The Multiple Facets of PACS

Nov. 1, 2006

Today’s PACS must not only deliver images and store them, but also lower the cost of doing business.

Many healthcare facilities today grapple with the issue of replacing a legacy or older picture archiving and communications system (PACS). While reasons vary, it is not uncommon for early PACS adopters to eventually need more functions and expanded capability. Gary Wildfong, director of technology at Axcess Diagnostics, believes that changing to a newer PACS was a requirement for their continued expansion and operational stability.

Today’s PACS must not only deliver images and store them, but also lower the cost of doing business.

Many healthcare facilities today grapple with the issue of replacing a legacy or older picture archiving and communications system (PACS). While reasons vary, it is not uncommon for early PACS adopters to eventually need more functions and expanded capability. Gary Wildfong, director of technology at Axcess Diagnostics, believes that changing to a newer PACS was a requirement for their continued expansion and operational stability.

“Over time, hardware and software becomes better, naturally,” says Wildfong. “A key reason why we invested in a completely new PACS, rather than upgrading our existing system, was the limited shelf life of certain products.” Even if a company tries to expand an older product, it may be automatically limited depending upon how the base software was originally written.

Axcess Diagnostics is comprised of three outpatient-imaging centers located in Venice, Sarasota and Bradenton, Fla. As an early PACS adopter, they have been on the cutting edge of new technology, providing advanced diagnostic imaging services with MRI, CT, PET and digital mammography.

“Our first PACS was a great, single-modality PACS for MRI. But it was not scalable,” notes Stephen Miley, M.D., Axcess Diagnostics’ founder. As the centers expanded to multimodalities they migrated to a new PACS. However, that system could not meet the functionality requirements of advanced imaging technology within a multicenter environment. Axcess Diagnostics required a system that was robust for advanced MR and multislice CT applications, yet flexible enough to accommodate rapid onsite and offsite viewing by multiple, authorized users.

The Needs of the Many
Two primary issues of the new PACS were critical to Wildfong. “From an operational standpoint, we required a high performance, stable system. However, we also needed a PACS that could deliver images throughout an expanded market, with additional tools for marketing our services to referring physicians.”

Stability of the PACS related not only to delivery of images, but also to archival storage. Wildfong has installed five different PACS throughout his career. He discovered that many PACS vendors simply didn’t understand the complexities of a storage infrastructure working in tandem with database management. He says it is critical that PACS performance and stability address both today’s operations as well as future storage capability. “We found that the newer generation of PACS vendors aren’t focused just on PACS, but also have ‘divisions’ for data storage and migration. These additional facets further expand the PACS’ reach and functionality.”

“We knew the Web was the future,” says Miley, “particularly for the distribution of images.” However, Miley also wanted a robust viewer that was intuitive and easy-to-use. He believed that the PACS should become a strategic partner, one that would help grow the business. “There are three aspects of a PACS—first there’s the viewer that most clinicians see daily; second is the back-end, which is a critical component that connects the modalities into the database; and third is the storage and retrieval of images.” Each component, working together, would fulfill Miley’s vision for an image distribution system that promotes strategic growth.

Together Miley, Wildfong and Gerald Grubbs, M.D., director of radiology, began an exhaustive search of 30 PACS vendors. They decided against the typical RFP process, instead choosing to evaluate each vendor telephonically, or through onsite meetings, to further delineate system features and capabilities.

Key considerations were: the number of installs in place for at least five years, particularly at sites similar to Axcess; whether the PACS was Web-based; whether it featured seamless multimodality connectivity; and company’s size and stability. The team also spoke with existing customers, which was crucial to their decision—especially those sites that had undergone several upgrades with the vendor. “The radiologists tested the viewer. But we relied heavily on the feedback from existing users versus just testing each system’s capabilities,” says Miley.

Live Within Days
In February 2006, Axcess Diagnostics installed its third and final PACS—IntelePACS from Intelerad in Montreal, Quebec. Miley, Wildfong and Grubbs based their selection on the performance and stability of the product. It also had lower reported service and maintenance costs, was scalable and provided rapid delivery of images—exactly what Access Diagnostics required. The installation went smoothly.

“We started the deployment on a Monday and by Wednesday morning, we were live at all three centers,” explains Wildfong. “It was phenomenal. [Intelerad] remotely configured the servers and sent the hardware in advance, so I could perform my local configuration with the modalities.”

According to Wildfong, the system’s design makes it inherently stable for the short- and long-term. The fact that IntelePACS also can expand to a hospital network level, and still provide the flexibility and functionality needed by a multiple imaging center organization, enabled it to meet Axcess Diagnostics’ scalability requirements.

“From our standpoint,” says Wildfong, “we must have one PACS that can serve two functions, as an internal PACS for the radiologists and an external tool for the referring physician.”

For Grubbs, functionality for his radiologists is crucial to effective and efficient reading. “Today, we have the capability to perform advanced reconstructions on any plane—MIP and MPR. These are fundamental tools for reading any high-quality MR or CT exam.” In his opinion, reconstruction is a natural evolution of advanced imaging and a process that should be seamless and simple to execute on a PACS workstation. “With this PACS, there are no extra buttons or clicking required and the speed of reformatting has increased the efficiency of our radiologists.”

The Bottom Line
Miley attributes reduction in radiologist overtime directly to the new PACS. Axcess now reads all exams the same day and distributes most of the reports that have images electronically, reducing film cost to referring physicians by 50 percent, as well as most courier costs.

Wildfong travels throughout the referring physician network installing IntelViewer, Intelerad’s softcopy reader, on the clinician’s computers or laptops. “Our referring physicians are viewing the images off our server and do not download the images to their computer, making this a completely HIPAA-compliant system.”

Based on industry averages for film production, staff time and film courier costs, Axcess Diagnostics saves $150 to $200 for each exam that is processed and delivered electronically. “I’ve installed 20 percent of our base, and of that percentage, 8 percent to 10 percent of them had the most film requests,” says Wildfong.

Yet, cost savings are not the only result of a reduction in film. According to Grubbs, “With film, it’s impossible to reconstruct images or provide same-day consultation with the radiologists, referring physicians or patients.”

Thanks to the stability of the system, which operates with minimal maintenance and has not incurred any downtime to date, Axcess Diagnostics has been able to cut prior IT outsourcing bills by $50,000 to $60,000. “We can now rely solely on our two internal staff for all our IT needs,” Miley says.

Most importantly, the system works to enhance patient care and service to referring physicians. “We now deliver near-instant patient care,” says Grubbs. He cites a recent example of an MR study that was viewed within five minutes of the end of the exam. The patient was diagnosed with a subdural hematoma and was operated on by a neurosurgeon the same day.

The new PACS also improves the clinical consultation process. “Radiation oncologists want DICOM images to perform intensity modulated radiation therapy (IMRT) or conformal radiation therapy. We’ve started collaborating with them to provide access to our images for import into their planning software,” says Miley. Images are readily available for consultation between the patient and their primary care or referring physician, without incurring any additional costs, often times as the patient leaves the center and heads back to that doctor.

Today, Grubbs can perform real-time, remote consultation with referring physicians and even collaborate with other radiologists on difficult cases—processes that he could not perform with film. “With a Web-enabled system, I can be anywhere, at anytime—in my office, home or in any one of our imaging centers—and access all the images.”

Wildfong rounds out the picture with his summary of the benefit. “For so long, we in radiology focused on providing only what is needed by the radiologist. That’s an inappropriate approach to the healthcare industry. This system gives our referring physicians the tools they need to practice medicine. That is so critical today.”

For more information on Intelerad’s IntelePACS,
www.rsleads.com/611ht-200

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