Converting to a filmless archiving system and wiring the radiology department to the desktop computers in a hospital -- and galaxies beyond -- doesn't have to be a dauntingly high investment. It just takes some astute comparison shopping and the wherewithal of a strong information systems department.
That's according to Matthew Barish, M.D., a staff radiologist at 354-bed Boston Medical Center. As part of a research agreement the medical center has established with Newton, Mass.-based Amicas, a privately held company specializing in radiology image management, Barish was helping to promote Amicas' Web-based image software at the 86th Scientific Assembly and Annual Meeting of the Radiological Society of North America in Chicago in November.
Barish says the hospital was shopping for a picture archiving communications system (PACS) but didn't want to spend a lot of money. Officials looked at soup-to-nuts packages from the market leaders such as GE Medical Systems and Marconi Medical Systems.
Finally, in the interests of cost, Boston Medical decided to go it alone. The hospital cobbled together its own "complete PACS solution" by working with small vendors. For example, from one small vendor it purchased the software that actually translates the digital images. From another small vendor, it purchased a radiology information system.
Finally, the Boston Medical radiology department bought off-the-rack hardware -- basic PCs, Barish says -- which would have been marked up considerably if purchased through one of the big PACS vendors.
A brand-name package would have cost $2 million to $4 million, Barish says -- too steep for Boston Medical. The solution the organization constructed in-house cost about $250,000, he says. Implementation and technical support rely heavily on the expertise of the hospital's information systems staff, he says.
Amicas' contribution to the solution includes archiving images -- such as X-rays and computed tomography, magnetic resonance imaging and positron emission tomography scans -- distributing them and integrating them into the hospital's information system.
The company, which was founded about five years ago and received Food and Drug Administration clearance of the software in 1997, claims 848-bed Massachusetts General Hospital in Boston as its first customer. The goal at the time was to bring radiology images to the 29,000 desktop computers at Massachusetts General, says Adrian Gropper, M.D., Amicas' co-founder, chief technology officer and chairman of the board.
With his long, brown hair, gaunt face and deep-set eyes, Gropper has somewhat of the mad scientist look about him, and in a way that's fitting. A Massachusetts Institute of Technology-trained engineer, he then attended Harvard Medical School and subsequently served a one-year internship at the University of Oregon -- just long enough to get his medical license. Since then, he has worked exclusively as a professional medical device developer, concentrating on computer-intensive devices. He says he has worked on such inventions as blood chemistry analyzers, HIV testing kits and minimally invasive surgery labs.
For Gropper, serving up diagnostic images on demand to desktop computers offers more than just a convenience: It's a crucial tool for bringing radiology into the hospital mainstream. Simply put, Amicas helps embed images into the medical record along with blood pressure readings, blood chemistry analyses and other test results, he explains.
Who hasn't been in a hospital and seen patients carting around their own X-rays? That's largely because the films are not a presumptive part of a patient's medical record. For better or worse, many patients often find themselves getting treated at the same facility where they are diagnosed simply because of this portability/convenience issue, Gropper says.
"Raising peoples' awareness that you can take it with you (to another provider) is the thing that drives me to do this," Gropper says.
Depending on volume and services provided, Amicas charges from 75 cents to $8 per study to embed an image in the record. Boston Medical, which logs as many as 250,000 images per year, is paying well under a dollar as part of the research agreement it has with Amicas.
The images are as good as the computer monitor on which they are viewed, Gropper says.
Barish says he loves the fact that he can just as easily access an image from home or from any desktop in the hospital any time of day or night.
In fact, local radiology departments are remarkably positioned to go global, according to researchers from the Cleveland Clinic Foundation who presented a study at the RSNA conference showing that radiology images can be sent over the Internet safely and inexpensively.
The study compares the speed and reliability of three ways of electronic transmission: high-speed telecommunications lines, local telephone lines and the Internet. The quality was the same over all three systems with no loss of information, the researchers say.
Although high-speed and local lines are more commonly used, the Internet is far cheaper, the researchers add. Internet technology, they say, easily allows radiology departments to refer brain images, for example, to specialists thousands of miles away if need be.