British firm ComMedica drives near-real-time image sharing

Emergency care gets boost from remote diagnosis

Teleradiology has been on the cusp of widespread popularity for years. But every time it gets close to making the jump to the big leagues, it falls short.

One problem has been convincing doctors that digital images can be sent to and among facilities without the loss of diagnostic information. Another has been cost. Even when the efficacy of teleradiology is proven, many healthcare facilities are unwilling or unable financially to install the newer models. The British firm ComMedica may have a solution.

In its installation at St. Mary's NHS Trust in central London, the company installed a PC server with its PiRiLiS (Patient Record Library System) and connected the ComMedica PACS server to imaging modalities in the emergency room. Using the existing NHSNet data network, neurological experts at the National Hospital for Neurology and Neurosurgery (NHNN) are able to diagnose patients with head injuries by viewing CT scans in near-real-time.

"Every night, through PiRiLiS, we are significantly enhancing the chances of a proper outcome and, quite probably, saving lives," said Mark Simon, CEO of ComMedica. "And the exciting part is that we do it with software and integration using DICOM. Through the use of existing equipment, we save money and lives."

St. Mary's NHS Trust faced a problem common to hospitals the world over--the need for rapid referrals in an emergency care environment. The hospital's emergency room has powerful diagnostic imaging equipment, but the facility is not a specialist center for neurological radiology. If a patient with a head injury needs surgery, time is of the essence. Thus, having rapid review of CT scans by neurological specialists can make a great improvement in patient care.

The ComMedica system supports that review, as well as the capture, storage, and encryption of complex patient data. This is a critical step toward an electronic medical record, Simon said, but it's more than just that.

"We have a clinical information capability that enables healthcare providers to bring together all forms of the patient record from sources including complex medical devices and patient management systems, using publicly available networks," he said. "What we advocate is that a hospital going for a PACS must do so in a way to support future EMR capability across the enterprise."

ComMedica's PACS has one benefit over competing models: It is purely software. The British company has chosen not to get into the workstation market. For most clinicians, viewing the images through a standard Web browser is enough. But for diagnostic-quality images, radiologists and others use a client-side application called ComMedica Image Viewer, which provides virtual workstation capabilities, including viewing of multiple images and handling groups of images. In a long-standing collaboration with the University of Southern California, ComMedica has installed its software PACS at USC and is capturing some 8000 images a day, which are sent to a 2-TB data repository.

ComMedica also has its own PACS broker--a brokerless PACS, as Simon calls it, since it does not rely on third-party software. ComMedica considers its PACS broker one opportunity for potential partnering with other healthcare software and device vendors.

"We provide a very light delivery method," Simon said. "We're interested in licensing discrete parts of our suite (the Image Viewer, Image Server, and PACS broker) to other vendors, and we're currently in talks with a number of companies."

ComMedica is not, however, contemplating a broad-based assault on the marketplace--at least not without partners. The company will use its foothold with USC to sell PACS throughout Southern California. In addition, ComMedica is working with another institution in the U.S. to provide an ophthalmology implementation of PiRiLiS (ComMedica O-PACS).

"We seem to be entering a golden age," Simon said. "The technology is proven and we've demonstrated that technology like ours can enable all forms of patient data to be shared between clinicians, enabling them to make better decisions."