Raleigh Radiology Offers Referrers Mobile Access to PACS

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 - Satish Mathan
Satish Mathan, MD

A mobile device offers a portal into everything from your bank account to the latest episode of your favorite television series, so why not give referring physicians mobile access to PACS? This question occurred to Raleigh Radiology in 2012, and when a mobile application became available for the practice’s Synapse® PACS, the tech-forward practice put the wheels in motion.

“Two years ago, with the explosion of an app-driven experience for all technology users, it seemed like a good way for us to differentiate our imaging services from our competitors,” Dr. Satish Mathan, president of the 25-radiologist practice based in Raleigh, NC, explains. “It’s all about ease of use: Everyone has their phone or iPad with them at all times. As someone who not only interprets images but uses images to make decisions on how I treat patients, I could recognize the value in it.”

An informal survey of heavy PACS users confirmed interest and the practice prepared to implement the capability and then roll out the application, first to super users, and then to all interested referrers. The resulting marketing campaign earned the practice the People’s Choice Gold Quest Award at the RBMA Marketing Conference last month.

Orchestrating the Roll Out

Diane Jones

Dianne Jones, marketing manager, co-heads a seven-person marketing department that was responsible for introducing referrers to the application. “Knowing that technology was going in the direction that it was, and that everyone was developing apps, we knew we had to roll this out as quickly as we could,” Jones says.  

In the latter part of 2012, the practice pinpointed referrers expected to be big users—orthopedics, neurology, urology—and targeted them as early adopters of the application. Six practice liaisons in the marketing department were trained to use the application and asked to download it onto their phones to familiarize themselves with the software. 

“A lot of physicians want to hand you their iPhones and iPads and have you download it for them,” Jones notes. The practice sent the liaisons into the field with a marketing flyer that reinforced the need for 24/7 access to images and included free-download instructions from the Apple Store.

“It’s extremely easy,” Jones says. “As long as they have credentials, they can get access.” Like activating an email on a mobile phone, the server name and URL address is all that is required.

Raleigh Radiology pulled out all the stops for a big push to all referrers this past fall, coinciding with the roll out of its redesigned, mobile-friendly web site and the release of a version of the Mobility application that could run on any desktop or tablet.

“We wanted it to be an eye-catching marketing piece, yet concise,” she says. A trifold promotion piece was created on heavy stock in the shape of an iPhone 5, again promoting the idea of ubiquitous access to images—“anywhere, anytime”—and including download instructions.  The iPhone trifold is small enough to slip into a shirt pocket.

The Technical Piece

Jonathan Rice

Activating mobile capability in the PACS was almost as simple as is downloading the application from iTunes, reports Jonathan Rice, IT/PACS administrator for Raleigh Radiology. “This is just another puzzle piece that sits in front of our main PAC system performing query/retrieves,” he explains.

Two small servers were added, each running 15 client licenses, with a concentrator that performs load balancing. “If one server is out of licenses, it forwards to the other server,” he adds.

Mobility utilizes hyper text transfer protocol secure (HTTPS) to move encrypted data over the Internet and provide remote access to FUJIFILM Synapse via iPhone and Android smartphones, as well as Macintosh® or Window’s®-based PCs and tablets of all kinds.

Because the application is browser independent, any headaches associated with the diverse computer environment in Raleigh’s referrer network—which runs multiple versions of multiple browsers—vanished instantly. 

Award-winning trifold helped launch the Mobility app.

“It’s a Flash-enabled browser in that it uses Adobe® Flash,” Rice explains. “That allows us to leave a zero-footprint on the client’s workstation or device and multiple browsers able to use the app.”

Credentials are managed by Rice in-house using Microsoft® Active Directory. “Users are added to a group, and that group is given access to the Mobility product,” he says. Access is restricted to the physician’s patient images via a viewing toolkit that includes window and leveling, MIP/MPR, and 3D advanced visualization. 

“The Mobility application is not just images and reports, it’s a very powerful tool,” Rice notes. “Physicians can do measurements and different views, such as a body soft tissue view, a lung view, a bone view, a liver view. It has a lot of the same functionality as our PAC system and does a lot of things that other PACS mobility applications can’t do.”

The app also enables referrers to connect with a radiologist and confer on images. “Mobility has a hosting collaboration session that allows our radiologists to collaborate with the referring doctors inside the Mobility product, ask question, and get answers,” Rice says. “The referrer would initiate the session.”

The trifold promotes Mobility and the practice's mobile-friendly website.

Mobility is FDA-approved for the communication, storage, reformatting, rendering, communications and display of DICOM 3.0-compliant medical images, with the exception of mammograms. The device is not intended to replace full workstations and should be used only when there is no access to a workstation. 

Use Cases

To date, 1,000 referring physicians have been credentialed for the mobile application, primarily specialists, many of whom have also loaded the app onto their tablets or PCs for in-office image sharing with patients.

“Many practices that we go into may be using the PC version of Mobility, but many have flat-screen TV monitors in the exam room so that they can take it to that next level with the patients in discussing their health issues with their imaging,” Jones reports.

Mathan, an interventional radiologist, reports that the practice’s interventionalists use the application frequently to consult with each other on how to approach a cryoablation, for instance, or a chemoembolization procedure. “If I’m not at work or out of town, a colleague may call me and say, ‘Here’s the ID number, look at this case, and tell me what you think.’”

Raleigh Radiology first introduced super users to the mobile app with a flyer.

Diagnostic radiologists do not use the app as often, with the exception of the practice’s musculoskeletal radiologists, who cover local sports teams and use the application to consult colleagues on complex cases as needed. “Any report for diagnostic purposes, however, has to go through a certified PACS product,” Mathan qualifies.

The practice’s partners have done their part to encourage adoption. “I’ll sit with a doctor and download it onto their phone,” Mathan says. “I’ve sent doctors text messages with a screen capture of the variables they have to do to get it working.”

One of the most powerful motivators, however, is seeing the application in use. Mathan recently related a story passed on by a referring physician. That physician shared an elevator with another physician who was not part of the health system served by Raleigh Radiology. When he saw the Raleigh Radiology client looking at images on his phone, he wanted to know how he could get the application. 

“That’s how apps and this technology spreads,” Mathan asserts. “It’s word of mouth. It’s been a good user experience and well received based on the feedback I’ve heard.”