Courtesy of Healtchare Executive Insight.
In 2009, the Hawaii State Department of Health began working with the state’s hospitals to enhance their capacity to handle patients with traumatic injuries, says Linda Rosen, MD, chief of the department’s Emergency Medical Services Systems Branch.
“One of the things we identified early on was that the ability to understand the results of diagnostic imaging from another hospital was an important factor in how soon patients could be accepted for transfer, when they would be transferred, and how they would be transferred,” she says.
At the time, a referring physician typically had to read the radiology report over the phone to a physician at the receiving hospital, then bundle the patient onto a plane along with a CD containing imaging studies. The CD might be hard to read, difficult to share among the staff, and easily misplaced, Rosen says. This could lead to repeat scans, with their attendant expense and risks from unnecessary radiation.1
In 2011, the health department launched a 6-month pilot program to use BEAM for trauma medical image sharing at Queen’s Medical Center in Honolulu and six other hospitals spread through the less populated Hawaiian Islands. Queen’s is the state’s lead trauma center, and it’s the best-equipped to handle severe or hard-to-treat cases.
Secure Image Sharing
BEAM, developed by OneMedNet Corporation, is a technology innovation that delivers fast, reliable, and secure image sharing. The system requires no special hardware for either facility. To use it, the sender alerts the recipient of a request to send images. Both must approve the transfer before it can be sent. The system accesses the images from the sender’s picture archiving and communications system (PACS), the central repository where images are stored in a hospital for physician access, and sends it to the recipient’s PACS. The information is encrypted during the transfer, and the peer-to-peer connection only lasts for the duration of the transfer.
During the course of the pilot study, many new uses for image sharing arose beyond trauma. “Once they saw what it would do, they wanted to use it for other stuff – you can imagine a cardiologist walking in and saying, ‘Can I use that?'” Dr. Rosen says. Today, more than 18 hospitals and imaging centers in Hawaii use the system for cardiology, oncology, orthopedics, surgery, and other cases. Imaging studies are even shared with hospitals and providers on the U.S. mainland.
The Small Hospital Perspective on Sharing Images
James McGee, MD – the sole radiologist at the 45-bed Kauai Veterans Memorial Hospital in Waimea – learned about the value of digitally sending images decades ago. In 1985, he was director of imaging at a hospital in Kalamazoo, Michigan.
“We had a problem. Someone had designed the 650-bed hospital with the X-ray department on the 7th floor, and of course, the ER was on the first floor. The logistics of this should have been obvious.” The Michigan hospital solved this problem by installing an X-ray machine in the emergency room and obtaining equipment to digitize the films and send them to the radiologists upstairs.
So when BEAM became available at his hospital, located 150 miles from Honolulu, “they didn’t have to convince us. We’d been wanting something like this for a long time,” he says.
Sending images of a sick or injured patient via the system, rather than CD, gives the receiving specialist time to formulate a treatment plan long before the patient arrives. “It can be life-saving in certain circumstances, since sometimes with critically ill patients, a few minutes makes a big difference,” McGee says.
In other situations, the technology offers another important benefit: It can prevent unnecessary transfers. Sometimes specialists at a larger hospital will review the images and respond that the outlying hospital can handle the case just as well.
“What that does is reassure the family of the patient that they’re going to get care as good as if they’d gone somewhere else. When it comes to someone who’s seriously ill, the family almost automatically says, ‘We should send them to XYZ place,’ ” McGee says. “But it may not be in their best interest to travel. Or it may be they’re better off staying here because they’re closer to family. Or if the patient isn’t going to survive, the family really wants to know if that decision was made with the full knowledge that they had nothing to offer the patient that we couldn’t do here.”
Benefits for Larger Hospitals
Medical image sharing is helping Queen’s Medical Center bring in patients from outlying hospitals more appropriately, says Cherylee Chang, MD, medical director of the Neuroscience Institute/Neurocritical Care and director of the Stroke Center at Queen’s.
“We have limited transfer resources in the islands, and we don’t want to tie up transfer for patients who really wouldn’t benefit from being transferred,” she says. “In some instances, we aren’t transferring some patients because we know it wouldn’t benefit them to come because it’s something too small or catastrophic,” she says. But in cases that would have been harder to call based on reading a radiologist’s report, “When you actually see the image, you say ‘Oh my gosh, this person needs to come, where you might not have brought them over after just reading the report.”
Dr. Chang frequently reviews imaging, including those of patients with brain hemorrhages from outlying hospitals. With a high rate of hypertension in the islands, hemorrhagic strokes are more common than on the mainland, and many facilities don’t feel comfortable managing those patients. The previous week, Dr. Chang had also evaluated scans of several vacationers with brain tumors who presented to smaller hospitals with headache or seizure.
Dr. Rosen recalls that “I had a pediatric orthopedic surgeon come up to me and say that (BEAM) saved the state thousands of dollars. He was constantly getting calls from general orthopedic surgeons saying, ‘I’ve got a kid with a fracture and I’m not sure if I’ve got the right treatment plan.’ In the past, he’d just say ‘You’ve gotta send me the kid.’ He’s a busy guy, and he doesn’t need the business, but he couldn’t give advice without seeing the X-ray. Now he can say in some cases, ‘You’ve got a perfectly good treatment plan, you don’t need to send the kid over.”
She sees the widespread adoption of medical image sharing in Hawaii as an example of a successful government public-health effort. “To me, it’s very interesting that it probably would have taken a lot longer if each individual hospital had to decide that they wanted to adopt it,” she says. “With government spending a modest amount on a pilot project, we were able to accelerate the use of this technology to benefit patients. It has turned out to be one of the most significant advancements I’ve seen in my career.”
1. Gupta et. al., Inefficiencies in a Rural Trauma System: The Burden of Repeat Imaging in Interfacility Transfers Journal of Trauma-Injury infection & Critical Care August 2010:69;2.
Eric Metcalf, MPH, is a freelance health writer and radio producer based in Indianapolis.