Improving Image Access and Transfer with Online Applications

The efficiency and effectiveness of viewing and sharing diagnostic images are vital when you handle the imaging process for 24,000 exams on annual basis, with 18,000 of those also including reporting.

Our facility, Cobalt Health, has had the hardware and software in place to properly handle the massive volume of images we collect throughout a given year, but new needs have arrived where what we had was no longer enough. These needs stemmed from two major issues:

  1. Referrers may not have had access to our PACS: This resulted in a staggered, inefficient process in providing them with access to needed images and reports.
  2. Images were transferred via CD/DVD: This resulted in issues related to information governance (privacy), losing image quality in transfer to CD/DVD, and high costs related to purchasing CDs, postage, etc.
Vue Motion

Cobalt Health received positive feedback from referrers who used Vue Motion to access medical images.

We solved both of these issues through the implementation of Vue Motion and MyVue. With the Vue Motion image viewer, we needed to address the issue of providing referrers with easy and access to images and exam results. The solution needed to be intuitive to view images from anywhere, at any time. We targeted MSKCAT (MusculoSKeletal Clinical Assessment and Treatment) referrers and received feedback that the image viewer was easy to use, provided access to previous imaging exams and reports, was easy to navigate, and was seen as a clear preference over using CDs.

With MyVue, the patient portal, we saw a positive result from patients who used it. From the 31 patients who responded back to us about its use, 85% said that the portal worked well. The use of the portal was able to streamline the image access and sharing processes, and thanks to its security, provided a vast improvement in information governance.

By providing this type of ubiquitous image access via web browsers—be it on desktop PCs, or on mobile devices such as an iPad—we were able to remove our worries about referrers not being able to see the images, while the patient access eliminated the need to use CD or DVDs.

What are your thoughts on improving image access and transfer capabilities? Have you been moving toward online/mobile applications instead of hard copy or CD/DVD? If so, what success and issues have you experienced?


Peter Sharpe, CEO, Cobalt HealthRoisin Dobbin-Stacey, Cobalt HealthPeter Sharpe (left) is the CEO of Cobalt Health, and Roisin Dobbin-Stacey (right) is the PET/CT operation manager and PACS manager at Cobalt Health. Together, they presented on their use of Vue Motion and MyVue at UKRC 2014.


Video: How an Organization Uses Teleradiology to Become Independent from RIS

Innovative Radiology covers a couple of hospitals, and Houston Medical Imaging, which is its primary medical imaging facility. The organization also provides readings for about 30 other facilities, which adds up to about 250,000-300,000 readings per year.

The video below is a case study on how Innovative Radiology uses teleradiology to become independent from specific RIS vendors. Now the organization can work with various RIS vendors, creating an easier, more efficient workflow.

Challenges to RIS+PACS Integration

Makori Arnon, Clalit Health Services

Makori Arnon, MD, MHA, Director of Imaging Informatics, Clalit Health Services, Tel Aviv, Israel

The world of radiology sees frequent use of the term “integration,” but this term can easily mean many things to different people. When used in conjunction with describing implementation of a RIS+PACS platform at a hospital, it demands we clearly define our expectations up front to minimize the challenges and disruption that can accompany integrating a new RIS+PACS platform into our workflow.

In the current environment we see that RIS, PACS and capture modalities are separate yet complementary entities that are really more bundled than they are integrated. We all know that RIS is a separate platform that is slowly being absorbed into the PACS or into EMR. PACS joins together both clinical information systems with the organization’s IT network and a successful implementation should have a very positive impact upon workflow.

Radiologists need to read images and dictate their findings, and being able to easily integrate images directly into the report via the RIS will help improve workflow. Integrating images into a RIS means that vendors will need to put more emphasis on developing improved RIS technology to provide higher-end throughput. By improving the RIS interface to better address workflow issues, a single-platform vendor will have a big advantage over another third party.

Carestream Radiology Information System

Integrating images into a RIS means that vendors will need to put more emphasis on developing improved RIS technology to provide higher-end throughput.

In the contemporary radiology department, knowledge is everything. This knowledge goes outside the walls of the healthcare facility with the advent of patient portals that allow patients to electronically access, store and share their medical images. With a well-integrated RIS+PACS platform, radiology professionals expect amplified clinical, business and IT benefits that include:

  • Greater value and insight resulting from the generation of clinically-rich reports
  • Improved workflow
  • Greater cost control and a streamlined data flow
  • Increased patient engagement and satisfaction with an intuitive patient portal; and
  • The ability to foster clinical collaboration without boundaries.

To achieve this, we need to improve upon the current integration process by providing a system or single platform for the reading and distribution workflow. Successful RIS+PACS vendors are making this a key focus of future product development activities.

Another issue to consider is that radiologists continue to change how they work. We are now seeing more “point of care” imaging where you have physicians creating medical images by capturing images with handheld ultrasound or endoscopy units. These physicians (not radiologists) are creating a workflow that is “orderless” or “non-scheduled”—and the organization will need to accommodate this workflow by supporting the input of these images into the PACS. Point-of care imaging is an integration point that we will need to see in future development efforts since it is clearly on the rise.

How is your organization handling the integration of RIS+PACS?

What will your RIS+PACS platform look like in the next 10 years?

Makori Arnon, MD, MHA, is the Director of Imaging Informatics at Clalit Health Services in Tel Aviv, Israel.

[eBook] From Trust to Use and Beyond: The Road to Clinical Decision Support

Diana Nole, Carestream Health

Diana L. Nole, President, Digital Medical Solutions

Healthcare is in store for its biggest transformation over the next few years. Between the evolution of technologies and laws, facilities are looking at a new age of patient care—one that is involves interaction, and is proactive thanks to the vast increases in patient data physicians have access to.

We created an eBook titled, From Trust to Use and Beyond: The Road to Clinical Decision Support to show how industry thought leaders are currently addressing or have addressed today’s IT issues

Information technology in healthcare is already playing a vital role in this change. Electronic medical data is moving past petabytes. Analytic tools and distributed platforms provide real-time access. The environment is ripe for this data to positively affect the quality of care provided to patients, but providers have hit a wall. Reporting has shifted to focus on the need to screen and manage the information flow to clinicians, while the value of information extends to what we make available to patients and how they can interact with their physicians about it.

The first chapter of From Trust to Use and Beyond: The Road to Clinical Decision Support focuses on fostering clinical trust via data. The chapter contains remarks from Maureen Gaffney, MHS, PA-C, RN, senior vice president patient care services and chief medical information officer, Winthrop-University Hospital, in Long Island, NY.

Gaffney explains how the facility achieved HIMSS Electronic Medical Record Adoption Model (EMRAM) Stage 6 recognition with a hybrid environment and is working its way to becoming entirely paperless.

We hope you find chapter one to be beneficial and please be on the lookout for chapter two, which will be released in the coming weeks and focus on overcoming clinical resistance to anything that changes the existing workflow.

Access and download the first chapter, “Building Trust,” in the eBook From Trust to use and Beyond: The Road to Clinical Decision Support.

Click the image to access the first chapter of the eBook, From Trust to Use and Beyond: The Road to Clinical Decision Support.

Click the image to access to eBook, From Trust to Use and Beyond: The Road to Clinical Decision Support.

Three Ways to Calm Patients’ Concerns about Patient Portal Security

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

This story is all too common: another security breach leaking confidential patient information to the masses and another fine totaling in the millions—$4.8 million to be exact.

We found in our study conducted last year that security was the number one reason why participants said they would not use a patient portal. An event such as this security breach is exactly what prevents patients from being open to new technologies. While patient portal may provide benefits, whether it is secure or not is what keeps the patient from using it. HIPAA (Health Insurance Portability and Accountability Act) and HITECH (Health Information Technology for Economic and Clinical Health) are the two most important pieces of U.S. legislation related to patient privacy and information security. Facilities should not only be securing patient information for sake of compliance, but also to show patients that their data is safe, and easily accessible. Here are four ways organizations can work to calm concerns expressed by potential patient portal users:

  1. Educating patients about portal security. Similar to banking online, the key is to educate end users on
    MyVue Patient Portal

    Physicians should educate patients, not only on how to use patient portals, but also how the portals works and protects their information.

    how to protect their log-in information and password. Just as they would not provide someone their banking ID, so should they treat healthcare information the same. Additional education about how information is protected should also be presented to patients.This includes informing them about portal monitoring, but also telling them about security systems in place, such as multi-tiered firewalls, that protect access to the portal and track for intrusions.

  2. Educating patients on the value of a portal versus the conventional method. Compared to the alternative, which is film, paper or CD, which means if lost, that information is more accessible by someone else.While patient engagement is a requirement of Meaningful Use Stage 2, facilities cannot force a patient to use a portal. Keeping the sign-up process voluntary removes the sense of pressure and relieves anxiety felt by the patients when being forced into a situation.
  3. Being proactive with incident and response programs. The portal should be monitored proactively so that risks can be alleviated at a moment’s notice and patients can be informed in a timely manner of any issues of which they need to be aware. Assuring patients that the well-being and security of the portal is looked after 24/7/365 adds an additional level of confidence that can bring in a larger volume of portal users.

Security in the IT space is becoming increasingly complex every day, but that is not slowing down the transition to digital environments. This means that organizations must adapt accordingly, especially with security measures, or else they will continue to see large fines for violating HIPAA and HITECH practices.

What do you currently see as being the biggest barrier to patient portal adoption at your facility? Are security concerns often expressed by patients? If so, what are they and how do you alleviate those concerns?

How to make emotional connections with patients through image sharing

Belimar Velazquez, MBA, Director of Marketing and Inside Sales, United States & Canada, Carestream

Belimar Velazquez, MBA, Director of Marketing and Inside Sales, United States & Canada, Carestream

Healthcare providers work every day to deliver the best quality of care and the best experience to their patients. In many cases, a provider’s compassionate care creates a special bond and once this connection is created, patient satisfaction and loyalty is established.

However, in some cases, as is the case for radiology professionals, this emotional connection is a little harder to establish.  Consider the “invisible radiologist”:

  • 80 % of radiologists don’t meet their patients
  • 50 % of adults surveyed don’t know that radiologists interpret x-rays
  • Focus group participants were split as to “whether a radiologist is a licensed physician or a technician”

Yet, images – the very medium that defines the radiology role – presents a unique opportunity to establish connections. Think about the rampant proliferation of image sharing online:

Image sharing apps like Pinterest, Instagram and Snapchat all have one purpose in common to connect and elicit an emotional reaction through images (and words).  Imaging professionals are at the right place and the right time to help the enterprise establish an emotional connection with their patients through image sharing.

And guess what?  Patients want to see their radiology images and they want to share them.  We partnered with IDR Medical to conduct a survey of 1000 patients across the US with various backgrounds and found that patients place great value on the ability to share images online:

  • 61 % want to share their medical images with family members and friends
  • 88 % want to share with other physicians
  • Only 4 % would not share their own images

A recent Diagnostic Imaging meme portrayed just this fact.


While the meme was supposed to be funny, a quick search on Instagram shows this image sharing is happening now for mammograms, ultrasounds and x-rays:

Ultrasound Mammogram X-Ray
3,645 photos tagged 5,736 photos tagged 1,571 photos tagged

*Source Webstagram Search  – various hastags indicating images in each category, i.e. xraypictures, ultrasoundpic, mammogramscan

How do you put images into the hands of your patients to build this emotional connection?

The radiology community can turn to secure applications that allow patients and radiologists to share images.   These applications, usually compatible with the EHR/EMR, allow radiologists to establish communication with the patient and “tell a story” through both, images and words.  Here’s how it works:


Building an emotional connection through image sharing can bring radiologists out of the dark and directly influence patient satisfaction. Our patient attitudes study found that:

  • 79 % of patients would return to a practice that offers online image access
  • 77 % would refer family and friends to a practice that offers online image access

What do you think? Can online image sharing play a more role in fostering direct connections with patients? 

Four Reasons Why Medical Images Must Be Included in Patient Portals

Ami Halperin, R&D PACS Product Manager, Carestream

Ami Halperin, R&D PACS Product Manager, Carestream

Electronic health and medical records (EHRs and EMRs) are commonplace in today’s medical environments. The rise in use of digitized records is in an effort to improve efficiency for physicians, and establish improved channels of communication between doctors and patients.

Often left out of the patient engagement equation are medical images. The biggest reason behind this is that radiologists and patients do not often interact. Radiologists typically send the images directly to the referring physician, leaving the patient in the dark.

As a testament to the importance of including medical images in the patient portal, we offer four reasons why patients should have access:

  1. Completes the health record. The health record does not start and end with data. The medical images provide a complete picture of patients’ history. Providing patients with access to the images in addition to data gives them a detailed and more complete picture of their exams and health history.


    A patient portal with medical images can improve patient engagement rates for physicians.

  2. Structures the reporting. Adding images to the report makes the information easier to understand, allowing the patient to match reference numbers to the image they correlate with. When patients are engaged and can easily read their reports, they’re more likely to return to the portal.
  3. Connects patients to their physicians. While an obvious benefit to patient portals as a whole, the inclusion of medical images sweetens the deal. In a study with IDR Medical, we found that 79% of patients would be more likely to return to a facility that offers medical images via a portal and 76% indicated they would recommend the facility to others.
  4. Brings the radiologist into the picture. Radiologists often do not have the chance to interact with patients. Including medical images in a patient portal enables the radiologist to become involved by providing more context around the images and accompanying reports. At this year’s American Roentgen Ray Society (ARRS) annual meeting, one study showed that 47% of participants would appreciate having contact information for the radiologist who interpreted their exam, and 14% wanted to have the option to meet with the radiologist.

The patient portal creates new communication channels and enhances the relationship between patient and physician. This is a capability that patients are coming to expect from their health providers facilities’ are working on making it a reality.

For more information about patients’ reactions and thoughts on using patient portals, you can click the link to download the study conducted by IDR Medical.


Top 5 Sessions to Attend at SIIM 2014

Julia, Weidman, Marketing Manager,  Healthcare Information Solutions, Carestream

Julia, Weidman, Marketing Manager, Healthcare Information Solutions, Carestream

SIIM 2014 is sure to be awash in healthcare IT discussions about the industry’s most important trends. It can be difficult to decide on which panels, roundtables, and education sessions to attend with so many quality choices, so we did our best at narrowing down the options.

Workflow & Process Improvements | Scientific Session: This session will “examine the latest theories, concepts, and experiments in the area of workflow & process improvements.” The co-chairs of this session are Andrew K. Moriarty, MD, Henry Ford Hospital, and Paul G. Nagy, CIIP, FSIIM, John Hopkins University.

Problems & Solutions in Breast Tomosynthesis | Innovation Theater: We at Carestream are a bit biased about this one since one of our colleagues is on the panel, but this is sure to be an informative session. Its objectives are:

  • “Describe additional challenges posed by Digital Breast Tomosynthesis (DBT) images, beyond conventional full field digital mammography (FFDM), for acquisition, storage, distribution, compression, display, CAD, and long-term archiving.
  • “Discuss the Breast Tomosynthesis DICOM Standard.
  • “Identify requirement to support DBT, such as PACS, VNA, cloud storage, and local/remote/CD viewers.”

Panel participants are Steve Deaton, Viztek, Ron Muscosky, MSEE, Carestream, Bobby Roe, Visage Imaging, Larry Sitka, MSc, Perceptive Sofware, Ketan Thanki, MSEE, Barco Inc.; and the panel discussion will be moderated by Matthew B. Morgan, MD, University of Utah School of MedicineSIIM14_Blue

Radiation Exposure Monitoring: State Requirements & Joint Commission: The objectives of this session are listed as:

  • “Discover informatics tools and integrating the Healthcare Enterprise profiles that assist in extracting radiation dose information from imaging modalities.
  • “Identify how to comply with requirements for radiation exposure monitoring that exists in the State of California and that are proposed by the Joint Commission (in July 2014).”

Patient Portals and PHRs: Benefits and Challenges in Imaging Informatics: This session will be moderated by Daniel O’Malley, MS, and Cree M. Gaskin of the University of Virginia Health System. The objectives are listed as:

  • Discuss benefits and concerns for providers, patients, and radiology departments.
  • Discuss challenges and decisions during implementation.

Moderating this session will be Kevin P. O’Donnell, MASc, IHE Radiology Planning Committee

Analytics: Making the Most of Your Data | Educational Session: This session will look at clinical and operational data and how it can support processes within the organization and improve profits. Objectives for this session are:

  • Survey the benefits and challenges in implementing analytics capabilities,
  • Discuss the process of evaluating, selecting, and working with vendors of analytics tools, and
  • Learn about technical and organizational issues in developing analytics capabilities.

The faculty participating in this session will be: Matthew B. Morgan, MD, University of Utah School of Medicine, Paul G. Nagy, PhD, CIIP, FSIIM, Johns Hopkins University, Daniel O’Malley, MS, University of Virginia Health System, Luciano M.S. Prevedello, MD, MPH, The Ohio State University Wexner Medical Center, and Kenneth C. Wang, MD, PhD, Baltimore VA Medical Center.

BONUS: The SIIM 2014 Hackathon: A hackathon is an event that lasts several days and involves a large number of people gathering to collaborate in computer programming, and this marks the first time that SIIM has hosted one. According to the association:

“SIIM is launching this new hands-on education program that will help support workflow and process improvement across your enterprise healthcare. SIIM will provide a set of cloud-based APIs to highlight the next generation of health IT standards including the new REST-based DICOM and HL7 standards: WADO-RS, QIDO-RS, STOW-RS, HL7 FHIR, and SIIM’s SWIM.”

Hackathons have become popular across the world in terms of developing new applications, algorithms, and online companies, so the type of environment created at SIIM is an ideal situation for productive event focused specifically on important healthcare issues.

It is exciting to see SIIM at the forefront of important healthcare IT issues. While the six events listed in this post are our preference, be sure to look at the complete SIIM 2014 schedule so you can find the most relevant sessions for you.

Editor’s Note: Carestream Health will be exhibiting in the vendor are of SIIM 2014.  You can learn more about our participation at


Q&A: What to Include in Your PACS RFP

Eddie Moore, HCIS Digital Solutions Architect, Carestream Health

Eddie Moore, HCIS Digital Solutions Architect, Carestream Health

What are the top five things to include in a RFP to best understand a vendor’s options?

  1. Know what you want. Clearly define the scope of the project before you begin writing and making requests.
  2. Be clear and concise. Keep the RFP as short as possible while still being inclusive of your requirements. You’ll receive better responses with clearly defined questions and specifications as opposed to long, rambling documents that leave too much to the interpretation of the responder.
  3. Rank and weight. Try to stick with 5 – 7 categories and relevant sets of questions, making sure they’re ranked and weighted appropriately. You want to ensure all relevant groups/departments are equally represented in the request so that one department doesn’t override or exclude another.
  4.  Understand and communicate. Provide an executive summary at the beginning of the document that includes where you are and clearly defines where you want to be at the conclusion of the process.  Don’t require a scope of features and functions that exceeds the actual needs of the project you’re quoting.
  5.  Include all relevant criteria.  Don’t exclude any specific features or functions unless there is a valid, documented business reason.  Allow the vendors to tailor their solutions to the full scope of the RFP.

What do most purchasers forget to ask in their RFP?

I find that a lot of RFP’s don’t ask questions. What they provide is just a long document of statements without any real questions in there.

I also believe that too many people jump right into RFPs and bypass the RFI (Request for Information). You get responses from everybody, big and small, when you only send out an RFP. It can be very confusing and distracting to sort thru a large number of vendor responses that may, or may not be relevant to the original request.  The RFI can be extremely helpful during the pre-selection process as it allows you to narrow down the potential list of vendors to your specific situation and weeds out the inferior vendors.

When dealing with PACS systems it’s very easy to overlook and miss things. Creating an executive summary equipped with detailed diagrams of your current and future state is critical to ensure you receive appropriate responses.  It acts as a guide by easily separating vendors that don’t suit your needs from ones that match your documented criteria.

What is the best way to evaluate products from different vendors?

I would say there are really three important factors to evaluate before selecting a vendor-of-choice:

  1. Compare apples-to-apples. Don’t let a supposedly unique feature make your decision for you. Make sure you evaluate each vendor equally based on your needs.
  2. Be objective and critical. Rank and weight the responses based on tangible, measurable results.
  3. Be proactive. Don’t make a decision solely based off of a piece of paper. Conduct on-site interviews of each vendor’s proposal.

Lastly, choose a vendor!  This can either be a blatantly obvious choice from your review of the RFP submissions, or require you to do a more in-depth evaluation in a head-to-head environment.  Either way, following these guidelines can provide you with the necessary assistance to select the best suited vendor.

Below is a sample template of a RFP, which can be downloaded here.

This post previously published on Everything Rad provides additional information about tender bids that can help the process.

Four Key Advantages for Radiologists Using Advanced Post-Processing Capabilities

Barry D. Pressman, MD, Professor and Chair, Department of Imaging, S. Mark Taper Foundation Imaging Center, Cedars-Sinai

Barry D. Pressman, MD, Professor and Chair, Department of Imaging, S. Mark Taper Foundation Imaging Center, Cedars-Sinai

Post-processing as part of the workflow is a given with PACS workstations today. These post-processing techniques must be simple and rapid and the benefits are several:

  1. Improved hanging protocols. Post-processing at the PACS station is the most convenient, if it is part of the hanging protocols. This saves the radiologist time by eliminating the manual reordering of images for diagnosis and ensures a consistent presentation of the images for a particular study.
  2. Faster turnaround time. When additional reprocessing is necessary, beyond what the techs provide, time spent calling the techs and the delay in TAT can be obviated.
  3. Reduced tech time. When performed on the PACS as part of the routine hanging protocol, tech time can be minimized and more throughputs of cases may result.
  4. Clarification. Post-processing can be performed on the fly to clarify abnormalities for the reader and to provide demonstrations to clinicians.

I have experienced these benefits in the workplace, further proving my confidence in post-processing workflow in PACS.   Here are two examples:

In the first example, a clinician came by immediately after a CT exam performed for complicated fractures in facial bones. The exam had been performed to clarify the extent of the fractures and to plan the imminent surgery. The 2D and 3D reformats had not yet been performed by the techs. Thanks to PACS post-processing capabilities, we were able to create the 2D and 3D images on the fly, which clarified the presence of a tripod type fracture with a subtle posterior component that was not obvious on the axial acquisition images.

By working directly with the clinician, I was able to quickly generate the views needed to answer his concerns. The clinician was rapidly satisfied that he had all the information necessary to perform the surgery, with none of the delays that would have occurred if the tech was involved.

The second example of success in post-processing involves selective views and measurements related to vascular stenoses (abnormal narrowing of blood vessels) using vessel probe type processing. This is performed by the radiologists on the PACS to clarify questionable findings on the acquisition images and/or the post processed images performed by the techs, increasing our level of confidence.

Post-processing In both of these cases provided our facility with the most efficient and effective workflow possible. Our post-processing capabilities at the PACS workstation have allowed us to make necessary simple and complicated 2D and 3D reformats in a short amount of time making it possible to quickly review procedures and to reach a higher level of confidence with our findings. We believe this has increased our accuracy level, and the confidence of our clinicians in our interpretations.