By Franklin Tessler, MD, and Lance Hamff
Imagine having to learn a new word processing application for every document that you write. This is similar to the issue that we in the UAB Health System faced in dealing with medical images from other facilities. A collaborative effort by a team from the Department of Radiology led to an innovative, low-cost solution.
Medical imaging CDs are a thorn in radiology’s side: The images they contain are crucial for health care delivery, yet viewing them is often frustrating and time-consuming. Despite ongoing initiatives to make imaging studies available online, similar to videos and music, we continue to struggle with digital media.
As the predominant academic medical center in our region, UAB deals with literally thousands of CDs every year. These discs arrive from facilities ranging from imaging centers to outpatient clinics to hospitals. Despite the widespread adoption of standards such as DICOM, viewing exams on disc is often problematic because each vendor provides a proprietary viewing application with a unique user interface. Often, the program will not run unless the computer’s security settings are lowered, rendering it vulnerable to viruses and other malware. Even after the images are viewable, there is a need to transfer them into our Picture Archiving and Communication System (PACS) for interpretation and permanent storage.
In the past, we used specialized hardware to import exams from CD. However, these machines were expensive to purchase and maintain. They were also not user-friendly, and required trained staff to operate them. Staff frequently complained that they had to manually search the CD contents to find the images.
We knew we could do better, and thus the “import-o-matic” was born.
The idea grew from a discussion with a radiologist, who said that OsiriX, a Macintosh-based CD viewer, could import almost anything thrown at it. We decided to put the software through its paces. Initially, we used OsiriX to import CDs that our specialized machine could not. To our surprise, many of them were importable. As an added bonus, OsiriX often located the images on the CD without the need for “fishing.”
We immediately knew we were onto something. However, we also were aware that we had to make the machines user-friendly and secure. To accomplish this, we partnered with corporate IT to access the machine’s built-in encryption in a way that satisfied their stringent security requirements. Next, we set up user accounts to make OsiriX prominent and made it impossible for users to access e-mail, use the Internet, or alter machine settings. When we were done, we had an appliance that staff could use with minimal training.
However, we still needed a solution for viewing the imported images across the institution.
Luckily, UAB had recently purchased iSite, a PACS from Philips Medical Systems. When we deployed it, we set up a parallel archive that we call the PCS (PACS without the permanent archive), which serves as a temporary repository for imported images. We configured the “import-o-matics” to automatically send studies to the PCS. The software used to view images in the PCS was already installed across our institution, so clinicians anywhere at UAB could readily view them.
For our initial implementation sites, we chose the neurosurgery clinic, a trauma-transfer intake point, and the film library (since rebranded as Imaging Services). The import machines are well-received.
“Before, many of the discs from outside facilities would not open for us and we had to repeat all studies. With the technology, I have been ordering fewer repeat imaging studies,” one trauma surgeon told me.
Additionally, Imaging Services personnel appreciated the speed and ease with which the “import-o-matics” processed CDs. They liked them so much that we eventually purchased five of them to largely replace the specialized equipment that they had used previously. Since then, we have received many requests to install them elsewhere.
The project has succeeded beyond our expectations, enabling the viewing of medical images on CD to occur more quickly, while saving money and effort. Going forward, we are planning to integrate the process with our EMR and to make it easier to an electronic ordering system. Although cloud computing may eventually provide a universal solution to sharing images between facilities, we’re confident that the “import-o-matic” will continue to serve the needs of our patients and caregivers for years to come.
— Franklin Tessler, MD, is senior vice chair for operations and vice chair for radiology informatics at the University of Alabama at Birmingham Health System. Lance Hamff is radiology informatics project manager.