The Hard Copier’s Dilemma

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Along London’s celebrated avenue of high-end medical care, Harley Street, it’s not uncommon to see sights that would make any hardened veteran of the US health care system green with envy. Though coverage through the UK’s National Health Service (NHS) is provided free to all comers—and is the only option available for emergency care—NHS exists alongside a competitive private health care system that Kaye Bonython, PACS program manager for HCA International, London, describes as “existing at a different level. It’s the premier, elite type of health care. A lot of people, if they can, would prefer to go private for the speed and the nicer quality of the surroundings.”
Kaye Bonython
Harley Street could be characterized as the nexus of the UK’s private health care system. Over 3,000 medical professionals are employed in the area in clinics, practices, and hospitals. On Harley Street, patients in hospitals receive private rooms with adjoining bathroom facilities; outpatients can walk from their radiologists’ offices to their referring clinicians’ offices with CDs of their scans in hand. The Harley Street Clinic, which includes a renowned cancer center, makes its home there, as does its dedicated PET/CT imaging center. The Harley Street PET/CT Clinic, operated by HCA International, interfaces with a top-of-the-line PACS to transmit images and reports instantly to those clinicians who choose to access the system. “A lot of our referring physicians now use the Web to access our PACS directly,” Bonython says, “but a lot of them also don’t. Many are frightened of the technology. We knew as an organization, when we started this process, that PACS is wonderful, but it’s only wonderful if the person at the other end can use it. Here in the UK, things are a little bit old-fashioned. Some physicians don’t even have PCs in their offices.” Most UK patients still expect to leave an imaging center with a CD or DVD in hand—literally. “A lot of patients come here for their imaging services, and then they walk around the corner to see the referring physician, who might be on the premises or a few doors down,” Bonython says. “This is an area where every building is full of consultants. The idea is that you’re seeing the consultant at 2 PM; let’s do your imaging at 1:30, and you walk out of here with your CD to deliver to him or her.” CD Takeout Bonython characterizes this takeout approach to imaging as a major difference between the US and UK cultures of health care. “In the private sector, patients have always been given packets with films in them,” she says. “Then, they probably put it in a drawer and never saw it again, but they were always given something to take home.” For that reason, the ability to produce CDs and DVDs efficiently was a must for the Harley Street PET/CT Clinic. The rarefied environment, however, created a unique set of challenges. “CD robots are not cheap to purchase, and in London, we are physically very constrained on space,” Bonython says. “For years, we’d been grappling with these less-than-ideal robots. We really needed a better option.” Initially, the clinic used the CD/DVD burners provided by its PACS vendor, but soon, Bonython discovered that they were insufficient to meet the clinic’s needs. “I don’t think our PACS vendor understood how important that aspect of the service was for us,” she recalls. “The burners they gave us couldn’t keep up with the speed of printing, and they were breaking a lot because we were putting them under tremendous pressure.” Bonython attended the 2007 RSNA meeting with the intention of shopping around for a more efficient solution. Wandering the show floor, she happened upon a demonstration of the Virtua XR Medical Disc Publisher from Codonics Inc, Middleburg Heights, Ohio. Shortly afterward, in March 2008, the Harley Street PET/CT Clinic implemented the system in place of its old CD burner. “It was so much more easy to configure. You could burn CDs and DVDs from the same burner, and the burn time was a fraction of what we were used to,” she recalls. According to Codonics, the Virtua XR Medical Disc Publisher is capable of burning up to 60 CDs or 30 DVDs per hour—a rate more than sufficient to meet the Harley Street PET/CT Clinic’s needs. “They’re incredibly reliable,” Bonython says. “They work at the pace we want and don’t create delays. This is now our preferred burner, and we’ve now implemented it at two of our other London clinics.” The Branding Issue HCA International operates a total of twelve clinics in the London area, which makes customization of CDs and DVDs particularly crucial. “Each site has its own logo,” Bonython says. “They’re all individually branded. A CD burner like this one, where the CD comes out with the right logo on it, is great for us on multiple levels. It becomes a marketing tool for that site as well.” Bonython explains that the CDs and DVDs also come complete with the Codonics viewer, preventing complications on the referring-physician side of the equation. “The big concern everyone always has when we hand them a CD is, ‘Will this work in my PC?’” she says. “The beauty of this system is we automatically burn the viewer onto the CD, so they can have the images they want.” Because some of the clinic’s referring physicians still work without computers, the option exists to print the radiologist’s report on paper, directly from the voice-recognition system. “Reports are sent from the speech-recognition application twice: once into our hospital information system and once into our PACS,” Bonython says. “Then, if the patient’s going off-site to someone who won’t avail himself or herself of the technology, we print to paper, customizing the report for the referring physician, depending on what he or she likes to use. Many people leave here with the printed report plus the CD.” The clinic recently implemented Codonics’ Horizon SF Imager to print color images from its 3D workstations. Now, Bonython reports, the Codonics family of printers and CD publishers is HCA International’s default choice for its clinics. “All new sites are having these installed as standard,” she says. “We’ve got four more installations coming up, and now, if we have to replace a burner, we automatically go to Codonics. As an organization, we need to focus on flexibility and catering to all needs, and speed and reliability are absolutely mandatory. This product has ticked all the boxes for us.”