Teleradiology: exploiting the opportunities in PACS (Picture Archiving and Communication

System) in East Africa

By Dr Muhammad Kashif Mirza

Manager Radiology & Manager PACS ProjectAKUHN

kashifmirza.com

Summary

• Basics–PACS–Teleradiology

• Teleradiology models –AKUH,K –AKUH,N

References

PACS

• A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities (source machine types).[1]

1- Choplin, R., (1992). Picture archiving and communication systems: an overview. Radiographics January 1992 12:127-129

Networka secured network for the

transmission of patient information

Workstationsfor interpreting and reviewing

imagesArchive

archives for the storage and retrieval of images and reports.

Benefits

Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or transport film jackets.

– Better Report Turnaround time -> Better Quality Healthcare– Fats access to old + recent Films -> Better Quality Healthcare– No Films printing -> Cost Saving + No Film Loss

PACS USE

PACS

Films Replacement

Electronic Linking with HIS,

RIS and EHR

Remote Access

Radiology Workflow

Management

PACS Use

• Films replacement (Film less environment):

– PACS replaces films based means of managing medical images.

– With the decreasing price of digital storage, PACS provides a growing cost and space advantage over film archives in addition to the instant access to prior images at the same institution.

PACS

Films Replacement

Electronic Linking

with HIS, RIS and

EHR

Remote

Access

Radiology Workflow Managem

ent

PACS Use

• Electronic image linking: – PACS provides a platform

for radiology images linking with other information systems.

• Hospital Information System (HIS)

• Electronic Health Record (EHR)

• Radiology Information System (RIS)

PACS

Films Replacement

Electronic Linking

with HIS, RIS and

EHR

Remote

Access

Radiology Workflow Managem

ent

PACS Use

• Radiology Workflow Management: – PACS is used by

radiology personnel to manage the workflow of patient exams.

• Less Patient waiting time

• Fast reporting• Resource utilization

monitoring

PACS

Films Replacement

Electronic Linking

with HIS, RIS and

EHR

Remote

Access

Radiology Workflow Managem

ent

PACS Use

• Remote access: – It expands on the

possibilities of conventional systems by providing capabilities of off-site viewing and reporting (distance education, telediagnosis).

– It enables practitioners in different physical locations to access the same information simultaneously for teleradiology.

PACS

Films Replacement

Electronic Linking

with HIS, RIS and

EHR

Remote

Access

Radiology Workflow Managem

ent

Networka secured network for the

transmission of patient information

Workstationsfor interpreting and reviewing

imagesArchive

archives for the storage and retrieval of images and reports.

Remote Site Expert Radiologist

Net

wor

k (In

tern

et)

• Generally, in Teleradiology, an image is sent from the examination site to a remote site where an expert radiologist makes a diagnosis.

• The report is sent back through various electronic means. (Fax/Information system/Email/Verbal)

Remote Site Expert Radiologist

Net

wor

k (In

tern

et)

ReportReport

Hospital Expert Radiologist

Net

wor

k (In

tern

et)

ReportReport

ReportReport

Network (Internet

)

Network (Internet

)

Network (Internet

)

What does radiologist needs for teleradiology reporting?

Images• Diagnosti

c class images

• Either scanned or acquired

• DICOM version 3 compression with agreed compression(if any)

Clinical Information• Patient

Demographics

• History• clinical

information

• condition to be ruled out

• Lab results

Priors• Prior

Exams images for comparison

• And• Prior

Radiology Reports

Workstation• Diagnosti

c Class Monitors

• All information (images+ Data - all integrated)

• Image manipulation functions

Meeting the goal…Beside image transfer following are the requirements

Report

Report management software

Billing

Agreed Billing models Payment transfer methods

Image/Report Archive Policy

Image retention durationRadiology Reports

Manpower

Trained manpowerandJob satisfaction

Legal Issues

LicensingCredentialingInsuranceConfidentialityStandards

Models of PACS-based Teleradiology

• One PACS – One RIS/HIS • One PACS – Multi RIS/HIS• Multi PACS – Multi RIS/HIS

• With Multi model : One may consider having Universal Patient ID for Continuity of Care; sometime called Master Patient Index (MPI)

Teleradiology ModelHub and Spoke

• Outreach centers (Imaging machines with no Radiologist)• Diagnostic centers (Imaging machines With Radiologist)• Main Hospital (Imaging machines with Radiologist and other facilities)

One PACS –One RIS- One HISDiagnostic Reporting

2nd OpinionReporting

Workload Balancing

Teleradiology in Pakistan and Afghanistan

Distance

Road travel1750 KM (approx)

Air travel1200 Km(approx)

Teleradiology between Pakistan and Afganistan

CT

REMOTEUSER

`

FILE SERVER

DICOM

COMMUNICATIONSERVER

DICOM

WEBAPPLICATION

RadiologistTranscriber

WORKFLOW

Diagnostic Station

Diagnostic Station

Video Conferencing

Teleconference with FMIC: Education and Training Session

Communication Link

*Current configuration for PTCL or ROSHAN may differ.

Teleradiology in East Africa

Active LinkReporting for all Exams: YesTurnaround time (regular): 24 Hrs Turnaround time (urgent): immed.Image Archive (AKUHN, PACS): YesReporting (Interim): ManualConnectivity-DICOM : via internetIntegration Model: One PACS-Multi HIS (under Plan)

Future LinkCurrent Status: Planning

Nairobi

Nairobi

Buru Buru14 KM Approx.

Avenue Hospital1KM Approx.

Reporting for all Exams: YesTurnaround time (regular): 24 HrsImage Archive (AKUHN, PACS): YesReporting : AutomatedConnectivity-DICOM : via internetModel: One PACS – ONE HIS Current Status: Active

Six Diagnostic CentersCurrent Status: Under PlanningModel: One PACS – ONE HIS

Thank you