PACS and the iPad: Possibilities and Potential

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David Hirschorn, MDIt’s more than a truism to discuss mobile computing as the next horizon in the delivery of health care. Today, the achievements of such systems are measured in degrees of eventuality, rather than possibility; their potentials are gauged in whens, not ifs. The landscape for such products, though, is far from conquered. In the imaging world, the next great barrier to overcome involves synchronizing the capabilities of mobile devices with the needs of the infrastructure that stores, transports, and accesses massive amounts of highly sensitive patient data. The business case for such products revolves, in large part, around the convenience that it affords primary-care practitioners, according to David Hirschorn, MD, director of radiology informatics at Staten Island University Hospital in New York. “The hand that feeds us is an ordering clinician,” Hirschorn says, “and clinicians use personal and mobile devices. That’s how they want to see their patients’ data, and those include images.” Patient-care Potential Hirschorn says that mobile devices are the catalysts that will unlock patient access to their physicians’ expertise during after-hours diagnosis. Although there are a variety of electronic medical record applications in the marketplace that can afford them this convenience, ultimately, many physicians are bound to whatever product is supported at the hospitals where they have privileges—and in many cases, the driver of such purchases is meaningful-use reimbursement. “What hospitals need is a good piece of imaging software that can access those records. They might have a portal for a Web-based PACS viewer and then have to find the patient all over again. There are many places that don’t even have a contextual link to the website, much less a mobile device. It’s not trivial, and it’s not simple to work that out,” he says. Mark Prodonovich is product manager for the iCRco-developed ClarityPACS solution, which offers mobile access via iClarity. In such environments, he says, purchasers prefer a clean and intuitive user interface that makes it easy for specialists to consider patient results in a variety of environments and to gather information quickly about the severity of a case. “Originally iClarity was designed for physicians to have mobile access to their environment,” Prodonovich says. “When physicians are off the premises—if they go home, and something comes across on the imaging side—they can use it to determine whether they need to come to the hospital. That coordinates advanced workflow, and the future of this goes even beyond what we’re doing today.” From the perspective of accelerated patient care, the business case for mobile clinical technology is couched in its potential to improve provider response time dramatically— which, in turn, improves billing cycles, Prodonovich says. Mobile technology also helps improve patients’ access to their own information, while reducing the overall expense of installing major workstations in every room at a given facility. Instead of bringing a patient over to a computer to view a study, it’s much simpler to hand him or her a tablet on which the image is displayed. “Having these mobile devices for clinical review with patients has been a real driver for us,” Prodonovich says. “If you look at the new iPad, that image quality (when configured properly) is probably equal to that of a three-megapixel monitor.” Trending Toward Mobility Prodonovich grants that on a tablet, physicians are looking at a small screen; using a workstation’s 20-inch monitor, he says, “You can actually pull in more information and have a larger overview.” Nonetheless, he believes that physicians will be making diagnoses straight from mobile devices soon. It also doesn’t hurt that many clinicians have a weakness for gadgetry—and tablet devices and smartphones are among the newest and most fun toys on the block. Prodonovich says that iClarity has helped him close more than a few deals for the iCRco ClarityPACS just because he introduced prospective clients to the mobile application at the top of his presentation. “The feedback has been extraordinarily positive,” he says. “We’ve had environments where we made a PACS presentation, and physicians had their iPads in front of them and downloaded the app during the sales presentation. That helped solidify a deal. There is zero learning curve; it’s just a very efficient tool.” As intuitive as iClarity is to operate, its chief value proposition lies in PACS integration. Although iClarity is intended for a variety of environments, from urgent care to family practice, in the past 18 months, Prodonovich estimates, “An easy two-thirds of 2/3 of iCRco’s PACS sales in the orthopedic marketplace have involved the iClarity module. It has been almost a line item on every one of our quotes.” Prodonovich likewise envisions iClarity eventually becoming a key part of an electronic health-care environment in which patients will have Web-based access to their own records via tablet or other mobile device. Instead of burning CDs to transport images, he says, patients could pull in their information using unique-ID access. “We will evolve this product as time goes on,” he says. Privacy and Security Prodonovich notes that concerns about accessing patient records on mobile devices are very real. He says that every developer in the marketplace will be contending with the challenges of local data storage on tablets, which are not known for their rigorous security. In addition, establishing secure remote and wireless connections to patient-data sources requires SSL certificates and additional authentication protections. Not only must these challenges be met for peace of mind, but as physicians face greater scrutiny from the federal government on HIPAA compliance, they represent significant financial and legal liabilities. “If security is being talked about in the industry, I can assure you it’s being worked on tenfold within our side of the business as well,” Prodonovich says. “I would say anyone entering this field of viewing capability and mobile devices would have to have this resolved.” Then there’s still the issue that there are no studies yet that demonstrate improved health outcomes for patients treated by physicians who use mobile devices in their practices. Until that day comes, according to Mark McEntee, PhD, senior lecturer in medical radiation science at the University of Sydney, practitioners will have to temper their expectations. “The technology now exists to do things we couldn’t have imagined 20 years ago, and the evaluation is not keeping pace,” he says. “In the past, we would have had clinical trials. Now, all you need is a budget. I think it’s great to be innovative, but you’ve got a very young generation of physicians coming out who may not have the patience that the older generations may have had to weigh the evidence.” Still, McEntee says, those caveats are reserved for limitations of the devices themselves, not necessarily the software that operates on them. “If you add the power of the iPad and the portability of it together with efficient and Web-based information—proper RIS and hospital information system data—then it becomes very powerful,” McEntee says. “If you’re talking about looking up blood reports and also seeing images, it becomes more and more powerful. If you could integrate all those information sources into one methodology that you can use, it becomes more powerful.” It is that integration evolution that will further define the next horizon in health-care delivery. Matthew Skoufalos is a staff writer for ImagingBiz.com.