the-shelf hardware.

According to Forrest Borchardt, practice administrator for Advanced Imaging, ?We switched from a GE system in 2005, and we are very satisfied with Thinking Systems? service and technology. They have met our every need and have contributed greatly to our growth. Indeed, every time we needed a fix or some new software adjustment, they were very responsive. We have mutual respect for each other.?

Borchardt considers Thinking Systems PACS software superior to any Advanced Imaging has encountered. ?We send referring physicians a CD containing Thinking Systems software to install on their personal computer system. Then they?re up and running.?

In contrast to Merge?s system, Thinking Systems? does not run on a MAC, rather only on Microsoft systems. ?Also, we?re still waiting for FDA approval of mammography viewing, which requires a 5-megapixel display,? said Borchardt. ?Thinking Systems is working on that upgrade.?

The new technologies enable new efficiencies for viewing, distributing, and manipulating radiology data, including images and associated information. That adds up to better workflow and enhanced satisfaction with referral sources. In short, today?s PACS solutions are all about helping imaging centers be more productive and profitable.

?Solving the problem of delivering an interactive experience for diagnostic images without the need for plug-ins is a true breakthrough,? said Kulbago of the Merge system. ?This technology ensures all clinicians have simple and comprehensive access to an image-enabled health record. There is tremendous value to health care practitioners and patients alike.?

James Markland is an contributing writer for Axis Imaging News.