Web access untangles incompatible PACS in far-flung network

Medical informatics has changed the face of healthcare. It is also providing a means by which radiology groups can solve unique practice challenges.Millennium Medical Imaging, a group of 30 radiologists spread over 250 miles in upstate New York, uses a homegrown teleradiology network to provide reading support for 10 regional hospitals and more than 10 freestanding imaging clinics. The MMI operation is complicated by the fact that most of the hospitals and stand-alone clinics use different PACS."They all have their respective PACS," said Millennium President Dr. Tariq Gill. Gil's radiologists must deal with PACS from Emageon, McKesson, Coactiv, and StorComm. Millennium itself uses Fujifilm's Synapse."We log on to all of them from the web," he said. Some PACS are easier to use from a distance than others. Some offer direct access to the entire network, but some don't. "Some PACS may be great products, but they don't allow us to tie into their network-based version, only the web-based version," Gill said. "In cases in which Millennium must look at images from these sites, those images are DICOM-pushed into our common platform."Millennium's teleradiology network grew out of necessity."Some of our customers' expectations are approaching the unreasonable," Gill said. "Three minutes after the patient gets off the table, you get a call from the provider wanting results."Gill needed a system that would address demand for rapid turnaround over a wide geographic area. "For us to be efficient and successful, we had to pick a system that catered to the weakest link and the strongest link in the chain," he said. "The net results are the same."Some of Millennium's radiologists are based in hospitals and some in the home office. All are equipped to read from home and on the road."From the road, we use laptops and a virtual machine setup from which I can access any PACS within my network," Gill said. "It doesn't really matter anymore where we are. We can communicate from anywhere. The referring physicians don't know if we're home, at the office, or on the road."

One problem Millennium deals with are groups with PACS that are not well supported and can't be connected to reliably. Millennium's solution is to have them to push images directly to Millennium's server.The same phenomenon occurs at smaller hospitals, where Brand X PACS that are not particularly communicative with the outside world are sometimes found. Instead of constantly squeezing these facilities with limited resources and no IT staff to upgrade their infrastructure, Millennium made them an offer they couldn't refuse: Millennium set up the network itself at its own cost. Now, all the hospitals have to do is press the button and push the images to Millennium's server. Interestingly, Millennium manages all this with no IT staff itself."We're not IT people," Gill said. "We try to run Millennium as a mom and pop operation. The radiologists have divvied up responsibilities."One spinoff of Millennium's network is the backup redundancy it provides to clients, Gill said. "If lightning strikes, they have the ability as the result of DICOM push to our common platform."Millennium's network not only increases business opportunity - it provides more efficient healthcare, Gill said. "Why would we disadvantage patients in a community that's smaller than Albany or Buffalo? Why should a child with a head injury from a bike accident have a different standard of care from someone in Manhattan?"Millennium's practice has evolved from a group of radiologists tired of commuting throughout upstate New York. Those times of radiologists scurrying around the state have changed. Millennium radiologists no longer commute. Gill considers this is an exciting time to be a radiologist."Electronics has not only provided us with expanded business opportunities - we now can do a better job," he said. Gill said in the past 30 years radiology has moved from the back to the front of the medical bus."We now perform triage daily for medical and surgical practices," he said. "Informatics has made this possible."