From Here to Eternity: Extending the Franchise Through Distributed-reading Solutions

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Few developments in radiology have been more productive (or disruptive) than the advent of PACS. To PACS, radiology owes its ability to increase productivity dramatically during the past 10 years, thereby conserving income levels at a time of diminishing reimbursement. To PACS, radiology also owes the very real threat of commoditization.

imageRobert Pollard

Nonetheless, the remarkable evolution of PACS technology is slowly but surely making its way back to old-school referrer interaction through distributed-reading solutions in a variety of settings. As prices drop and vendors leverage Web-based architecture, PACS has become a necessary tool for radiology practices seeking to expand service through the distributed-reading model, perhaps including on-site consultation with referring physicians.

One example of a personal touch melded with technical savvy can be found at Advanced Medical Imaging Consultants (AMIC) PC, Fort Collins, Colorado. Raym Geis, MD, is part of this group, which covers 22 sites from Casper, Wyoming, to Sidney, Nebraska. AMIC’s 29 fellowship-trained radiologists offer full service for facilities with several hundred beds (and others that are much smaller). It’s a bit like traditional radiology, except that it is distributed over a wider area.

imageEric Slimmer, CEO

AMIC sends radiologists to contracted sites at least every other week, when biopsies or interventional procedures can be performed. Most studies are read remotely, and on any given day, AMIC has radiologists at up to seven different sites doing subspecialty interpretations.

The distributed-reading workflow has improved through the years, and various sites are tweaking it as needed. “In the ideal world, we would be able to read from any type of workstation,” Geis, a veteran of many RSNA lecterns, explains. “We don’t have that situation yet. We read from basically three different PACS. One system is a fairly thin client, but I can’t just go to any computer, log on at an Internet site, have all the programs show up, and read from it. I must download things to that computer, and I must have an IT person come and set up a workstation.”

Through interfaces, AMIC’s radiologists are able to read images for all but two of the company’s 22 clients from its own Web-based PACS. Radiologists covering all sites, therefore, must have access to three different workstations.

For smaller health-care providers (such as practices and mobile imaging services) that might once have been reluctant to deal with the hassles of a distributed-reading business model, the technological barriers are not so formidable anymore. Robert Pollard, IT director at Decatur, Alabama-based Drs4Drs (, is the technical guru behind a consortium that represents physicians and provides multiple services, including mobile ultrasound.

Pollard uses a Web-client PACS to manage images from a central location so that radiologists can read the studies from standard workstations. Typically, image files are uploaded to a centralized PACS over a wireless microwave network at 5MB. “Radiologists from various locations in Georgia or Alabama log on over the Internet, and they read the studies and write the reports,” Pollard says. “We get the reports to the ordering physicians within a 48-hour turnaround time.”

Pollard has two different ways to obtain prior studies. Since not all the studies are in the system, the first way is to go back and get documents, scan them, and import them. “We mark them as medium-level stat, which bolds the actual study on the worklist,” Pollard explains. “The radiologists can immediately see that it is a prior study, or that it has a prior study associated with it. They open it, and in the lower left frame they can see all of the standard documents from prior studies. If we already have a study in the system, we add another study for that patient. It is automatic; all the studies show up, and radiologists can go back and look at the prior studies anytime.”

Beating Worklist Woes

With 30 years of IT experience, Pollard selected his PACS with an eye toward governing the company’s worklists, which are refreshed constantly. “You log into the PACS, and the worklist is isolated to your specific login,” Pollard says. “We can customize it to show studies originating from specific clinics, or use any criteria you want.”

imageRaym Geis, MD

After the technologist completes the scan, the study and the supporting documentation are uploaded to the PACS