As someone who has found himself—more than once—in a mad dash to catch the day’s last FedEx® pickup so that an out-of-town physician could have a patient’s images stat, Tom Hasley sees the wisdom of a cloud-based solution to image delivery. Hasley is systems support manager, ambulatory services, for Rex Healthcare (Raleigh, North Carolina), and he oversees image delivery for the system’s 400-bed hospital and four ambulatory sites, which conduct about 175,000 diagnostic-imaging procedures per year.
In addition to meeting the health-care needs of its patients (including the occasional patient who transfers to a luminary site), Rex Healthcare is provider to the Carolina Mudcats, a local baseball farm team for the Cleveland Indians. When a player is injured, the team’s orthopedic surgeon does not want to wait 24 hours to receive a CD.
In March 2011, Rex Healthcare launched a cloud-based image-sharing solution and began the arduous process of weaning patients, referrers, and radiology providers off the bedeviling CDs and VPNs that require so much support and so many resources. The next step is the transition to a new cloud-based provider with sharing that is tightly integrated with Synapse PACS from FUJIFILM Medical Systems USA (Stamford, Connecticut), the institution’s longtime PACS provider; this will enable radiologists who wish to share an image with a referrer to do so within the Synapse user interface.
Several years, ago, Rex Healthcare began the transition to digital image exchange in the same way that many other institutions did—by setting up VPNs with its radiology provider, Raleigh Radiology Associates; several other heavy image requesters; and a competing hospital in town.
“The initial VPN was for surgeons in the operating room who needed images quickly,” Hasley says. “The CD was forgotten, the films weren’t sent in time, or they didn’t have the films from exams that were performed elsewhere in the facility, so we came up with a VPN solution for an orthopedic practice. The VPN solution was extended to many of the offices with which Rex Healthcare had a high degree of CD and film exchange, in an attempt to lessen that burden.”
Hasley has been tracking monthly film and CD requests since September 2009, and film requests have dropped from 32% to between 18% and 25% in September and October of this year. On the other hand, monthly CD requests have risen from 63% to between 75% and 82% in the most recent months.
Five FTEs staff the image service center, where the printing of film, the burning of CDs, and the transfer and import of any images are handled. Within the VPN model, the service-center staff takes the image into Rex Healthcare’s test PACS and opens the image, where the medical-record numbers and patient IDs are validated. If the patient has been registered in the Rex Healthcare system, then the patient number is changed to match the Rex Healthcare patient number, so that the image would immediately be associated with the patient’s existing data in the Rex Healthcare system.
“We import them into our system and can activate a deletion rule so that, after 30 days, they would be deleted from our system,” Hasley explains. “There is even more staging that needs to be done with a CD.”
In an Ideal World
When cloud sharing of images came onto the Rex Healthcare radar, Hasley saw the opportunity to begin to eliminate the cumbersome CDs and VPNs by getting the two local hospitals and their radiology practices onto the same cloud-based image-sharing system.
Representatives from all major imaging stakeholders were assembled to hear a presentation by a cloud vendor, but the system described was deemed too pricey. Rex Healthcare went, instead, with a different provider, and the other stakeholders are currently sitting on the fence, preferring the VPN method of image exchange for the bulk of their needs.
“It is so much easier to do one of these solutions,” Hasley says. “With cloud storage, you do not necessarily have to import those images into your system. Radiologists can view the images to see what they want to use, and if they want to use an image as part of the diagnosis, we can import that image.”
Both the current system and the new system (Agilisys, DatCard Systems, Irvine, California), which is tightly integrated with the Fujifilm Synapse PACS, work on a subscription system using national provider identifiers. When a physician’s office calls to request an image, if it is enrolled in the image-sharing