Radiology departments in new hospitals go digital
ProMedica’s new Bay Park Community Hospital sits on a 50 acre site astride the Lucas-Wood County line just west of 1280. The 70 bed hospital opened on November 5, 2001. On August 26, 2002, Mercy Health Partners’ newest hospital, St. Anne’s, opened at Secor and Sylvania in west Toledo. The radiology departments of both hospitals were designed to be filmless, operating on a digital picture archiving and communication system known as PACS.
Teleradiology itself is not new. What is spurring the implementation of PACS in hospital settings, reports Frost & Sullivan, an international marketing consulting and training company, is the growth of digital imaging modalities: computed tomography, computed radiography, ultrasound, fluoroscopy, angiography. The company estimates that the PACS market amounted to $421 million in 2000 and predicts it will exceed $ 1.1 billion by 2007.
Mercy Health Partners’ PACS conversion is part of an overall strategy to improve physician access to information, according to Jim Albin, vice- president/CIO. From day one, St. Anne’s was 100 percent filmless, with the exception of mammography. St. Vincent’s will have converted by the end of 2002. And St. Charles will be filmless by the first part of ProMedica will install PACS at both Toledo and Flower Hospitals in the next 12 months, reported Tom West, PACS administrator at Bay Park.
Under the old, film-based system, when a patient went to radiology for a procedure, an X-ray cassette was inserted into the piece of equipment. After the procedure, the cassette was brought to a darkroom where the film was taken out, processed, and viewed by a technician. If the image was too dark or too light or if the patient had moved and the image was blurry, the test was redone. If any previous X-rays had been taken, the patient’s folder was retrieved possibly from an off-site location – and brought to the radiologist’s viewing room. The new film was hung, the radiologist dictated the results, and the folder was refiled.
Under the new system, an image receptor in the tabletop takes an exposure and converts it to a digital image. Within seconds, these images are in the patient’s digital “folder.” Contrast that with the old system where, says West, “with a real busy file room, your images might not be hung until the next day.”
With PACS, all the hassle of pulling and assembling folders and hanging images, is eliminated. There are no file rooms or file room staff. Images are stored on magneto optical disks in something called a jukebox, which is about the size of a refrigerator. There are no darkrooms or darkroom staff. “We’re not dumping chemistry down the drain,” said West, who expects the EPA will start regulating how and where hospitals can dispose of the hazardous waste produced in the developing process.
As the price of film continues to rise, both new and old hospitals are finding they can justify a digital picture archiving and communication system. PACS vs. film is “pretty much a break-even prospect,” says Albin, the capital expenditure associated with PACS being offset by the savings in film costs over time. But PACS has implied, non-quantifiable benefits as well: it enables the hospital to attract high-quality radiologists and offer improved patient care.
Dean Hountras, M.D., medical director of diagnostic radiology, came to Bay Park from the Cleveland area. He finds PACS convenient and efficient compared to the traditional film system. “It would be frustrating to go back,” he said.
Bay Park purchased its system from Philips Medical Systems, a Dutch company. The workstations, servers, storage devices, software, and training came to roughly $1 million. “It’s been an excellent partnership as far as I’m concerned,” said West.
For St. Anne’s, Mercy chose Eastman Kodak’s PACS. Mercy had worked with Kodak before, explained Albin, and was satisfied with both their equipment and service.
But are all PACS- essentially variations on the same theme? “Probably in 70 percent of them the base functionality is the same,” said Albin, but they vary as to how efficient they are in storing images.
At Bay Park, the “retrieve from archive” command takes about ninety seconds to load. Workstations are located in radiology, ICU, and the ER. There the radiologist can review not only the patient’s entire image history, but the diagnostic reports as well. He doesn’t have to go to radiology and sort through a bulging folder. “The efficiency gained is tremendous,” said West.
For referring physicians to communicate with PACS off-site, Bay Park set up a virtual private network that uses the physician’s office PC and highspeed Internet connection.
Mercy physicians will be able to view PACS images from any PC, says Albin at their office, even at home. But the highdefinition images intended for diagnostic use will be accessible only at certain nursing stations at St. Anne’s.
So, does PACS have no drawbacks at all? Two issues that come up are privacy and image quality. The International Hospital Federation reports that security of patient data is a concern that hospital administrators need to evaluate when they consider moving to PACS.
“We’re ultra-sensitive regarding patient security,” said Albin. “All the data is encrypted and very secure in that regard.” In fact, he explained, the PACS electronic management system that keeps track of who is looking at patient data for what purpose is more secure than trying to manage film images or data on paper.
West says that the Philips system at Bay Park meets or exceeds all the patient privacy requirements of HIPAA, the Health Insurance Portability and Accountability Act, which goes into effect next year. The system is password-protected and logs off automatically after a few minutes of inactivity.
As for image quality, there’s debate as to which gives the radiologist a superior image: film on a light box or a digitized image on a monitor. With PACS, “you can manipulate the image in a number of ways you can’t with film,” said Hountras. The contrast and brightness can be changed. The image can be rotated. The whole image can be made larger, or the radiologist can use an on-screen “magnifying glass” to enlarge just a portion of it. But the resolution on a monitor still isn’t as good as film, so mammography – for which sharpness of image is critical – isn’t being done yet on PACS.
As for downstream improvements, West says the PACS workstations going in at Toledo Hospital next year are probably three times faster than the ones he has at Bay Park – simply because PC technology changes so rapidly. Some vendors are adding other functionalities to their systems so that radiology scheduling and administrative systems can be integrated into PACS. Soon workstations will be able to burn images to CDs. And Albin anticipates that even mammography will go digital in another two to three years.
Copyright Telex Communications, Inc. Sep 01, 2002
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