When it comes to medical imaging, the days of CDs are behind us, as the most advanced organizations are implementing technology that will enable them to instantly view, share, and store medical images and associated reports for patient care.
Undoubtedly, patients want fast, decisive care decisions, while clinicians need instant access to medical exams and images. And certainly, that need heightens in the face of trauma, as time is of the essence.
In Birmingham, Children’s of Alabama hospital serves as the state’s only pediatric trauma center and the only pediatric burn center in the Southeast. As everywhere, receiving medical images on CDs became very problematic at the hospital, as issues would constantly arise with formatting and damaged discs, says Josh Pavlovec, PACS (picture archiving and communication system) administrator, at Children’s. “[Image] viewing had been an ongoing issue for us, as our workflow is complicated even more due to the fact that we don’t have 24/7 attending radiologist coverage,” Pavlovec says, noting that Children’s would often be dependent on radiology residents who would sometimes be down the street at the university hospital. “If we had a CD come in to be imported into our PACS for remote viewing, the disc had to be walked down the street to that resident. It caused a lot of heartache and patient care issues,” he says.
Children’s of Alabama
After investigating different resolutions, Pavlovec and others decided on the Burlington, Mass.-based Nuance’s PowerShare Network, a cloud-based medical imaging network that enables providers and patients to coordinate care and share information across disparate health systems (Nuance recently announced that 3 billion images have been shared on its PowerShare Network). Prior to joining the network, Pavlovec says, providers were not able to easily share images and reports with nonaffiliated organizations, resulting in inconsistent and delayed patient care, and added costs for unnecessary reimaging.
But now, he continues, it is extremely rare that Children’s gets images that it cannot import and view remotely. “It has evolved to the point where we will see images sometimes hours before the patient arrives. We’ll have it imported in PACS before the patient comes through the door,” he says, adding that the ability to view it on the mobile app has even allowed physicians to see images on their phones when they’re at conferences. “Physicians love that they don’t have to deal with a CD anymore. The network takes their mind off of whether or not they can access an image—allowing them to focus on treating patients.”
At last count, notes Pavlovec, there are more than 80 facilities that Children’s has connected with that could push images to the hospital immediately, as well as several of its referral facilities and countless physicians that are set up on the network. “Our workflow structure has eight physicians that are part of our facility, and we give them full access to images on our cloud. It’s part of our Health Insurance Portability and Accountability Act (HIPAA) coverage, and can view anything as long as they log in securely,” he explains.
Regarding data security, Pavlovec says that any device issued by the hospital to a staff member has built-in encryption or requires a passcode, even for email. “If you install our email on your personal device, it will require a log in. And that goes for the mobile app too. We trust the vendor and its security measures,” he says, adding that if an outside organization wants access to a patient’s images, once the method of contact—usually email—is secure and signed up, the images can be sent. “We receive a lot more [images] than we send out, but if we have a patient getting a procedure done or getting a second opinion in Salt Lake City, for example, we contact that physician, and we can share those images through this product within five minutes of getting the email address. And we police everything, such as if they could view only or view as well as copy, says Pavlovec.
Regarding patients’ ownership of their images, even though Stage 3 of meaningful use will require providers to be able to give a medical portfolio to caregivers and patients—including images—Children’s is not quite there. “Meaningful use was definitely a driver for our patient portal, and while viewing images on the portal is possible right now, the results of the scans are not involved yet,” Pavlovec says. However, he notes that is on the horizon, in addition to moving to a vendor neutral archive (VNA) architecture, citing the desire to not be locked down to just one viewer.
That said, since implementation of Nuance’s product, Pavlovec says the volume of CT scans has dropped considerably, and repeat scans—especially for trauma patients—have also been reduced significantly to the point where they are extremely rare. What’s more, previously, if a patient had a contrast material— needed for some CT scans to help highlight the areas of your body being examined—there would have to be a wait to do it again, which could increase the length of stay for the patient. “We’ve had numerous instances when patients didn’t bring images with them, and if the scan couldn’t be repeated at the time of the visit, the patient would have to return for a repeated scan,” says Pavlovec. “We can now pull those images almost immediately and prevent the patient from having to return. It’s a scenario that has happened many times, and it’s saved a lot of time,” he says.