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Lending Rural Hospitals a Hand

April 1, 2006
by Bill O'Leary
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By networking its PACS with eight remote hospitals, KalispellRegionalMedicalCenter brought radiologists (virtually) to them.

With its purchase of an advanced picture archiving and communications system (PACS), Kalispell Regional Medical Center (KRMC) in Kalispell, Mont., achieved major efficiency gains. Turnaround time for image processing and radiologist reporting was slashed, as clinicians could access both current and archived studies with a few mouse-clicks using an Internet connection.

In rural areas beyond Kalispell, however, hospitals were stuck with a more primitive form of radiology. They were too small and financially stressed to afford their own PACS solution. Most were limited to once-a-week service provided by a traveling radiologist who drove to the facility to do readings off of film.

Good-bye to the digital divide

Thanks to some creative thinking by both KRMC and its PACS vendor (DR Systems, San Diego, Calif.), the digital divide between KRMC and several of these rural facilities has been bridged. By networking with KRMC's PACS, eight remote rural hospitals and a clinic now offer imaging services comparable to KRMC's own. The networked facilities, some on the Blackfoot Indian reservation and some of which are 175 miles away, have 24/7 access to KRMC's radiologists for reading, just as if the studies were performed at KRMC.

They receive voice clips of the radiologist's initial report within two hours, and can access the complete study online immediately and within six-to-10 hours can receive the written report on the Web-based viewing stations (Web Ambassador Software). KRMC also archives the studies for them, saving them the substantial cost of servers and storage media. For all these services, they pay KRMC a single, modest per-study fee ($5.50) that is a fraction of what they used to pay in film costs alone.

Several elements made this marriage work, starting with vendor flexibility. Many PACS designs would not have been able to accept images from the remote facilities' legacy scanners, which in some cases were not DICOM-compliant and in other cases were not even digital.

With the DR Systems PACS, the older scanners could be connected via the video capture capability of the PACS quality control workstations to capture images and transfer them to the PACS. This saved the rural facilities the capital costs of new scanners or of a blackbox video converter.

The PACS was also able to accommodate the existing T1 telephone infrastructure in the rural areas. This was a crucial factor for data transfer because broadband was not available in the outlying areas. Together with cost-saving aspects already mentioned, this helped make the networking with KRMC both affordable and, from a connectivity standpoint, immediately achievable for the remote facilities.

The arrangement between KRMC and its rural partners was helped by several other features of the PACS, as well. For instance, the PACS' Smart Client technology allowed images to be transmitted and viewed via the Web, through a standard Internet connection, with users in the rural areas retaining the full functionality of their personal computers.

In addition to the cost savings built into the design, rural facilities choosing to participate in the KRMC's PACS Outreach program may apply for grants from Federal Rural Health programs.

Caution at first

Still, buy-in by the prospective rural partners was not automatic. The rural partners were concerned that KRMC would pull patients and revenue away from their facilities if we had access to their databases (KRMC Archiving). KRMC gained trust by contracting with an initial facility in early 2002, and studying the impact of the project. Observers from prospective member hospitals examined the metrics and realized the many benefits of networking.

One example, for instance, is the ability to treat a patient the same day of an exam instead of sending him home for a week while waiting for the radiologist's report. KRMC has taken pride in improving healthcare, and if a patient gets referred to KRMC for further care, we get the patient back to their home town as soon as possible for follow-up care. By the end of 2003, four rural facilities had joined the network.

The logic of an arrangement like KRMC's PACS network is tremendously compelling. Small rural hospitals, which may have imaging volumes as small as 3,000 to 6,000 studies per year, don't have the budgets to afford a full-featured PACS. And even if they did, the hospitals would still face the challenge of recruiting and paying around-the-clock radiologists to read and diagnose.

From KRMC's point-of-view, the per-study fees it collects from its rural partners help finance its own future PACS acquisition and operating costs. The partners also provide referrals to KRMC, a 100-bed hospital that includes a long-term care facility, chemical treatment center, cancer center, and home health services.

What's more, the arrangement requires little additional investment for either KRMC or the partners beyond the network's initial PACS acquisition. Clearly, this model can solve the radiology problems of many rural areas and improve rural patient care nationwide, while helping to finance the purchase of a PACS by larger facilities.

Bill O'Leary is responsible for Regional Outreach and PACS Administration for Kalispell Regional Medical Center in Kalispell, Mont.