PACS pioneer Hammersmith calls itself a 'virtual hospital'

Famed Hammersmith Hospital in London, one of the first healthcare facilities in the world to embrace PACS, claims to be one of the world's first "virtual" hospitals.

The reengineering or streamlining of all workflow areas throughout the enterprise is complete, all computerized systems have been integrated, and a paperless as well as filmless environment has been achieved, according to Dr. Nicola H. Strickland, a consultant radiologist and senior lecturer in Hammersmith's department of imaging.

All that, plus the introduction of Web browser technology and the integration of teleradiology, makes Hammersmith a "virtual" hospital, she said.

The workflow reengineering was enabled by PACS, Strickland said. Though proven as a clinical tool, most PACS must still justify themselves financially by providing added value to the enterprise. Workflow reengineering is one such added value. Certain specialized software packages, such as remote teleconferencing and exploitation of Web browser technology, are integral to the virtual hospital.

"These have important financial benefits, since they support academic activities such as publishing and teaching, as well as clinical purposes," she said.

Four new DICOM concepts helped facilitate Hammersmith's virtual migration:

• DICOM modality worklist. This enables single data entry on the RIS, whereby the list of patients to undergo an imaging procedure, such as a CT scan, is transferred directly to the scanner. Typographical errors are thereby avoided, and the appropriate images are always sent to the correct entry on PACS. This DICOM attribute streamlines imaging workflow at acquisition.
• DICOM storage commitment. No images can be lost in transit. PACS confirms that the expected number of images from a study have been received and stored, guarding against any image deletion from the sending modality before all the images are received on PACS.
• DICOM display consistence. This ensures that an image has the same gray-scale appearance regardless of the screen type or medium used to display the image.
• DICOM performed procedure step. The acquisition modality tells both the RIS and PACS that an exam part has been completed, meaning that exam step can be closed but the whole exam kept open to add other steps to the same exam, something impossible until now.

"Previously, additional steps had to be included as separate imaging examinations, an inconvenient process for the user," Strickland said.