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Off the Front Lines

June 19, 2007
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Building a PACS network communication system may improve business efficiency in the private realm, just as it has improved care for injured soldiers.

by Stacey Kramer

The government mandated the military to better use health information technology. After congressional pressure to find an electronic way to better care for soldiers as they were moved from military hospitals to Department of Veteran's Affairs (VA) rehabilitation clinics, the Department of Defense (DoD) called on Agfa HealthCare (Greenville, S.C.) to create a linked-in image transfer system.

The new, private, secure network connected the radiology departments at Washington D.C.'s Walter Reed Army Medical Center, Bethesda's National Naval Medical Center in Maryland, and the James A. Haley Veterans Medical Center in Tampa, Fla., and enabled radiologists and clinicians to share poly-trauma patient picture archiving and communication systems (PACS) information.

Prior to the Agfa connection, soldiers injured in the Middle East were being flown from Iraq to European hospitals, and were then transported primarily to Walter Reed. After that, when it was time to transition to a VA facility, patients would arrive with CDs of their medical records. Frequently, what that meant was broken or lost CDs, and missing patient information. Even if the CDs arrived intact, the transition was far from seamless.

"They were basically getting CDs, manually importing that data and massaging it into their system," says Tim Artz, global government program director at Agfa HealthCare.

"It's not rocket science to connect two DICOM (digital imaging and communications in medicine) systems together," Artz says, "but the fact is that the DoD and VA are on different patient domains, they have different ways of dealing with things, and network security was a really big factor." However, as there was already a proxy at Bethesda and Walter Reed, the transition was far from lengthy.

Going into the project, the goal was to complete the system in a week. It took five days.

According to Tom Lewis, program manager for the Air Force PACS office, what Agfa's channel did was to move a process that took approximately a week to get patient data, and turn it into one where the records were "just a few clicks away."

Lewis, a biomedical engineer located in the Air Force medical unit at Fort Deitrich, Md., has been involved with DoD PACS projects for the past decade. Though sending DICOM images relies on standards-based protocols, and sending images between vendors is possible, for Lewis, choosing Agfa was "kind of a low-hanging fruit," he says, as all three parties were already using the vendor's PACS solutions.

According to Antonio Garcia, research manager, medical imaging and patient monitoring for North America at Frost and Sullivan, linked-up radiology systems such as the one Agfa created, can be useful in cutting down on diagnostic time. "A diagnosis may be made as soon as a radiologist reads a study, or even before a preliminary report is signed," Garcia says, "perhaps even in a matter of hours. So you could imagine some cases where it could be a life saving technology."

And connecting disparate PACS is not only of benefit to the military, or during a time of war. Private healthcare entities, too, may find these connections attractive.

For providers, even beyond increased patient care, may be the lure of enhanced business efficiency. Connecting PACS can allow multiple physicians to view images in multiple locations. "Even if a radiologist is on contract with, say, Walter Reed, more than likely they also have their own private practice, and they may have some arrangement with other facilities to do the reading there as well," Garcia says.

Linking PACS is part of a larger trend towards connecting hospitals themselves. "It's becoming increasingly important for hospitals that are part of a network to be able to share information and, more than that, to be able to share their information network resources," says the San Antonio-based consultant. For example, integrated delivery networks may have radiologists from one hospital reading studies from another, Garcia says, and having the radiologists be able to do work from whichever hospital or facility they find themselves during the course of their work would also be extremely important. And according to Garcia, cross-hospital integrated PACS themselves may provide savings in lives and costs.

Integrating is not a question of financial cost or of technology. "There is so much wire that has already been laid," Garcia says, "We have all this infrastructure." The question, he says is "how do we leverage it — use it most efficiently — so that we get the most out of it for the healthcare system?" For many providers in public and private sectors, connecting PACS may be part of that answer.