Hospital Information Systems
PACS in your pocket
By Elad Benjamin, November 2010
The age of the mobile, integrated PACS platform is here.Radiology work flow has experienced dramatic change in the last few years. Until recently, most radiologists were physically present at hospitals or reading centers when reading exams. Radiologists who read remotely would only have access to a small subset of the clinical tools they needed.
But work-flow needs are changing. The modern radiology work flow is much more geographically diverse. Individual radiologists, groups and sub-specialty physicians provide services to multiple hospitals, leading to the demand for comprehensive, fully featured solutions that are completely mobile. Radiologists today need access to all their reading tools and functionality from any computer, anywhere. Their preferences, hanging protocols, clinical and reporting tools need to follow them wherever they go. In addition, the PACS needs to be fully interoperable with RIS and other systems that provide patient data, voice dictation, access to reports and other functions.
The advantages of a mobile PACS go far beyond improved productivity for radiologists. Healthcare providers gain expedited reading and reporting of imaging exams. Some PACS enable a global patient work list that allows efficient reading for multiple sites throughout an enterprise. Studies can be quickly and easily routed to specialists. Referring physicians gain rapid access to reports with embedded key images and can view entire imaging studies if desired (and authorized). This streamlined work flow ultimately benefits patients through prompt treatment and enhanced collaboration among radiologists, specialists and referring physicians.
Here are the key characteristics of a truly mobile and enterprise-wide PACS solution:
Advanced functionality should be standard and available anywhere. Whether at home, in the office or from any remote computer, radiologists need access to a full set of clinical tools through a single, common user interface. Most remote solutions don't provide access to advanced post-processing and reporting tools. A mobile PACS should include the ability to automatically compare and register current and prior exams and support post-processing tools such as cardiac CT analysis, PET/CT, coronary analysis and vessel segmentation. Intelligent streaming technology allows productive, interactive reading of large data sets even over slower bandwidth connections. A mobile PACS should also support native reporting and voice-recognition features or tight integration with existing systems to eliminate the need for radiologists to switch between systems or manually dictate results. Easy methods for sharing key findings, embedding key images and creating and sharing reports should be available as well. With a mobile PACS, all of these capabilities need to be geographically independent of any hospital or imaging center and available to any authorized radiologist, regardless of location.
Support for a multi-site work flow is a necessity. Hospitals are affiliating with each other and with medical imaging centers, clinics and other facilities to share patient medical images and information. As a result, radiologists are now reading for multiple medical imaging providers, and specialists are reading for entire healthcare systems. Modern PACS platforms should deliver an enterprise-wide reading work flow that eliminates geographic and vendor-specific system limitations.
This environment requires a global patient work list for multiple, disparate systems. All forms of patient data required for accurate diagnosis should be readily available, regardless of where that data is stored. A multi-site global work list enables healthcare providers to balance reading and reporting among available radiologists throughout the enterprise. This eliminates the barriers caused by disparate physical locations of images and users, as well as variations in network speed and reliability. Use of an enterprise-wide global work list delivers substantive improvements in radiologist productivity and enhances report timeliness and overall resource utilization.
Easy integration with EMR/EHR systems is essential. Federal initiatives are driving greater adoption of EMR/EHR systems in the United States. Today, most EMR systems have trouble supporting imaging information, which represents a significant amount of a patient's medical record. A mobile PACS system should support an open, seamless interface with EMR/EHR systems so that clinicians have a holistic view of a patient's history and current condition, regardless of their location. This holistic approach can lead to a higher level of patient care through more accurate diagnosis and treatment.
Mobile PACS can be purchased as a service. As healthcare providers enter their second-, third- or even fourth-generation of PACS, many consider the option of purchasing PACS functionality as a pay-per-use SaaS (software as a service). A secure, cloud-based service can provide full PACS functionality while eliminating equipment obsolescence. Vendors assume full responsibility for maintaining data centers that supply excellent performance, technology upgrades, data security and other tasks. With this model, patient information can be shared with authorized physicians over a simple Internet connection. As with an enterprise-wide PACS, this service enables convenient remote reading for a primary diagnosis, as well as the ability to obtain a second opinion from another radiologist or specialist. PACS as a service is an operating expense with a monthly fee based on the number of imaging exams produced each month.
As the radiology environment changes, the solutions offered to radiologists and imaging service providers must change as well. One of the greatest challenges to a smooth radiology work flow is the mobility and the geographic dispersion of images and physicians. In this environment, PACS systems need to provide a full set of clinical tools to any authorized clinician — in an environment that is completely integrated, despite the fact that it is remote. Only fully featured mobile PACS architectures will allow healthcare facilities and physicians to maintain and improve responsiveness while continuing to enhance
Elad Benjamin is general manager, healthcare information solutions, Carestream Health.
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