Call nights are by far the worst part of being a clinical cardiologist. I love what I do during the day, but on weekends where I am taking clinical calls for my 6-man (one woman) cardiology group, as well as covering weekend echo and TEE for my hospital, the stress can be high.
With the advent of efficient cardiac PACS, however, many of the stressful elements have gone away; in particular, the ability to remotely read and report on cardiac imaging studies has revolutionized my workflow. Now the need to get in my car and drive to the hospital to view studies has been eliminated. Leaving the hospital is no longer dependent on all work being completed.
On a recent Friday evening on a call weekend, my Eternal Fiancée insisted that we go to Oceano for happy hour. Oceano is a Clayton, MO seafood restaurant which has arguably the finest happy hour in the Western World. In the Dark Era preceding EHR and online PACS, this would have been out of the question.
As we were walking out the door, endeavoring to reach Oceano before happy hour ended, the sonographer on call texted me that he was going in to perform a STAT echo on an ICU patient to rule out pericardial effusion. In the Dark Era this would have been devastating. The Oceano visit would have been canceled and I would have had to drive in to the hospital.
When I started at St. Luke’s 10 years ago, our cardiac Cath lab stored their Cath films on ScImage’s PICOM365 Enterprise PACS, and we have subsequently added echo, vascular, ECG, stress and Holter storage and reporting. I can easily access any patient study, no matter the discipline.
The first time I read an on-call STAT echo using PICOM365 Cloud technology on my iPad in a restaurant, my mind was blown. It was as if a heavy weight had been lifted from my call duties.
Now, ten years later, I’m eating Oceano’s delicious Blackened Big Eye Tuna (rolls of ahi tuna filled with radish, shiitake mushrooms, pickled ginger, and scallions with spicy mustard sauce) when the sonographer texts me that the STAT echo is ready and that he is concerned about a pericardial effusion. I had brought my MacBook Pro with me (yes, hospitals have finally figured out that doctors often use Macs), so I logged into PICOM365.
As I pulled up the STAT echo, the loops could be viewed in real-time and I could rapidly step through them to determine that this patient had hyperdynamic LV function, no significant valvular abnormalities, normal Doppler and no pericardial effusion. The echo-free space around the LV was not an effusion, just a prominent fat pad (more properly termed epicardial adipose tissue (EAT)).
An echo and report on this patient from 6 years ago were automatically pulled up and available for me to review and I could see within a few mouse clicks that the prominent epicardial adipose tissue was present in 2012, thus solidifying my diagnosis.
I finished my last bites of ahi tuna appetizer and turned my attention to reporting out the echo. Fortunately, the drudgery and inefficiency of Dark Era telephone dictation is long gone. The true beauty of my current system is how automated and personalized my reports are. One of the joys of working with ScImage is that I have been able to craft templates for our lab’s echo reports that are exactly what I want. In addition, since the vast majority of a report comes from template-generated comments we have created ourselves, the reporting is consistent and complete no matter which of the 15 cardiologists (with wildly varying styles) reads the echo.
Contributing to this standardization of reporting between cardiologists, and to easing the reporting time burden, is something ScImage calls “evidence-based reporting.” In the Dark Era (and in many labs to the present day) cardiologists would make subjective interpretations of the size of the cardiac chamber, the function of the ventricles and the severity of valvular disease. This created huge inconsistencies in interpretation.
In my lab we emphasize precise measurement of these crucial cardiac parameters; using the sonographer-generated measurements, and a range that we specify for each parameter (using ASE guidelines), the report is automatically populated with the corresponding appropriate statement. For example, the echo I was reviewing had a left atrial volume index of 35 (just over the upper limits of normal). “Mild left atrial enlargement” was already present in my report, along with the correct description of LV and RV size and function as well as RA size.
Thus, with a few clicks, I had completed the report between bites of the truffle chicken chanterelle flatbread (beurre fondue, grilled chicken, chanterelle mushrooms, parmesan, truffle oil) the Eternal Fiancée had just ordered.
As we were settling the bill, I received a page: I was being consulted on a 92 year old man (Mr. Card Infarct) in the ER with chest pain and elevated troponins. In the Dark Era, the only information I would have available to me would be what the nurse or ER doctor on the phone told me. If they were ill-informed or English-challenged, a trip to the hospital likely would be necessary.
In 2018, fortunately, while sitting at the Oceano bar, I can review my partner’s office notes on Mr. Infarct and review everything that has been done on him (CABG 2015, stent 2017, ICD 2017) in our hospital’s system. Since our cardiology PACS has all modalities viewable in one list from one log in, it is a very simple matter for me to review Mr. Infarct’s last catheterization, his last echo and compare his prior ECGs to the current one. Within 5 minutes I pretty much am armed with everything I need to know about Mr. Infarct in order to best handle his case. When I call the ER, I can easily process the information the ER doctor gives me about his presenting signs and symptoms and develop a plan.
Life for this on-call cardiologist is good. It’s more normalized here in the Digitally Enlightened Era. I’m no longer shackled to the hospital. And I can enjoy excellent appetizers in a convivial environment without (excess) guilt or anxiety.
Anthony Pearson, M.D.,
is medical director of the echocardiography laboratory at St. Luke’s Hospital in Chesterfield, MO. He blogs about cardiovascular disease at theskepticalcardiologist.com.
WVU Medicine Deploys Cloud-Based CVIS to Expand Access throughout West Virginia using PICOM365’s Remote Imaging and Consultation Capabilities
WVU Medicine is Making a Change
West Virginia residents experience disproportionately high instances of cardiovascular disease in comparison to other states, with greater than 40 percent of adults suffering from hypertension and only two out of 10 adults receiving screening for cardiovascular risks. These statistics, coupled with a shortage of healthcare professionals, provide West Virginia with a unique opportunity for innovation and improvement in the detection of latent cardiovascular disease.
“Our goal is to use advanced cardiac visualization and imaging management technologies to detect the early stages of the disease and improve patient care,” said Partho Sengupta, MD, Professor and Chief of Cardiology and Chair of Cardiac Innovation at West Virginia University. “ScImage’s Cloud-based enterprise imaging solution for cardiology is helping us expand access to high-quality cardiovascular care throughout West Virginia. PICOM365’s availability allows remote imaging and consultation so patients can receive services wherever they live.”
WVU Medicine has deployed ScImage’s PICOM365 Enterprise PACS at the Heart and Vascular Institute for integration throughout the entire WVU Medicine infrastructure which is anchored by a 645-bed academic medical center and includes four community hospitals, three critical-access hospitals and a children’s hospital.
ScImage’s PICOM365 is a fully-realized Cloud PACS solution offering a resilient computing infrastructure securely accessible from anywhere utilizing high availability technologies with end-to-end redundancy. Far beyond one instance serving one institution, geo-redundant storage systems with multi-petabyte scalability have the power and flexibility to leverage massive bandwidth for maximum data throughput to simultaneously serve thousands of institutions. PICOM365’s secure end-to-end imaging and reporting workflow feature real-time advanced threat analytics along with data encryption at rest and in transit. Additionally, full IT and medical device regulatory compliance capability eliminates all barriers to entry, allowing full functionality with ease.
“ScImage has an excellent solution to support our non-invasive cardiology needs for a project of this scale (advanced reporting capabilities, remote work and full integration with Epic, etc.). With PICOM365, we can make a remarkably positive impact on patient care in West Virginia,” said Jim Venturella, CIO WVU Medicine.
The Cloud: Disruptive Innovation that Supports a New Age of Caring
PICOM365 delivers secure cardiovascular image management, viewing and reporting capabilities to all cardiology modalities (Cath, Echo, Vascular, Nuclear, Stress, Holter and ECG Management) on a seamless viewing platform, providing WVU Medicine the full benefit of an on-premise solution in a “pure Cloud” offering.
“This comprehensive Cloud solution allows seamless integration of imaging and full workflow customization to meet our specific exam interpretation requirements while empowering physicians to review and report from anywhere. This is a disruptive innovation that supports a new age of caring for patients using automation and speed to provide better and more cost-effective care,” added Dr. Sengupta.
ScImage and WVU Medicine, leaders in forging predictive solutions to improve patient care and increase physician efficiency, have worked to optimize structured reporting, with advanced ASE-evaluated measurements and sectional reporting among other productivity enhancements. ScImage’s inclusion of full Epic integration providing discrete data, image links, encapsulated PDFs and diagnostic view-and-report capability creates a fluid EHR interaction. Added flexibility to control the presentation of the final report, the by-product of the diagnostic procedure, improves the referring clinician experience.
Grace Verzosa, Assistant Director of Cardiovascular Imaging at the Heart and Vascular Institute, stated the ability to customize the workflow was critical. “To enable our physicians to read current and prior studies and report with maximum efficiency, we needed the freedom to develop our workflow recipe, including customizable hanging protocols, tight integration with quantification and visualization software tools in a consistent SR platform across all cardiology disciplines.”
ScImage’s open SQL database maintains the quality of images and patient data in its native format to access, run reports, pull priors and customize pre-fetching rules. Full reporting capabilities via VR, transcription and Macros enables automated report generation; and, as technologists enter measurements from echo exams, PICOM365 auto-populates preliminary reports using the most current ASE guidelines.
“Not only is the reporting process more efficient, but it also reduces the need for fellows to conduct preliminary reads and has reduced our report turnaround times,” said Verzosa. “PICOM365 has also provided many quality enhancements. For example, I can review studies offline at any time and correct inaccurate measurements for the final report. Additionally, the configurable “To-Do List” includes a reporting checklist, which ensures that reports are completely finalized, assuring a more accurate diagnosis and complete billing.”
Making a Difference in Population Health
The WVU Heart Center Innovation Lab is known for pursuing new technology and methods to increase population health. Dr. Sengupta noted, “Advanced imaging and visualization tools have made tremendous strides in improving the diagnostic process. However, inequality in access to these tools remains, and that is where the automation and speed of Cloud-based imaging technology are so important; improved access leads to better patient care and, ultimately, better outcomes.”
Sai Raya, PhD, founder and CEO of ScImage explained, “as Cloud PACS have become more popular, their true definition has become more dubious. With so many companies offering so many Cloud PACS, differentiating between competitors can be difficult, leading to the misconception that simply moving servers from an on-premise cabinet to a commercial data center is a sufficient solution to storing vital data. This is not a solution; this is a single point of failure.” WVU, upon careful consideration of all options, determined a pure Cloud solution to be the most effective pathway to improved health access and outcomes for West Virginians.
“By leveraging Microsoft Azure technologies, ScImage utilizes the industry’s most advanced Cloud security and encryption technologies allowing us to focus on providing the best care through remote imaging and consultation without worrying about security. ScImage brings industry-leading technology to the table as well as the positive outlook necessary to move innovation from ideas to real solutions,” concluded Dr. Sengupta.
Flexible cloud-based PACS platform for fast and accurate reporting.
Synergy Radiology Associates is Houston’s premier radiology team, comprised of more than 75 Board Certified Radiologists and one of the fastest growing radiology groups in the county. We sat down with J. Armando Saenz, M.D. to discuss how the flexibility of PICOM365.com, ScImage’s cloud-based PACS has supported Synergy’s vision for growth and patient care.
Why did you select ScImage’s PICOM365 cloud-based PACS?
With more than 75 radiologists, Synergy provides radiology reading capabilities for more than 100 sites. We serve different facilities with varying needs, some have no PACS of their own, others have systems already in place but they need a quality radiology group to be plugged into their workflow. The robust capabilities of the PICOM365.com architecture give us the flexibility to have arrangements that meet the technology and workflow needs for clients of varying sizes.
Most of our clients are cloud-based, but one of our major clients requires a physical server at each facility. Ultimately, our vision is to have workflow in which radiologists can use a single platform with one window, or at least one monitor – a way to easily look at the worklist and manage the list without necessitating too many monitors or steps, and allows control in terms of how and where the studies are routed.
How does the flexibility of ScImage’s cloud-based PACS help you serve your clients’ needs?
ScImage worked with us to create a master worklist that tied our workflow with other clients and facilities. This included revamping the radiology reading dashboard to create a second worklist for the on-premise exams, giving radiologists two windows on the same screen to watch the different server environments. On our end, our radiologists log into one worklist and are able to see everything they need. We have tags that allow us to know where the studies are coming from but they all show up on one work list, and one system. It has been working well.
The flexibility to use both cloud and physical servers is further enhanced by custom filters to manage which studies go to which rads. As a result, when a radiologist logs in, they only see the studies they need to read, giving us the ability to handle various facilities with different credentialing makeups.
How does ScImage’s PicomSentry Help Support Growth?
Overall, ScImage has supported our growth because it is a very robust system, it is easy to implement, and helps us keep up with, and accommodate client demands. Because we serve so many different facilities with varying system needs, a quick and easy implementation is critical to get plugged into their workflow.
As we bring on new sites, we’ve started deploying ScImage’s PicomSentry, a preconfigured security appliance that enables users to utilize ScImage’s PICOM365 Enterprise PACS with plug and play convenience. Whether a facility has an existing solution or no imaging system place, PicomSentry provides immediate back-end interoperability and they’re up and running with a robust system. It provides our customer with options to leverage the PACS they have already invested or start a sophisticated image management solution. It’s quick and easy, and we can get a site up and running in weeks, not months – it’s one of the fastest implementations in the industry.
Why is the speed of report turn-around time important?
In addition to patient experience, speed and accuracy are critical to the delivery of high quality medicine in the ER setting. Accuracy is a given, we have a process to maintain accuracy and our error rate is well below the national standard. So, why does speed matter? It matters because when the report takes longer, the clinician is waiting – and even, more importantly, the patient is waiting.
We’re very proud that Synergy is able to consistently deliver some of the fastest report turn-around times in the country. That is one of the most important reasons we’ve implemented PICOM365 by ScImage. We did not want exams being sent from server to server or from server to cloud which is going to add time, and therefore, impact the final turn-around time. Speed, accuracy and quality are not only the keys to good patient care, but they are critical to our ongoing success and growth.Download PDF
Enhancing the physician experience and improving patient care.
Founded in 1997, Foothill Cardiology focuses on providing high quality, comprehensive cardiovascular care to patients, their families and the community, within a compassionate and service-oriented environment.
Foothill Cardiology/California Heart Medical Group is Southern California, San Gabriel Valley’s Largest Cardiovascular Practice with 15 board certified cardiologists who specialize in the diagnosis and treatment of cardiovascular disease. Services range from routine cholesterol reduction program to EP Studies, Invasive Coronary Procedures, Structural Heart program, Vascular Services, Nuclear Imaging, and Clinical Research.
Foothill Cardiology, a long time NextGen user, utilized an imaging and reporting solution that was hosted onsite and had limited remote capabilities and limited editing of Structured Reports. Looking for an integrated PACS solution capable of supporting an image-enabled EHR, Foothill Cardiology was introduced to ScImage at a NextGen Users Conference.
ScImage was able to provide Foothill Cardiology with a comprehensive and robust Hosted Solution that fulfilled the vision of minimal onsite service with a completely remote diagnostic venue for reading and reporting all of their exams, including Echo, Vascular, and Nuclear Images.
According to John Gonzalez, Operations Manager, Foothill Cardiology, ScImage was selected to address these needs due to their innovative software approach, flexible architecture, enterprise Web-Based offering and the company’s willingness and ability to accommodate our specific requirements. “It was really the functionality of the PICOM365 Cloud solution and the ability to integrate with our NextGen EMR. The way that it integrates with the order management process is something that I’ve never seen from any other PACS,” added Gonzalez.
In addition to serving its own patients at three locations, Foothill Cardiology supports six regional hospitals. Secure Cloud-based image sharing capabilities and interoperability built into the ScImage platform, enable Foothill Cardiology to upload and interpret diagnostic cardiovascular studies on patients performed at other facilities and largely eliminate CDs for patients that come from outside referrals. “However, in cases where the patients are sent with image CDs, we can upload them to PICOM365. Not only does this give us a permanent record which can be viewed throughout the treatment process, it is much more efficient than having to hunt for CDs every time someone wants to view the images,” said Alex Durairaj, M.D., FACC, President, Foothill Cardiology.
“Anywhere access has been tremendously helpful – both from a viewing and a reporting standpoint. When I’m at a remote site, it’s nice to be able to see the study and not have to call someone to send it to you manually,” said Dr. Durairaj, who also attributes better workforce management to anywhere access. “Not only does this free our clinicians from being tied to one location to read, but when one office is busy, clinicians from another office can pick up the slack by reading studies from the centralized worklist to maintain proper report turn-around times. This flexibility improves our efficiency with no interruption to workflow and helps me better manage staff utilization.”
ScImage’s high availability PICOM365 Cloud solution delivers constant security and encryption enhancements to balance the need to safeguard Foothill Cardiology’s data with the need for easy and consistent access.
“Web-based is absolutely the way to go,” said Gonzalez. “We had Cloud capabilities before partnering with ScImage; however, service for the onsite server and applications needed to be managed daily by internal staff as well as a contracted IT company, increasing costs and decreasing efficiency. Leveraging Microsoft Azure technologies, ScImage adds a layer of security and protection that we may not have been able to accomplish in-house. This helps ensure that our data is protected, private and HIPAA compliant,”
Integrating ScImage’s PICOM365 Enterprise PACS with native EHR information improves clinical collaboration. ScImage’s open SQL database maintains the quality and liquidity of images and patient data in its native format to access, run reports, pull priors, and customize pre-fetching rules. With optimized structured reporting, the open database also provides the ability for Foothill to explore data-mining and analytics capabilities.
Foothill Cardiology and ScImage have continued to work together to enhance the physician experience and improve patient care through technology and collaboration. ScImage has a close working relationship with the both the clinical and IT department and continues to have regular meetings to stay abreast of the latest technology and ever-evolving clinical requirements that a world class institution such as Foothill Cardiology encounters.Download PDF
Workflow and Connectivity Drives Growth
Neighbors taking care of neighbors, with the technology and clinical expertise equal to or surpassing a big city hospital – that’s the approach that Butler Health System Cardiovascular Services takes as it delivers top-quality cardiology services.
Founded in 1898, BHS has numerous locations throughout Butler, Pennsylvania and surrounding counties. With more than 20 highly educated specialists, BHS provides care for everything from routine cardiac care, interventional cardiology, electrophysiology, open heart surgery, TAVR, and rehabilitation. The 296 bed hospital system has been recognized for receiving a 5-star rating from Health Grades for its cardiovascular surgery program and earning the Apex Award from VHA for Acute Myocardial Infarction and Heart Failure.
“The only way for a small, community hospital to survive in today’s changing environment is by continuing to provide quality care, to expand into new regions, and by adding cardiovascular service lines. You have to build partnerships and demonstrate their value, and you can only do that with image management technology that drives workflow and connectivity well beyond the physical walls of the hospital,” said Thomas W. Raraigh, BS, RT (R) (CT), Director, Cardiology & Imaging Services.
In 1998, in search of an image archive for Cath lab and echo studies, BHS found a cardiovascular information systems (CVIS) provider that approaches partnerships in much the same way. Starting with an archive for Cath lab images in the early years of digital archiving communication systems, the BHS and ScImage partnership quickly expanded to consolidate multiple cardiology data silos within a single database with a single log-in, including Echo, Peripheral Vascular, ECG and Nuclear Medicine.
“The major Cardiology PACS upgrade we completed with ScImage in 2013 has been pivotal in our success over the past three years. For the first time, ScImage gave us the ability to launch cardiac PACS within our EMR, providing full diagnostic viewing and reporting capability for seamless workflow during patient imaging communication. This has resulted in faster clinical decisions and improved our workflow, reducing the length of stay for inpatients by enabling cardiac diagnostic testing interpretations 24/7,” said John R. Falen, PACS Administrator.
ScImage upgrades have also featured structured reporting, providing BHS a fully order-driven imaging solution for all cardiology services and capabilities.“ Previously, cardiology reports were not uniform and turn-around ranged from 24 to 72 hours. Referring physician satisfaction scores have significantly improved now that reports are consistent across all interpreting physicians. Importantly, the structured reporting and seamless access to a unified SQL database offers clinical and operational analytics that play a key role in meeting the stringent requirements of the ICAVL and ICANL accreditation bodies,” added Falen.
In addition to serving its own patients, Butler Hospital supports several small, rural facilities that perform echo exams and contract with Butler to interpret the studies. Previously, this required cardiologists to physically drive to the other facilities to read the exams. Additionally, STAT studies would often have to be deferred to another cardiologist group if the assigned physician was completing office visits off site.
“Our group is extended well beyond the front doors of the hospital, in some cases, 30 miles. The ScImage platform has provided us ability to provide services in these remote locations and still provide quality and timely reporting for studies performed at any one of our outpatient or in-patient facilities,” said the cardiology group administrator.
Secure Cloud-based image sharing capabilities and interoperability built into the ScImage platform enable BHS to upload and interpret diagnostic cardiovascular studies on patients performed at other facilities. Cardiologists have the ability to launch the PACs from anywhere and complete interpretations at anytime, including STAT studies. This allows BHS to provide services to remote sites without the expense and difficulty of setting up multiple cardiology PACS systems at each location.
“With the ScImage system, I can read from anywhere, in my office or at home, making it very efficient, timely and paperless,” said Dr. Prem Kumar, BHS Cardiologist.
According to Dr. Phillip Painley, BHS Cardiologist. “It’s serviceable and cost effective, I utilize the mobile platform frequently while on call and the report tools make delivery of studies more efficient.” “By providing the diagnostic cardiology services at these smaller rural facilities, we help ensure that all patients have access to timely, high quality cardiac care,” added Raraigh. “In turn, we continue to strengthen our relationships and receive referrals for high end cardiology services at our main campus. This investment has helped build our surgical and cath business and resulted in a strong downstream revenue for high end cardiovascular procedures.”
Raraigh attributes some of the success of Butler Health System Cardiovascular Services over the past several years to its partnership with ScImage. “We have been able to improve workflow and efficiency, not just for our cardiologists, but for our entire staff and for our patients. With the ability to get diagnostic testing done faster and generate reports more efficiently, we can treat and discharge patients faster and more cost-effectively. Based on ScImage’s ability to help us reduce report turnaround times, increase access and reduce costs for our cardiovascular services, Butler is now reviewing ScImage’s Enterprise Imaging solution to integrate radiology and other imaging services.”
“As we have grown, ScImage has grown with us. For more than 17 years, they have been more than a vendor, they have been our partner – small enough to be responsive yet big enough to get it done,” concluded Raraigh.Download PDF
Tucson Medical Center (TMC) is a locally governed nonprofit regional hospital in Tucson, Arizona. Licensed at 629 beds, the medical center treats 30,000 inpatients, 122,000 outpatients, and over 80,000 ED patients annually in addition to 6,000 infant births. TMC is Southern Arizona’s leading provider for emergency and pediatric care, and includes the region’s first Pediatric Emergency Department with specialized treatment for young patients. Other specialty areas include women’s health, maternity, cardiovascular, orthopedics, neuroscience, hospice care, imaging and senior services. More than 600 physicians are on staff, representing 60 specialties from anesthesiology to vascular surgery.
Cardiology and radiology images were being captured as DICOM files and stored in their respective imaging systems at TMC. IT administrators were surprised to discover that a number of different systems were being used to store non-DICOM images (such as JPEG, MPEG and AVI files) on a variety of media in many other clinical departments. Some images were burned on CDs, others were on optical discs; still others were copied onto DVDs. Aside from the lack of consistency, managing these images was inefficient and limited the ability to replicate the images at TMC’s disaster recovery site.
Additionally, the non-traditional images were not available to all physicians as part of the online patient record. When IT administrators realized that these images, which were patient content and just as pertinent as the data they had spent years transferring to the EMR, they needed to find a way to integrate the images across the continuum.
TMC also wanted to bring all images online to a digital, filmless system with appropriate support and oversight. It needed to develop a strategy to integrate, manage and store all imaging through a central system that would provide privacy and allow accessibility for important patient data through the EMR.
In an effort to bring a higher level of service to its physicians, TMC expanded the capability of the PICOM365 platform previously implemented by ScImage that consolidated five cardiology workflows (cardiac catheterizations, echo cardiograms, ECGs, and vascular imaging) onto a single platform. TMC found this to be a cost-effective, efficient and seamless way to add non-DICOM images.
- All cardiology and non-DICOM images are displayed in a single patient folder, improving clinician access and patient care
- Images can be viewed directly from PICOM365 from anywhere, or through the EMR
- Staff productivity is improved
- Departmental resources and space are freed up
- Images are managed, secure and in compliance with the TMC Disaster Recovery Plan
Seamless Workflow and True Interoperability
For over 150 years, Children’s Hospital of Philadelphia (CHOP) has been devoted exclusively to caring for infants, children, teens and young adults. As the nation’s first children’s hospital, CHOP has a history of innovation and excellence. The 535-bed facility in Philadelphia is home to world-renowned programs for cancer, cardiac care, orthopedics, fetal surgery and many others. CHOP treats more than 1.2 million children a year through hospital admission and outpatient visits. More than 2,000 physicians in the CHOP Care Network serve patients at more than 50 locations in Pennsylvania and New Jersey.
Through the years, Children’s Hospital of Philadelphia has been the national leader in pediatric care, and as such has experienced many dramatic firsts in the field. The Hospital has fostered medical discoveries and innovations that have improved pediatric healthcare and saved countless children’s lives.
- CHOP wanted to make high quality pediatric radiology services available to all children, regardless of their location and the size/capability/staffing of their local hospital/medical institution
- The hospital wanted to offer the full CHOP experience to all children, including access to top pediatric radiology specialists to interpret studies and radiology exam protocols to reduce radiology dose to patients
- CHOP needed to move patient data between CHOP and partner institutions seamlessly
- CHOP needed to expand capabilities to reverse the internal downward trend in radiology revenue
To address the problems, CHOP was faced with managing complex interoperability issues. The hospital needed to provide diagnostic imaging that was available across disparate health systems for physician interpretation and reporting. The platform had to be automated, capable of managing differing MPIs, and proven to integrate at both the HIE and departmental system levels.
CHOP sought a company that had the experience and expertise in virtual radiology to handle large networks of images that could be moved to pediatric radiologists, sent back to the originating institution, and stored in its EMR/radiology system. This needed to be accomplished independent of the RIS, PAC and EMR without changing workflow at either institution. The company had to be able to insure record security and understand the needs of the customer (CHOP) as well as the customer’s customers (partner institutions).
ScImage provided the expertise, experience and interoperability required. The ScImage platform allows for configuration of complex business rules and provides automated, secure and bi-directional movement of relevant prior studies, current images and reports between CHOP and the referring medical center. Images and final reports are stored in the information systems of both hospital systems without disruption of workflow at either institution. The end result is increased quality of care, productivity and physician confidence in the reporting due to new access of comprehensive information.
ScImage also has extensive experience with partner-driven relationships and understands the needs and concerns of both.ucture we can focus on improving our workflow instead of learning new software.
- Children throughout the country have the advantage of the CHOP experience
- Reduce radiation dose to the patient
- Studies are read by top pediatric radiologists
- Physicians have full access to prior studies resulting in less test duplication
- Cost of care to patients is reduced
- Studies are passed back and forth with security and maintained at the patient’s hospital of origin
- Seamless radiology is provided, resulting in better quality of service
- Build strong relationships between institutions
- Patient care and revenue is enhanced
- The model is a microcosm for healthcare delivery of the future
PICOM365 technology by ScImage provides a platform for true interoperability between different healthcare organizations with disparate information systems. The result is a seamless workflow to radiologists for reading and reporting between different organizations. This capability allows CHOP to extend its “brand” reach regionally and nationally to promote excellence in pediatric radiology.
One of the youngest branches in the U.S. military, the Air Force was borne from the Army Air Forces in 1947 and continues today as one of the most formidable branches of today’s armed forces.
Recent estimates indicate a cost of nearly $2.6 million to fully train an air force fighter pilot. That same fighter pilot is strapped into a fighter jet like an F-22, costing upwards of $150 million. With that much on the line, it’s probably a good idea to keep the pilot and other flight personnel in good cardiac health.
Keeping pilots, co-pilots, flight engineers and navigators airborne is in part the responsibility of the USAF School of Aerospace Medicine, Aeromedical Consultation Service (ACS). The ACS interprets and reports on ECGs, cardiac stress, holter, echocardiography, cardiac catheterization, cardiac CT & MRI.
When a rated aviator presents with cardiac related symptoms, or exhibits any cardiac anomalies during a routine physical, surveillance or medical flight screening, test results are directed to the ACS for clinical evaluation.
Using a secure, DIACAP accredited PicomEnterprise PACS from ScImage, Inc., flight clinics worldwide can electronically transfer exams to ACS for rapid assessment. Inbound exams are reconciled with MilPDS and subsequently presented to specialists along with relevant priors for primary reading. It’s all about having access to the right data, quickly. ACS physicians report their observations electronically, providing quick decision support for the disposition of flight personnel.
USAF_docIn the past, aviators could potentially be disqualified from operational status until their exams were physically delivered to ACS, read and returned to the flight clinic. Now, that valuable aviator can be rapidly evaluated and re- deployed to operational status in hours rather than days.
When phase II of the ACS Central Library project is completed, ACS will have the foundation of a complete cardiology recordset, consisting of imaging, reports and discrete test data for all rated aviators; including an ECG library reaching back nearly 60 years. This vast volume of data will provide the USAF with profound research capabilities, all from one database.
Provide immediate access to cardiology related exams to assess the cardiac health of all rated aviators in the USAF, USAFR and the ANG.
Creation of a USAF-wide, comprehensive digital system for the categorization, visualization and interpretation of full diagnostic quality cardiac studies.
Using secure Cloud technologies provided by ScImage, cardiac exams will be captured at USAF flight clinics worldwide and delivered securely to USAF Consultation Services for evaluation and determination.
- Secure electronic submission reduces physical media delivery costs by over $100,000 annually.
- Automation in study processing reduces manpower requirement by over 60%.
- Offers real-time, expert response to critical cardiac investigations.
- Provides new level of research capability with access to test metadata, including cross-correlation between modalities.
- Expedites aeromedical cardiovascular decisions and results reporting, vastly reducing flight disqualification delays.
- Eliminates regional servers with isolated data and limited access, instead providing a global dataset for research and instant access to relevant prior exams.
Collaborative Medicine Wins Through Multi-Department Use of Enterprise PACS
Situated near the shores of Lake of the Ozarks in Osage Beach, Missouri, Lake of the Ozarks General Hospital (as it was known in 1978 when it first opened its doors) has grown over the past 25 years to become a state-of-the-art medical facility. Known now as Lake Regional Health System, the facility supports a full range of medical and surgical services, including complete cardiovascular care. Additionally, because of the increased summer population, Lake Regional also has one of the state’s busiest emergency departments. In keeping with the tradition of the community-minded visionaries who founded the hospital, Lake Regional continues to innovate and adopt new technologies. Today, Lake Regional is one of only a handful of medical centers in the country that is collecting,storing and distributing data from multiple departments (primarily cardiology and radiology) in electronic format.
Early this year, Lake Regional purchased ScImage’s PICOM Solution. The product gives the cardiac and radiology services at Lake Regional the ability to review, distribute and archive patient studies, including reports and procedure data along with patient demographic data using ScImage’s Web- enabled Electronic Patient Folder (EPF). The EPF allows authorized users to securely access patient data stored in uniquely identified individual EPFs on the PICOMEnterprise server.
Overall, the PICOM Solution has given physicians at Lake Regional the tools they need to practice collaborative medicine and the hospital a means for reducing capital expenditures, improving workflow efficiency and providing the flexibility to integrate data from imaging studies with data from patient procedures from multiple departments in the hospital.
Cardiologists and referring physicians can now access a variety of data generated in the cardiac services department and stored on ScImage’s PICOMEnterprise server from the lab, their office and even from home. This includes cardiac stress tests and hemodynamic information from the cath lab’s hemodynamic monitoring system,as well as reporting for the cardiac cath and echo labs. Soon, the physicians will be able to view EKG waveforms and reporting from vascular procedures. All of this data is or will be linked to the patient’s medical record number and made available to authorized attending and referring physicians.
Cath lab manager Connie Rugen sees the benefits everyday. “Our cardiology department is logically integrated to enhance workflow for surgeons and cathing physicians. They have been anticipating an easy way to access patient information from any location, and are pleased with ScImage’s solution. Physicians can now review imaging and non-imaging studies alongside hemo data and stress results. Efficiency will improve further when viewing EKG reports and vascular reporting become available.”
The PICOM Solution is also fully integrated into the radiology department. Images pertaining to all digital radiology modalities are being captured and stored in the EPFs of the PICOMEnterprise server and made available enterprise-wide. Robust 2-D and 3-D viewing tools allow physicians to read cases at the hospital and by using PICOMEnterprise’s built-in telemedicine functionality,they are also accessing studies remotely. “Being able to roll out of bed and quickly review an ED case gives me the opportunity to determine whether I need to get to [the] hospital immediately or if I can get [a] few more hours of sleep,” stated one of Lake Regional’s on-call radiologists. To supplement on-call reading, PICOMEnterprise’s intelligent scheduled routing services are automatically routing images to a remote teleradiology group for nighttime reading.
Integration was a key element in the decision to adopt the PICOM Solution. In addition to serving the needs of the imaging intensive departments, ScImage also provided a means for managing workflow and patient scheduling via an HL7 interface to the hospital’s Meditech patient registration and order messaging system. The integration gives the hospital a way to reduce data entry errors by capturing patient demographics that have previously been entered. In addition, procedure ordering and patient information are pushed to ScImage’s scheduling product PICOMScheduler. The scheduling software gives both departments a means for tracking patient procedures and also sends “order completed” messages back to the Meditech system. Integrating with the existing solution gives the hospital the opportunity to reduce capital expenditure costs and increase workflow efficiency at the same time.
“ScImage seamlessly interfaced their PICOMEnterprise solution to our different point-of-care clinical systems and imaging modalities including CT, ultrasound, MRI, nuclear medicine, cardiac cath and echo,” according to Steve Grotewiel, Director of Medical Imaging. “Now, physicians at Lake Regional have near real- time remote access to procedural images, reports and other clinical information. Getting clinical information into the hands of every caregiver at Lake Regional Health System is a top priority for the facility and for me personally.The result is that physicians have the right tools to make the best decisions when treating patients. We evaluated many systems but went with ScImage because they were able to provide us with a cost effective, integrated solution.”
About Lake Regional Health System:
Lake Regional Health System supports medical and surgical services in orthopedics, complete cardiovascular care reconstructive surgery, obstetrics and gynecology, outpatient services, community health education and prevention. Credentialed by the Joint Commission on Accreditation of Healthcare Organizations, Lake Regional offers high-tech medical diagnostics and treatment, coupled with high-touch patient care. Nearly 1,000 employees support the medical expertise of 70-plus full-time medical staff. With a 100,000 square foot expansion in 1999 — larger than the facility’s original structure — the 140-bed facility now includes a 12-bed observation unit, an 18-bed intensive care unit, rehab therapies, cardiac rehabilitation, an additional cardiac catheterization lab, an oncology suite, physician offices, an expanded outpatient surgery area and a chapel. Lake Regional also features a network of clinics, pharmacies and rehabilitation services located throughout the region. The organization’s vision is to transition from a primary/secondary hospital into a regional, tertiary care medical center and related clinical services.
Enterprise-Wide Solution Integrates Cardiac and Radiographic Studies, Enabling Facility to Practice Collaborative Medicine
Founded in 1937, the 222-bed Alton Memorial Hospital located in Alton, IL, served more than 90,000 patients in 2003. The local leader in cardiology services and a member of BJC HealthCare based in St. Louis, Alton Memorial Hospital opened the region’s first diagnostic cardiac catheterization lab in 1988 and the first balloon angioplasty program in 2000. The hospital provides numerous other heart care services, including enhanced external counterpulsation and a complete cardiac rehabilitation program that features state-of- the-art exercise and monitoring equipment.
Alton Memorial Hospital performs approximately 900 diagnostic cardiac cath cases per year and also performs more than 70,000 radiology exams annually. Recently, Alton Memorial Hospital announced an enterprise-wide digital imaging initiative. The hospital intends to implement the project in multiple phases, with the initial phase beginning with cath, echo and EKG capture, information analysis, integrated reporting and system management for the Cardiac Services Group.
Assisting Alton with their digital initiative is Los Altos-based ScImage. The enterprise PACS provider will serve both radiology and cardiology to provide a single point of access for patient studies and information generated in both the cardiology and radiology departments. Once all phases of the project are completed, ScImage’s enterprise-wide PACS, PICOMEnterprise, will give caregivers at Alton Memorial — and eventually at other institutions in BJC — an overall centralized integrated solution with the means for accessing data collected in multiple departments. As part of the digital initiative, ScImage will also integrate the capture of reports from legacy reporting systems and use PICOMEnterprise’s Web-enabled Electronic Patient Folder to store those reports alongside patient images to provide a more complete record of patient exams for both attending and referring physicians. Once in place, physicians will be able to access all available patient images and the associated information from a single login.
About the Hospital:
Founded in 1936, Alton Memorial Hospital is a JCAHO-accredited, full-service hospital serving the River Bend area of southwestern Illinois. Recognized for its heart services, orthopedic surgery, oncology services, women’s health services, outpatient surgery and testing, gastroenterology, pain management, pulmonary medicine, rehabilitation and sports medicine, the hospital also provides numerous health education and wellness programs to the people of Alton, IL and the surrounding communities.In addition to boasting the area’s only balloon angioplasty program, Alton Memorial Hospital offers open MRI through Twin Rivers MRI Center,CT services, PET imaging, nuclear medicine and cardiac and pulmonary rehabilitation. The hospital operates a 24-hour emergency center and the area’s only hospital-based ambulance service. 225 medical staff members and 596 FTEs provide these services.
Phase two will connect all of the DICOM compatible modalities in the Radiology Services Group so that digital images can be captured, stored and distributed throughout the enterprise. Integration with the hospital’s radiology information system (RIS) was critical to Alton’s digital imaging initiative. In addition to storage for the hospital’s images, ScImage will also provide a means for managing workflow and patient scheduling via an HL7 interface to the hospital’s Siemens Novius RIS. The integration will provide the hospital a way to reduce data entry errors by utilizing patient demographics that were entered at the time of admission. This second phase of the project will begin in the fall of 2004 and will also include conflict resolution and DICOM modality worklist functionality.
Phase three will bring the remainder of the modalities in the Radiology Services Group up to the DICOM standard and also add computed radiography modalities to enable standard films to be read digitally. During this phase, the hospital will also add high-powered radiology review stations for use by the reading radiologists. Once phase three is complete, the hospital’s vision includes connecting the system to BJC HealthCare’s multiple campuses for image and information access.
“We took a lot of time to evaluate different vendors including extensive site visits to narrow the search that brought us to choose ScImage,” stated Al Hibbett, manager of Cardiopulmonary Services. “In the end, it was an easy decision because they were able to meet our requirements of cost effectiveness, use of non-proprietary hardware and satisfy multiple service lines all under just one roof.”
In addition to the web-enabled Electronic Patient Folder, PICOMEnterprise also employs ScImage’s ForeverOnline architecture. ForeverOnline is a low-cost, high- availability solution that employs intelligent image routing to serve high-volume, centralized reading environments. This configuration of PICOMEnterprise combines a powerful multi-processor server with a highly scale-able storage solution that eliminates the wait for image and information retrieval by keeping everything online. Alton Memorial Hospital will also coordinate its digital initiative using ScImage PicomOnline Web-based disaster recovery hot site for both secondary secure storage and backup application delivery for teleradiology and remote access.
“We selected ScImage because this project will be critical to the ongoing success of the hospital and we knew that they could meet our aggressive requirements for integration,” stated Jack Wepler, manager of Medical Imaging Services at Alton Memorial Hospital.
PICOMEnterprise will allow multiple departments to store and distribute patient information both inside and outside the hospital. This will allow attending and referring physicians at Alton Memorial Hospital to practice collaborative medicine, which will ultimately lead to better patient care.
Complete Workflow Solutions: Multi-specialty Group Practice Adopts Comprehensive Digital Workflow
When Dr. Walter M. Whitaker brought the first EKG machine to Quincy, Illinois in 1930, little did he know what remarkable advancements in medicine were to come. Seven years later, in 1937, Dr. Whitaker, Dr. Orie F. Shulian and Dr. Kent W. Barber merged their private practices and opened the Quincy Clinic. This early clinic introduced the innovative concept of group practice to the tri-state area. The idea of group medicine has advanced greatly over the last half century but in 1937 the concept was new. In fact, at the time, less than one hundred group practices existed in the entire country, with only two or three in Illinois. The early clinic contained a complete diagnostic and therapeutic unit and was considered to be one of the most modern buildings in Quincy.qmg
In 1945, the Physicians & Surgeons Clinic opened its doors and Quincy, Illinois became one of the Midwest’s primary centers for healthcare. The Physicians & Surgeons Clinic and the Quincy Clinic merged in 1987, combining their vast resources in staff and equipment.
In the spring of 1994, a new state-of-the-art medical facility was opened at 1025 Maine Street and became known as Quincy Medical Group (QMG). April 2003 saw the grand opening of a new facility on Hampshire Street, housing various medical services and offices, with the Surgery Center of Quincy occupying the top floor. In order to provide quality primary care to their patients in rural communities, QMG also maintains affiliate offices in Canton and Lewistown, Missouri; as well as Mount Sterling, Pittsfield, Pleasant Hill, and Barry, Illinois.
A Unified Multi-Specialty Workflow Solution
After careful consideration, the committee and Ms. Williamson selected ScImage for RIS, PACS, ECG Management, Orthopedic workflow, long-term storage, archiving and telemedicine. “The decision was easy. Our experience with ScImage, who was already providing image management, long-term archive and telemedicine for our CT and MRI exams, had been positive. When we learned of their complete workflow management solution for multiple departments and that they could provide the right kinds of clinical productivity tools for our health care providers, we knew we had found our vendor,” stated Ms. Williamson.
The solution that ScImage created for QMG enables a comprehensive digital workflow. ScImage’s radiology information system, PicomRIS, will allow each of the affiliate locations to schedule imaging exams for their patients. Worklist integration with the variety of modalities used in the practice will speed the turnaround between patient registration and exam completion. The technologists performing the exams will also benefit from ScImage’s web-based conflict resolution and post-acquisition order resolution-making it easier than ever to make corrections to exam data from anywhere within the clinic. The RIS will also provide digital dictation for the reading physicians, as well as web- based transcription tools. Automated billing services will enable faster turnaround for reimbursements and the administrators will be able to track and manage the overall workflow using the sophisticated management reporting tools included with PicomRIS.
“ScImage’s complete workflow management solution for multiple departments provides the right kinds of clinical productivity tools for our health care providers.”
Robyn Williamson – Senior Director, Imaging Services, Quincy Medical Group, Quincy, IL
Today, QMG, as it is commonly known, is one of the leading multi-specialty group practices in the United States. After nearly 70 years of service to the tri-state area, the clinic provides the highest quality healthcare services available to more than 300,000 people within a 75-mile radius.
With nearly 100 physicians, physician’s assistants and nurse practitioners, this physician owned group covers 24 medical and surgical specialties. Among these specialties are cardiology, radiology, general surgery, vascular procedures, orthopedics, neurosurgery, ear, nose & throat and obstetrics/gynecology.
The Need for a Digital Workflow
Because of QMG’s dedication to quality patient care, the group has always looked to the future. The group felt that in order to continue their success, they needed a long-term plan for a complete digital workflow. Adopting an entirely digital workflow would be a multi-faceted project that would tie together several systems. This included their practice management system (PMS) and electronic medical record software (EMR). The group agreed that making the imaging exams performed at the clinic available through the EMR would enable a more efficient workflow. QMG also needed a radiology information system to manage the imaging workflow and began evaluating several vendors —some large, some small.
Based on previous experience with a digital workflow, Ms. Williamson knew QMG needed a complete solution that would address their unique and complex workflow, help attract and retain a strong referring physician base and assist QMG administrators in making sound future business decisions. She and the committee also knew that none of this mattered if the solution they selected would not allow them to stay true to the group’s mission of providing the highest quality health services by people who care.
Any solution they chose needed to make all of the patient’s information available to the physicians when and where they needed it as seamlessly as possible. This solution also needed to be responsive, flexible and customizable so there would be little or no disruption to the clinic’s busy workflow.
QMG_labOn the backend, ScImage’s multi-departmental PACS solution, PicomEnterprise, will launch exam images, data and reports within QMG’s existing electronic medical record software. This includes all of the traditional imaging modalities, as well as ECG. Physicians will be able to access information stored in PicomEnterprise’s Electronic Patient Folders (EPF). The EPF concept allows ScImage to gather all relevant clinical and non-clinical objects (images, reports, wave files, waveforms, scanned documents, etc.) under a unique patient identification number. This number will be tied to the existing EMR giving QMG providers access to the data when and where they need it.
Ms. Williamson and the IT Steering Committee also wanted to ensure that any solution they chose would address the needs of their referring physicians. They understood that the needs of these very important customers required that they be able to schedule patient exams and review exam data with patients during their follow-up visits. Since QMG had been using ScImage’s offsite disaster recovery and telemedicine solution, PicomOnline, for more than two years, it was clear that this active data center could improve information exchange with their referring physicians. “In speaking with several physicians in Quincy and our affiliate locations, we knew that these folks needed to be able to access their patient’s information from not only the office, but from home and the hospital too. We also knew that administering this kind of access could prove to be challenging and time consuming. ScImage’s solution makes that very easy for us. Having a disaster recovery solution that satisfied our business continuity goals while giving our referring doctors secure access to their data just made sense,” stated Ms. Williamson.
One of QMG’s internal medicine practitioners and the IT Steering Committee’s physician champion, Dr. Greg Andrews agrees, “ScImage’s overall workflow solution is going to assist us in growing our business and will enable a more efficient workflow for the group. We have been using the PicomEnterprise solution since 2004 with great results and look forward to adopting the elements that complement and complete our digital workflow.”
© 2006 – ScImage QMGCS20061117
Single Database Solution Unifies Group’s Approach to Reading In Rural Oklahoma
Founded in 1969, Diagnostic Imaging Associates (DIA) initially provided Oklahoma’s rural hospitals and clinics with “circuit-riding” radiologists that would read cases once per week for a few hours before moving on to the next facility on their list. While these circuit riders provided a valuable service to the rural communities, as technology advanced, it became clear that there was more that could be done for these communities. Today, DIA has grown from a two-man operation into a radiology physician group with more than a dozen radiologists that specialize in MRI, CT, X-ray and all interventional radiology procedures. The group relies heavily on a robust telecommunication network that is run by the state of Oklahoma to provide radiological testing for patients and diagnostic image interpretation. DIA’s focus is on treating patients with the least invasive means at the highest success rate. Among their customers are Tulsa Regional Medical Center and its affiliates, Cancer Treatment Centers of America and several small community hospitals throughout the state. DIA also provides fellowship opportunities in interventional radiology and a residency program for radiologists in training.
The Oklahoma Telemedicine Network and OneNet
Circuit riders supplied by DIA and other subspecialty groups served a valuable purpose to the residents of rural Oklahoma. In an effort to provide better service using the technology available, the Oklahoma State Legislature signed a bill in the early 1990s to create the Telemedicine Advisory Council. This council set about leveraging advancements in Internet technologies which led to the creation and initial development of the Oklahoma Telemedicine Network (OTN) in 1993. OTN placed new high-bandwidth connections or used existing high-bandwidth connections between 45 hospitals throughout rural Oklahoma to better serve these communities. The communications lines were used for telemedicine, video conferencing and other types of point- to-point communication between hospitals, physicians and their patients. Toward the end of the 1990s, OTN was turned over to OneNet, which is run by the Oklahoma State Regents for Higher Education and is operated in coopera- tion with the Oklahoma Office of State Finance.
A native of rural Oklahoma himself, DIA’s president and a long-time proponent of telemedicine, Dean Fullingim, D.O., understood that the state’s rural population required access to radiology services. However, because fewer and fewer physicians were being trained as radiologists, access to those services was limited. Dr. Fullingim saw potential in the network being run by the state and set about making use of this valuable resource. Working at Oklahoma State University at the time, he devised a way to put the medical school’s telecommunications infrastructure to work in order to provide teleradiology services to rural Oklahoma. Leveraging OneNet’s infrastructure Dr. Fullingim made it possible for patients in rural communities to receive diagnosis and treatment without traveling long distances or waiting for a circuit-riding radiologist’s weekly visit.
“I no longer have to maintain three solutions and the data being stored is seamlessly delivered to our physicians..”
Allen Noland – DIA Director of Systems Technology
DIA has grown considerably since inception. Today DIA comprises a dozen radiologists reading for 41 facilities from eight central locations around the state. This growth and the advancement of technology by way of advanced visualization applications for CT and MR has meant using solutions from multiple vendors to get the work done. Dr. Fullingim and DIA’s director, systems technology, Allen Noland, knew it could be done more efficiently.
From Multiple Vendors to One Solution
In late 2004, DIA set out to consolidate their efforts. The group practice was using systems from three different vendors to provide interpretive radiology services to their customers. DIA’s homespun radiology information system, DIA RIS, tied the three solutions together so any solution they selected needed to be standards base d and must interface to the RIS seamlessly. This is because DIA RIS currently handles patient scheduling, film requisitions and reporting for the group’s busy reading environments. In an effort to end the frustration associated with using several solutions to complete their work, Dr. Fullingim and Noland needed a single solution to provide cross-sectional imaging tools, efficient telemedicine and standard radiology imaging — all features that their current three vendors provided.
After considerable research and evaluation of several solutions at the annual Radiological Society of North America (RSNA) exhibition in Chicago, DIA launched a pilot project to evaluate ScImage’s Enterprise PACS, PicomEnterprise. What attracted the two telemedicine veterans to the PicomEnterprise solution was its Web-based design, combined functionality for key components of their workflow and consistent user experience. The solution was also cost competitive. Shortly after the evaluation began, a decision was made to move the entire group off the existing combined product approach and onto ScImage’s PicomEnterprise solution. The impetus for the decision was that DIA could begin reading all exams from their 40-plus institutions using a unified platform.
According to Noland, “Because of ScImage’s single database approach, the solution is easy to manage and administer. I no longer have to maintain three solutions and the data being stored on our PicomEnterprise server is seamlessly delivered to our physicians through our DIA RIS front-end. In addition, the built-in visualization tools for MPR and Oblique Slicing make image interpretation and manipulation much easier because our radiologists don’t have to move to a separate workstation.”
In fact, DIA currently reads an average of 900 radiology exams per day from outlying facilities that are interconnected via the OneNet network. Using the Web-based PicomEnterprise solution, a dozen reading radiologists provide primary interpretations for CR, CT, MR and ultrasound from eight facilities around the state. By eliminating the circuit-riding radiologists, physicians can now stay in one place and provide more efficient service to more patients, more rapidly.
“DIA has been providing world class teleradiology services to the residents of rural Oklahoma for the last 17 years,” stated Dr. Fullingim. “We have worked with multiple vendors during this time. We interpret more than 200,000 exams annually that come from 41 facilities around the state. ScImage helped us unify our approach to reading and now we all use the same system, the same tools and the same interface. We couldn’t do that without ScImage.”
Blessing Gets More of a Good Thing: Information Management Systems Expand the PACS Backbone
Since 1875, Blessing Hospital (Quincy, IL) has worked to provide area residents with the highest quality medical care possible. Today, Blessing continues to respond to the changing healthcare needs of the community — upgrading technology and facilities to provide economical, high quality medical care. As a result, they have developed the most complete healthcare system in the region.
In keeping with Blessing Hospital’s long history of providing quality care and the most advanced services available, the facility has embarked upon an enterprise-wide digital imaging initiative. This initiative will provide Blessing Hospital with an integrated cardiology/radiology image and document management system for their healthcare enterprise that will make use of the existing PACS.
As part of this initiative, Blessing has purchased ScImage’s Enterprise PACS offering, PICOMEnterprise. When the installation is complete, two clustered PICOMEnterprise servers linked to a Blessing supplied SAN will be located at Blessing Hospital’s Data Center providing a highly secure, redundant auto-failover platform.
To assist the facility in meeting its budget, diagnostic review stations will be built using hardware provided by Blessing Hospital. Those diagnostic workstations will be able to perform MPR, oblique slicing and 3-D volume rendering tools using ScImage’s 3-D visualization product via a network-based license.
Additionally, viewing throughout the facility will be accomplished by accessing the data stored on the PICOMEnterprise servers. Prior imaging exams that are currently stored on the existing PACS will also be available via these interfaces, providing referring physicians with a robust archive of all imaging exams performed at Blessing Hospital.
The hospital also intends to integrate PICOMEnterprise with its newly acquired Eclipsys Sunrise clinical information system. This integration will result in a single point of entry for all referring physicians to access critical patient data that until now could only be accessed via multiple systems.
In order to lessen the chance for data entry errors, the hospital intends to integrate the ScImage solution with the existing HIS to capture demographic data. Additionally, exam orders will be sent from both the radiology department and the cardiology department using the new Sunrise XAClinical Information System from Eclipsys. This will provide the hospital with modality Worklist functionality by collecting HL7 ORM messages and storing those orders within the DICOM Modality Worklist database on the PICOMEnterprise server. When the exam is complete and the images have been sent back to the PICOMEnterprise server, several things will happen. First, a secondary copy is pushed to the facility’s existing
PACS. A Study Complete (SC) message will also be sent to indicate that the study has been completed. This will trigger an ORU message that will notify the Sunrise XA CIS that the study is available and will give the location via a URL hyperlink within the Sunrise XA product. By clicking on the hyperlink, anyone with access privileges at Blessing Hospital can view the patient’s exams right from the PICOMEnterprise server. The result is an integration that brings all of a patient’s imaging data to a single point of entry within the hospital.
In addition to the integration with the Eclipsys CIS, PICOMEnterprise will also capture, store and distribute data from the hospital’s existing PACS solution in order to provide a more complete solution for image acquisition, diagnostic review, short-term storage, reporting and Web-based distribution utilizing a single application platform. “We selected ScImage because they were able to meet our needs for integration,” stated Stacey McGrath, Blessing’s IS supervisor, systems, and integration. “Given the nature of clinical workflow in our facility today and knowing where we need to be tomorrow, we knew we needed a product that could seamlessly integrate with our current digital tools quickly and easily. Workflow integration is the key to a successful digital initiative. ScImage’s experience with integration made the decision easy.”
Boyd Spoonmore PACS coordinator, Blessing Hospital commented, “As PACS has evolved over the past five years since our original Radiology specific PACS deployment, we have seen a significant trend towards an integrated Enterprise Wide Image and Information management and distribution requirement, this includes along with centralizing all clinical images and information. ScImage was one of the only vendors that could provide a flexible, broad technology platform for Blessing Hospital to adapt into our current clinical workflow.”
When the hospital completes its digital imaging initiative, data from Cardiology Imaging Services, Radiology Imaging Services, and EKG Management will be delivered to the Sunrise product. PICOMEnterprise will also be used to provide telemedicine capabilities to designated members of the facility.
“We are pleased that Blessing Hospital has selected ScImage’s Enterprise PACS solution to tie together data coming from multiple departments,” stated Sai P. Raya, founder and CEO of ScImage. “We believe that Blessing Hospital’s digital initiative will improve overall patient care and are looking forward to working closely with them to assist in their medical imaging workflow goals.”
“We needed a system that would fit with our overall goals for workflow,”stated Candy Tretter, director of radiology at Blessing Hospital. “ScImage understood where we needed to go with our digital initiative. By utilizing our existing infrastructure we can focus on improving our workflow instead of learning new software.”
Value and Extensibility in Cardiology PACS
One of America’s 50 Best Hospitals for the 9th year in a row – 2015
Change is the one constant in healthcare today. Facilities are relentlessly challenged with new regulations, reimbursement models, economic forces and performance pressures. In order to remain viable and competitive, many health systems focus on the tangible value of clinical systems and related processes.
This is also the case with St. Luke’s Hospital in Chesterfield, Missouri. Founded in 1866, this prominent 493 bed hospital, offering over 60 clinical specialties, is nationally recognized for many of its services including cardiovascular care and surgery. With the notoriety of being recognized as one of the nation’s 50 Best hospitals for nine years in a row, St. Luke’s regularly demonstrates prudence and vision. Fortunately, they found an image management partner with similar insight.
With overwhelming supportive evidence, the current trend in the PACS market is to consolidate redundant imaging resources into a single enterprise system. This enterprise concept was already available commercially in ScImage’s PICOM® platform which St. Luke’s installed in 2002 to manage cath imaging. “For our facility, ScImage has provided an incredible value” says Scott Holtswarth, director of information systems at St. Luke’s. “We installed its PACS initially to manage imaging for our cath labs. Shortly afterward, ScImage helped us integrate imaging into an early EHR of our own design, called WebPINS (Web Enabled Patient Information Network). ” Today, ScImage is an integral part of the management of images, waveforms and data throughout St. Luke’s network.
After learning more about the intrinsic flexibility of the PICOM365® architecture, Mr. Holtswarth and St. Luke’s envisioned developing a comprehensive cardiac record.
“With every subsequent project, ScImage has always come through. We’ve added echo and vascular imaging and reporting; perinatal workflow, pediatric cardiology, ECG management, holter and stress test reporting and a cloud application hot site for specialty reading.”
From a clinical perspective, ScImage’s PICOM365 enterprise imaging system provides caregivers with extraordinary workflow flexibility and unmatched diagnostic access. The single database approach to data management affords cardiologists at St. Luke’s the ability to view all diagnostic disciplines in cardiology through a single login.
All of the innovation amassed in the ScImage platform provides clinicians with optimized productivity and seamless access to data, to assist in providing the best patient care. Dr. Anthony Pearson, director of the echocardiography laboratory at St. Luke’s, routinely logs in remotely to manage his workload by creating and signing cardiac reports. While Dr. Pearson is on call, he receives notifications of STAT echos and EKG’s that have just been completed in the intensive care unit. Using the ScImage zero footprint viewer, he is able to review the echo images and immediately convey the results to the intensivists.
ScImage’s single database approach to multi-department image management has been an integral benefit of the PICOM365 PACS platform since the product’s inception in the late 1990’s. By systematically collecting information from multiple data sources, both operational and clinical data can be collected, indexed and categorized. Now, with PICOM Analytics, users can seamlessly access production data to evaluate operational performance and execute ad-hoc queries for in-depth clinical outcomes investigation. Access to the non-proprietary SQL database offers crucial data points to address PQRS, comparative analysis and other regulatory reporting. “The real value is in the breadth of the system’s capability, ” added Mr. Holtswarth. “When we add another department or clinical service, the incremental cost is a fraction of what it would cost to implement another specialty system. ”
St. Luke’s foresight helped the institution position itself for the requirements of value based healthcare. The extensibility of ScImage’s PACS has allowed St. Luke’s to leverage its current implementation to add secure, cloud image sharing. Image sharing became a key component as St. Luke’s looked to implement strategic outreach for critical and specialized imaging procedures.
Ultimately, ScImage’s PICOM365 enterprise PACS has helped St. Luke’s diversify its services, drive down system costs, improve access to historical data for better clinical decisions, improve report turnaround efficiency and consolidate patients’ records for a more holistic clinical view.
ScImage helps our healthcare partners position themselves for the future with solutions – BEYOND PACS.
Data Migration Key to Leading Heart Hospital’s Image and Information Management System Selection
Missouri Baptist Medical Center, a 489-bed hospital in St. Louis, Missouri and a member of BJC HealthCare, has been providing world-class services to its patients since its founding in 1884.
Long recognized as a leader in cardiac services, Missouri Baptist Medical Center received the inaugural American Hospital Quest for Quality Prize in 2002 from the American Hospital Association for its leadership and innovation in patient care quality, safety and commitment. This commitment to excellence is prevalent throughout the entire organization.
Recently, Missouri Baptist began a large construction project to expand and upgrade its heart hospital within the existing medical center structure. The plan includes 40,000 square feet of new construction/renovation, including the following:
- two additional cath lab rooms;
- a 14-bed cath lab prep and hold unit;
- a second EP lab;
- a 10-bed post-surgical cardiovascular recovery unit;
- a 6,000-square-foot cardiovascular diagnostics suite;
- an endovascular OR suite;
- and new office space within the center for the hospital’s four cardiothoracic surgeons — Nicholas Kouchoukos,MD; Peter Murphy, MD; Michael Murphy, MD; and Michael Mauney, MD.
As part of the project, the hospital has upgraded its existing AngioCOMM image and information management and distribution solution. The system,designed by ScImage of Los Altos, Calif., has served the hospital well since it was first installed in 1998. However, the demands of modern medicine and significant advances in technology led the hospital to modernize the system using ScImage’s latest image and information archive and distribution solution, PICOMEnterprise.
PICOMEnterprise gives Missouri Baptist Cardiac & Vascular Center the ability to review, distribute and archive patient studies, including reports and procedure data along with patient demographic information using ScImage’s web-enabled Electronic Patient Folder (EPF). The EPF allows authorized users to securely access patient data stored in uniquely identified individual electronic patient folders on the PICOMEnterprise server, which is the backbone of the PICOM Solution.
Data migration was a key concern and one of the reasons why the Missouri Baptist Cardiac & Vascular Center elected to upgrade to PICOMEnterprise. Because they provided a seamless upgrade path for previously archived studies,
the decision to choose ScImage again was an easy one. More than 18,000 exams currently stored on magneto optical disk will be migrated and converted, storing them on a large storage device using ForeverOnline.
ForeverOnline is a low-cost, high-availability solution that employs intelligent image routing to serve high-volume, centralized reading environments. This configuration of PICOMEnterprise combines a powerful multi-processor server with a highly scalable storage solution. It eliminates the wait for image retrieval by keeping everything online,thereby increasing productivity in heavy workload environments and eliminating the need for a mechanical jukebox. PICOMEnterprise will house the hospital’s archived and future studies and make the data available to physicians both inside and outside the facility using the latest security protocols.
Once the upgrade is complete, cardiologists and referring physicians will have immediate access to a variety of data, images and reports generated by the Missouri Baptist Cardiac & Vascular Center. This includes hemodynamic information from the physiological monitoring systems as well as echocardiogram images/reports and cardiac stress test reports. This data will be linked to the patient medical record number and made available to authorized attending and referring physicians from the lab, their private offices or even their homes.
“We are excited to see the first steps of our heart hospital upgrade,” said Douglas Sohn, director of the Missouri Baptist Cardiac & Vascular Center. “The new facilities are designed with the needs of the patient and efficiencies for our physicians as the top priorities. The jukebox storage system we have used for years is overflowing and cannot keep up with current demand, including the need for immediate access to study information. Eliminating the mechanical storage device is going to reduce wait times for both physicians and patients.
“In addition, migrating our data to ScImage’s ForeverOnline storage architecture will also support our disaster recovery plan,” Sohn continued. “We will no longer be responsible for hundreds of MODs. Instead, we will have a single archive, which will make backup for disaster recovery and business continuity a much more straightforward process.”
Simultaneous to the data migration, a new echocardiography reporting solution will be put in place. The goal is to reduce the turnaround time from the completion of a study to availability of the final report. This translates into higher throughput for the department and shorter wait times for study results — two very important factors for this award-winning facility.
Overall, upgrading to PICOMEnterprise is giving physicians at Missouri Baptist Medical Center the tools they need to practice collaborative medicine and the hospital a means for eliminating its reliance on outdated technology. The result is improved efficiency, a more patient-centered environment and a heart hospital within a hospital that positions the Missouri Baptist Cardiac & Vascular Center for the future.