After one snowstorm in early 2011, for example, the University of Pennsylvania Health System’s radiology department performed 156 injury-related x-rays over two days, which was more than double their normal x-ray rate.

When temperatures fell into the 20’s after a few days of 35-degree highs, the resulting ice led to a swarm of accident victims flocking to Good Samaritan Medical Center in Brockton, Mass.

In January 2011, during a two-week stretch that saw several fluctuations between slightly-above-freezing to slightly-below-freezing temperatures, the emergency room at Northwestern Memorial Hospital in Chicago saw double the number of patients it normally sees.

This could mean an increase in radiology for medical imaging professionals.  And for radiology facilities that don’t have a PACS, it means that it’s time to think seriously about getting one.

Why? A PACS provides several benefits to a radiology department and, in fact, to an entire medical center:

• Reduced need for film in diagnostic imaging, saving on the cost of film, time needed to develop film, and the space needed to house film. A PACS also eliminates the need for duplicate images.

• Quick and easy access to patient images and reports. This means better, faster care in radiology and throughout a medical facility. For physicians, a PACS means easy access to a patient’s radiology history.

• Share-ability. An image can be sent electronically to other medical facilities with a few clicks of a mouse.

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The issues at stake, however, are less well-known. Here is a very brief summary of the Supreme Court documents that show what the justices have to wrestle with (in no particular order):

• The individuals mandate. PPACA states that, as of 2014, individuals who have not purchased health insurance will be subject to a fine. The big question is, “Does Congress have the authority to do this?” Those who say “yes” appeal to the Constitution’s commerce clause, which grants Congress the power “to regulate interstate commerce.” Those who say “no” assert that allowing the government to penalize citizens for commercial inaction is tantamount to tyranny.
• The severability of the individual mandate. Suppose that the Court finds the individual mandate unconstitutional. Does that mean the rest of PPACA is unconstitutional as well? Is the individual mandate “severable” from the rest of the law, in other words? At least one district judge has said that it is not, and one appeals court has said that it is.
• The Anti-Injunction Act. This one’s tricky. There is precedent for limiting the Court to ruling on cases involving penalties only after someone has been fined. If the Court rules that this precedent applies to PPACA, then no one will be able to challenge the individual mandate’s constitutionality until after 2014.
• Medicaid expansion. PPACA mandates that states expand Medicaid to cover more people. The practical problem is that the states themselves have to fund part of this expansion. The legal problem: does Congress have the authority to make such a huge demand of the states?

The Court has slotted 5 ½ hours of oral argument time for these issues – a modern record.

Will healthcare reform hinge on the Supreme Court’s decision? In some ways yes, in some ways no. Many of the not-yet-implemented reforms of PPACA are already taking place in the private healthcare world, especially the move away from a fee-for-service reimbursement model. The healthcare market – and not government policy – is dictating reform on many fronts, in other words. But many changes that will affect healthcare pricing and delivery – especially the state-run “exchanges” and penalties for some employers that don’t provide adequate coverage – are almost certainly dependent on the continuation of PPACA.

Needless to say, June should be an interesting month.  Stay tuned to see how this plays out and what affect it will have on PACS, CVIS and other medical imaging functions.

And for good reason.

Despite the exponential growth of processing and storage capability over the past decade, the PACS products available during that time generally did not keep pace with CT improvements that enabled radiologists to take images of ever-thinner sections of the body.

Viewing the sophisticated 3D images that resulted from advanced CT required computing power that only a few computers in a radiology center had. Moreover, some PACS programs often made storing such images impossible. 3D images had to be viewed in 2D, or time had to be spent reconstructing the original 3D image from the information in the PACS. Needless to say, such a setup was not very efficient.

Now, however, PACS programs have caught up with CT technology, and “advanced visualization” PACS enable radiologists and other medical imaging professionals access to 3D images at many (if not all) workstations at a radiology center – and sometimes, given the growth of teleradiology, in radiologists’ homes.

Speed is still an issue for many 3D PACS. The problem is generally solved by running the PACS on a large server which workstations can connect to. In such a setup, the speed of the PACS does not depend on the workstation computer. In general, the only thing that slows a 3D PACS down is multiple users trying to use the program at the same time.

What’s next for the medial imaging community? No doubt, PACS that can handle ever-more sophisticated images and image manipulation. Some have already enabled radiologists to line up images taken at different times. And then, 4D PACS, which will be able to store and manage the “videos” made by assembling CT scans over time.

McKesson offers the Variable Thickness Regional Intensity Protocol (VTRIP) medical imaging solution which allows faster case reading times, scan to read times, and potentially, increased scanner utilization all without the need to launch an external 3D viewer for these common tasks.

To learn more about PACS, check out McKesson’s PACS website and stay tuned for updates on this blog.

According to an article in the Journal of American College of Radiology, it’s time for medical imaging professionals to think like lean manufacturers too.

The “lean” approach to manufacturing started in earnest with Toyota in the 1980’s. By focusing intently on both large-scale and small-scale inefficiencies, the company was able to significantly improve quality and reduce standing inventory without adding employees. Simple things (like the number of times a bolt was handled) and complex organizational patterns were altered so that machines and workers could operate at peak efficiency without being overworked. As Toyota’s bottom line drastically improved and as its superior cars put pressure on American auto makers, the rest of the manufacturing world began adopting its principles.

Some of the authors’ suggestions for applying lean techniques to medical imaging include:

• Integrating speech recognition into PACS and RIS will reduce excess mouse clicking and image manipulation, which will in turn improve workflow efficiency.
• Better process flows can reduce “down time” – i.e. unproductive waiting – for both patients and medical imaging workers.
• Improved communication and medical imaging protocols can significantly reduce the number of unnecessary orders.
• Accurately tracking scanning and processing times will help medical imaging professionals know when equipment and personnel are being overused and underused.
• Improving transportation flows will decrease wasted time and the likelihood of damage to equipment and injuries to patients.

Some have criticized the use of lean manufacturing principles in medicine because the goal – healthier human beings – is categorically different from a manufactured product. But since lean techniques have, in fact, resulted in healthier human beings without an increase in costs (and often with a greater sense of productivity and job satisfaction among healthcare workers), it makes sense to explore them in every type of medical practice, including medical imaging.

It turns out that we were right.

Here are the pertinent numbers from market research conducted by IMV’s Medical Information Division:

• 87 percent. That’s the percentage of expenditures involving PACS that’s going toward upgrading existing PACS systems.
• 85 percent. That’s the percentage of full-system PACS purchases that were replacement systems (meaning that just 15 percent were from first-time PACS buyers).
• 84 percent of hospital with 100 or more beds (the only ones surveyed) used a PACS that was implemented somewhere other than their own location.
• 59 percent of hospitals with 100 or more beds have (or have direct access to) a cardiology PACS.

According IMV, the upgrades involved increasing storage capacity, improving PACS workstations, improving infrastructure, and adding advanced visualization software.

The above numbers confirm another claim in that May post: the PACS market will continue to grow steadily (or maybe even rapidly). The speed of technological improvements will continue to drive demand for upgrades and replacements, especially since more and more hospitals and other healthcare institutions are investing in PACS.

On a related note, the research from IMV noted that 93 percent of hospitals have an RIS which is integrated with a PACS or HIS. There are lots of opportunities, in other words, for upgrades, replacements, and integration work in the RIS world as well.

For more information on PACS and other medical imaging news, subscribe to this blog.

In the past, the cardiology department would have disparate systems for cath, echo, ECG management, etc. Cardiologists and other medical imaging professionals had to log into each system separately, and in many cases, information and images that were available in one location (like a hospital) were not available at another (like a clinic). To use technical language, the systems were “siloed.”

A CVIS overcomes these and other problems by offering:

• One system. No more multiple logins, clicking between different tabs, or other time-wasting procedures.  Duplicate data entry is eliminated, since data entered for one part of the cardiovascular record, passes seamlessly (and without interfaces) to other parts of the cardiovascular record – such as from a hemodynamic monitoring system to a catheterization procedure.
• Easy access. Cardiologists and other medical imaging professionals can access the entire cardiovascular record from any computer within a hospital’s network and, in many cases, remotely (and even with a mobile device).
• Expandability. A CVIS can start as a centralized system for two or three different modalities and grow as needed. With a CVIS, in other words, it’s easy to incorporate new imaging systems – like cath, echo, ECG, CT, MRI, nuclear, and the inevitable upgrades of old software – into the central database.
• Interoperability. A CVIS is not simply a big silo that contains lots of smaller silos. It is truly a single system, with a single database, which gives cardiologists and other medical imaging professionals the ability to see the entire cardiovascular story of a patient – including non-imaging information like lab test results, ECGs and a patient’s cardiovascular history – all at once.
• Integration with other hospital systems. Billing, supply ordering, electronic medical records, and others – they all can be seamlessly integrated with a CVIS.

All of these CVIS features improve the quality of work in a cardiology department while also improving the efficiency of cardiologists, imaging technicians, and administrators.

Learn more about McKesson’s CVIS here and subscribe to this blog to keep up with CVIS news and other updates about the world of medical imaging.

Goldsmith, an Associate Professor of Public Health Sciences at the University of Virginia, thinks that radiologists and other medical imaging professionals need to think differently about their profession in order to effectively meet future demands. In particular, he thinks that micro-imaging (even at the molecular level) has yet to meet its full potential as a diagnostic tool and that typical diagnostic technologies should be seen as potentially therapeutic (such as high-intensity focused ultrasound). Such advances require medical imaging professionals to think outside the “radiology is only about imaging” box and the “radiologists don’t have anything to do with medicinal chemists” box.

In short, the future will demand lots of new specialties, sub-specialties, and partnerships from the medical imaging world.

Healthcare reform will also demand outside-the-box thinking from radiologists and other medical imaging professionals.

One focus of the Patient Protection and Affordable Care Act (PPACA) of 2010 is the creation of accountable care organizations (ACO), which will essentially move away from the standard fee-for-service model and toward one that is outcome-based.

What do ACOs mean for medical imaging professionals? Goldsmith suggests the following:

• Bundled or a “one-payment-for-all-radiology-services” payments
• Increased vigilance over unnecessary testing and re-testing
• Innovation that narrows diagnostic uncertainty and reduces the need for medical imaging
• Increased demand for radiologists and other medical imaging professionals to justify their work

The medical imaging world has always had plenty of work to do. If Goldsmith is right, that won’t change any time soon.

It’s free and it’s wherever you are. All you need is a good internet connection and questions about the rapidly changing PACS world.

This year’s PACS Spring Virtual Conference is designed especially for those who can’t attend the June conference of the Society of Imaging Informatics in Medicine (SIIM) in Washington, DC. It even includes a roundtable discussion co-sponsored by SIIM!

The details:

PACS in an Age of Change is on Tuesday May 17, 2011, starting at 10:00 am Eastern Time.

Presentations:

• Meaningful Use and Radiology: What Next? Adeel Siddiqui, MBBS, Cooper University Hospital
• Diagnosis in the Palm of Your Hand? The iPad, iPhone, and Everything Else. Mark McEntee, BSc, PhD, University of Sydney
• Cloud Computing in Radiology. James Philbin, PhD, Johns Hopkins University
• Business Analytics for the Radiology Manager, Janice Honeyman-Buck, PhD, FSIIM, University of Florida

Roundtable Discussion: Top Trends in Imaging Informatics: A Preview of Pressing Issues and Emerging Trends at SIIM 2011. Participants:

• Katherine Andriole, PhD, FSIIM, Harvard Medical School, Brigham and Women’s Hospital
• Bradley J. Erickson, MD, PhD, FSIIM, Mayo Clinic
• Elizabeth A. Krupinski, PhD, FSIIM, University of Arizona

Q&A to follow.

It’s free, so register now! When you register, you become eligible for great prizes like the latest iPad, Kindle, and more presented by Aunt Minnie. Visit  http://pacsspring.auntminnie.com for more details.

McKesson and other manufacturers of picture archiving and communication systems (PACS) have a lot to look forward to. Consider the following:

• According to a study by healthcare research firm Kalorama Information, the U.S. PACS market could hit $1.46 billion this year.
• The same report forecasts double-digit growth for the PACS market through 2015, which means that in three years, hospitals and other healthcare institutions could be spending upward of $2 billion each year to add, replace, or upgrade a PACS.
• Currently, the majority of radiology PACS are between 3 – 6 years old, and the majority of cardiology PACS are 1 – 4 years old meaning that they will need to be upgraded or replaced soon.
• 21 percent of radiology PACS owners are considering replacing their PACS in the next two years, and 15 percent of cardiology PACS are considering replacing theirs in the same time frame.

Interestingly, over 20 percent of those considering replacing their PACS are inclined to buy McKesson PACS – higher than any other PACS vendor. We are certainly proud to be the industry leader, and we have no intention of being anything but that!

For more information on PACS and other medical imaging news, subscribe to this blog.

“We knew we needed a stable system out of the gate.” So says Chuck Lakso as he explains why his department chose McKesson PACS to replace its outdated image storage system.

Lakso is Radiology Director at the Nebraska Medical Center, the University of Nebraska’s medical hospital which performs more than 250,000 imaging procedures each year. Before implementing McKesson’s PACS solution, “The tools available to the radiologists weren’t adequate for everything we needed to accomplish,” says radiology chair Craig Walker. Images could not be downloaded or uploaded quickly, only certain computers could be used to view images, and paper orders were necessary to ensure that image interpretation wasn’t being duplicated.

The results: delays in image interpretation, time wasted moving from computer to computer and unnecessary work duplication when paper orders were misplaced or improperly sent.

Lakso, Walker, and their colleagues chose McKesson’s Horizon Medical Imaging PACS because it enabled them to seamlessly move from one system to the next. Horizon’s PACS was compatible with the Medical Center’s existing imaging technology, so no one had to learn a new imaging system. Moreover, Lakso had heard that McKesson tested its PACS in labs prior to shipping, so he was confident that his staff could hit the ground running with its new Horizon solution.

Lakso and others have seen significant improvements in their operations with their new PACS. It is available at all times and on every computer in the Medical Center, paper orders have been eliminated, images download and upload quickly, and the system is easily compatible with other software used by the Center. The department estimates that it has achieved a 25% increase in productivity and an 8% reduction in turnaround time since the Horizon solution was implemented, which has translated into more time caring for patients and training medical residents.

The bottom line: McKesson’s Horizon PACS led to better medical care and better medical training.  That’s what it’s all about!

A full report of the implementation of McKesson PACS at the Nebraska Medical Center is available here.

Check this blog regularly (or better yet, subscribe) for more stories about McKesson’s PACS and other imaging technology. You can also follow McKesson Medical Imaging on Twitter and Facebook.