Rex Healthcare: Implementing a Single Platform for Medical Images

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When Rex Healthcare (Raleigh, North Carolina) went shopping for a cardiology image-management solution, it was looking for three things: good vendor support, the ability for cardiologists to access prior studies from the radiology PACS, and a willing development partner to grow with as it built an employed cardiology practice and a new heart hospital. Tom Hasley, MS, RTR, was Rex Healthcare’s systems support manager for ambulatory services when the hospital acquired the Synapse® Cardiovascular (CV) PACS (FUJIFILM Medical Systems USA, Inc) in 2011. Although the system had merged with University of North Carolina Medical School in Chapel Hill some years ago, collaboration in ancillary information systems was minimal, but that is changing—Hasley has been appointed enterprise systems manager for radiology and cardiology for all of UNC Health Care. Rex Healthcare—which operates a 660-bed hospital in Raleigh and associated outpatient clinics— installed its first radiology PACS (Fujifilm’s Synapse) in 1999 and now completes about 175,000 radiology exams annually. A single radiology group is contracted to perform all interpretations. When Rex Healthcare decided to upgrade to a new cardiovascular PACS in 2011, it looked at offerings from various cardiology PACS vendors, including an incumbent cPACS vendor, before settling on the Synapse CV, Hasley reports. Key selling points were the service and support that Rex Healthcare had received for its Synapse radiology PACS over the years. “We also liked the direction that Fujifilm was headed with its cardiovascular PACS,” he says.

Tom Hasley“We wanted a development partner because we were in the process of building our own Rex Healthcare cardiology group—and we will be building a new heart hospital, set to open in 2016 or 2017.”

—Tom Hasley, Rex Healthcare

A Common View A third (and important) factor in the decision to install Synapse CV was that Rex Healthcare’s cardiologists would be able to look at prior studies from the radiology Synapse PACS seamlessly—without exiting the Synapse CV platform. While the radiology Synapse PACS and the Synapse CV PACS constitute two separate databases, Fujifilm has implemented a method that uses patient identifiers and other data to let users of either of the two databases share images. The images aren’t transmitted from one database to the other, Hasley says. Instead, the technology takes the user to the requested images inside the database where they reside. A Synapse CV user, for example, will be given a view, inside the Synapse radiology PACS, of the appropriate patient file. “It’s like an internal common view between the two systems,” Hasley explains. “It’s two databases almost put together to look like one. If you’re in the system, you wouldn’t know it was two databases. If you were a radiology patient who had received a chest radiograph two months ago, and you came in today and had an echocardiogram, the cardiologist reading it would know that you’d had that chest radiograph.” The cardiologist would be able to access the chest radiograph immediately—or, for that matter, a radiologist would be able to access the echocardiogram. The moment that images enter one PACS, they are available via the other, Hasley says. Efficient, Saves Money For the most part, it is the cardiologists at Rex Healthcare who make use of the common-view feature between the two PACS, Hasley reports. They want and need to see the radiological studies of patients before they begin cardiac catheterization or some other heart-related procedure that the Synapse CV is designed to process. “It’s important for the cardiologists to be able to view a chest film or some other procedure done in the radiology suite while they are in the cardiovascular PACS,” Hasley notes. “They don’t have to go into some other system; it’s automatically there for the cardiologists to see, saving them time by giving them immediate access to the comparison studies.” Hasley discovered another benefit when Rex Healthcare installed a Fujifilm Synapse mobility product that makes studies from both the radiology PACS and the cardiovascular PACS available to physicians when they are using portable devices. “That’s another advantage of a one-vendor platform,” Hasley says. As an IT professional, Hasley is aware of the benefits to physicians of a single-platform image-management solution, but is less involved in assessing the solution’s patient-care benefits. Of course, he adds, patients benefit when their radiological studies can be immediately viewed in the cardiology suite and when physicians at the bedside can retrieve images from either system via their portable devices. Referring physicians with the proper clearance can access information from both PACS, as can emergency-department physicians. Hasley also emphasizes the financial benefits of having a common view between PACS. He says, “I don’t need to have a file-room person request that images be sent to another system. There’s no need for duplicate storage, so there’s a cost saving, in that regard.” Nonetheless, the systems do remain separate, with regard to upgrades. Hasley says, “Upgrades to the radiology Synapse PACS and the Synapse CV have to be done separately. You have to keep up with that. Cardiologists and radiologists use two different tool sets.” While it’s unlikely that the different tool sets would ever be combined in a single system, Fujifilm is working on a design for a full-fledged, single-database platform for both the radiology and cardiovascular PACS, Hasley says. George Wiley is a contributing writer for