The radiologist’s-eye view on remotely hosted PACS

While helping to steer 105-bed Western Reserve Hospital in Cuyahoga Falls, Ohio, toward a remotely hosted PACS solution, Jeffrey Unger, MD, repeatedly voiced one crucial concern: Would he and his fellow radiologists have to wait at their workstations, precious seconds ticking away, while PACS servers sitting hundreds of miles away processed massive datasets?

Five months after the hospital went live with McKesson Radiology’s Remote Hosted PACS, Unger is happy to report today that the answer is a big “no”—no waiting, no wondering, no discernible difference from the local PACS they’d been using for years.

For Unger, who serves as medical director of radiology at the hospital and is a staff radiologist at Akron Radiology Inc. (ARI), it’s even better than that. The uncompromised speed of service holds even when he or a colleague works from ARI’s Hawaii office, which ARI radiologists do on a rotating basis in order to supply overnight reads to Ohio. The time difference takes care of fatigue avoidance, as overnight hours in Ohio are dinnertime-to-bedtime hours in Hawaii.

(For the back story on how Western Reserve came to consider, choose and implement remotely hosted PACS, read “For Western Reserve, offsite PACS servers provide onsite PACS excellence.”)

“This has actually been very cost-effective for the group, and our referring physicians like it,” Unger says. “Our emergency departments know who they are talking to at 4 o’clock in the morning. We keep the work in-house by sending someone to Hawaii for two-week rotations. It has worked out quite well.”

Technically, the data transmittal from McKesson Radiology Hosted PACS servers in Atlanta to Western Reserve Hospital’s workstations in Ohio and Hawaii is quite sophisticated. It involves calculations and algorithms to figure and adjust for ebbs and flows in the cables and fibers connecting far-flung physical sites. However, to the end user, these processes are invisible.

Whether reading from a workstation at the hospital or from the office in Hawaii, Unger reports that there have been no delays. “I click on the case, it opens up, I read it and send my report,” he says.

Meanwhile, he adds, he has been delighted to find McKesson Radiology interfaces quite seamlessly with all of Western Reserve’s imaging modalities. “They’ve been a good vendor for facilitating integration and collaboration,” Unger says.


Prioritization station

Unger also likes that McKesson Remote Hosted PACS does everything McKesson’s on-site radiology PACS does.

For instance, it incorporates McKesson Clinical Reference Viewer, as well as Nuance Powerscribe 360 dictation software, while also offering the full menu of features available through Conserus Workflow Intelligence. These include enterprise worklists, critical results notification, STAT communication with the emergency department, radiologist peer review and business intelligence.

“The Conserus enterprise worklist is actually very elaborate, although we are a small enough facility that we can basically work on one list,” Unger explains, describing the system’s case-prioritization capabilities.

This allows numerous radiologists to view the list at any given time. Using different color codes, they designate that, for instance, an emergency case appears as red, an inpatient case as yellow and everything else in green except for, say, STAT cases that may be yellow. A numeric grading system for triaging cases further fine-tunes the relative urgency of each case.

“This helps the technologist prioritize cases for us,” Unger says. “It’s a quick way to communicate things like, ‘this case needs to be looked at right away while these cases can wait a bit.’”


A glimpse of the future?

In shopping for a remotely hosted PACS solution, Unger, Western Reserve CIO Pam Banchy and team made a site visit to a large hospital outside New York City that was running McKesson Radiology and Conserus solutions. Unger recalls how impressed they were with what they saw.

“It’s a little more elaborate than what we need,” he says. “They’ll have an enterprise work list that is specific to neuro or abdominal or musculoskeletal. The Conserus Workflow Intelligence, enterprise worklist feature is highly customizable and helps compartmentalize cases even further than we need.”

The upward scalability of the features may yet come into play, of course, as Western Reserve Hospital continues to grow in the future.


Pleased referrers and well-served patients

Crucially, Unger reports that he has been getting good feedback from referrers, including emergency physicians, on turnaround times and quality.

“No complaints,” he says. “It’s been pretty much business as usual. Now as with our previous PACS, our referrers get reports within the hour always, in all cases. Everything has pretty much kept up since the move to remote.”

Unger says the next step is getting to where the referrers can view the images along with the radiology reports in the EMR.

“One of the reasons we chose a big company like McKesson is because we believe they’ll be able to get us closer to that kind of operation in the near future,” he says. From there, he hopes, the next step will be real-time image sharing with the use of cursors, messaging and web conferencing through the EMR and/or the PACS.

“Ironically, this would get me back to the old days,” he says, speaking of the times when referrers would come to the radiology reading room for in-person consultations.


Back to the future

“I’ve been in radiology for 25 years now, and I like to communicate with my referring physicians,” Unger says. “I like to get to know them. I feel that I am a lot more helpful to them when we actively communicate. That is happening less and less in medicine today and it’s really unfortunate. If we can get back to that by developing better communication methods with our PACS, we can get back to communicating closely on our patients.”

“Some of us from here participated in a McKesson user group at the last RSNA,” he says. “McKesson did a very nice job facilitating the exchange of information and ideas. I feel confident we can work together and work with them to improve our imaging and our communications going forward.”