Top 10 Hospitals

Exactly what is innovation and how is it defined in health imaging and information technology? Is it related to the size of a facility's digital storage system or the number of digital modalities it has installed? Or perhaps it is more important to examine how a facility uses imaging technology to increase revenue and improve physician productivity and workflow.

There's also the question of return on investment (ROI). Can an imaging facility with a lot of technical bells and whistles be considered innovative, if it hasn't met - or doesn't have - ROI goals?

Our editorial team struggled with these questions as we planned this month's cover story about the preeminent facilities in health imaging and healthcare IT. Ultimately, we realized that innovation is best measured by evaluating a combination of objective and subjective data.

We created a survey to collect quantitative data that could be easily scored and weighted, and sent it to a database of more than 10,000 healthcare contacts, including radiologists, cardiologists, PACS administrators, CIOs, technologists, vendors and industry consultants. Although we received responses from all over the world, we decided to limit the results to U.S. healthcare facilities to maintain simplicity and eliminate geographical variances.

In the first phase of the selection process, we used the returned surveys as screening tools and created a list of some 20 applicants with whom we conducted in-depth phone interviews. From this information we gathered qualitative data on how each facility implements, manages and innovates digital images. After the interviews were completed, we reviewed all the responses and began the selection process.

Although our original intent was to select the Top 10 facilities, we found it difficult to evaluate hospitals and specialty facilities together. We exercised our editorial prerogative and expanded the selection to include the Top 10 Hospitals and the Top 5 Specialty Providers that best exemplify the spirit of innovation in digital imaging.

Some readers may expect our list of the top facilities to include primarily large teaching and university institutions that have access to ample funding that often allows them to research and design state-of-the-art health imaging systems. But smaller organizations must develop creative business models and ways of innovation with much less money.

So, here it is - the first annual Health Imaging & IT Top 10 Hospitals and Top 5 Specialty Providers. Because of thediversity of the finalists, we didn't rank them numerically. You'll find them listed in alphabetical order. More detailed information on each facility is available on pages 15-27.

Return on Investment (ROI)

Because the cost of a picture archiving and communications system (PACS) and other crucial elements of an integrated digital system constitute a huge capital expense, most organizations must build a compelling business case that the purchase eventually will pay for itself. Most often, ROI is measured by calculating reductions in operating costs and staff, as well as gains in productivity and revenue.

Most respondents said that ROI is a critical component of achieving internal support to transition to digital imaging technologies. Six months after converting from a film-based imaging system to a completely digital setting, Providence Health System's St. Joseph Medical Center and Holy Cross Medical Center are 90 percent filmless and have eliminated film costs, chemistry and processing expenses, and film library staffing. Such successes please the Providence administrators, who insisted on ROI within a year of implementing the system.

Some early innovators didn't have the same positive results. Measuring only hard cost savings, its initial foray into PACS didn't give the University of Pittsburgh Medical Center (UPMC) a positive ROI. Because the system provided the best image quality and functionality to those in the radiology department, non-radiologists still ordered film. "We weren't saving money on film and processing costs, because we had a parallel infrastructure," says Paul Chang, M.D., director of radiology informatics at UPMC.

Chang solved the problem by inventing a technology called dynamic transfer syntax (DTS), which allows workstations across the enterprise to have the same functionality and image quality. Using PACS technology based on DTS (subsequently commercialized privately), UPMC now is accumulating yearly cost savings of $3 million to $5 million at their largest hospital.

Of course, there's much more to ROI than eliminating film and processing costs and reducing administrative staff. Productivity increases are often the easiest variable to measure. Most facilities noticed an immediate rise in patient throughput and the number of cases read each day.

After Baltimore VA Medical Center installed its enterprise-wide PACS in 1993, Chief of Imaging Eliot Siegel, M.D., and his team tracked the number of cases performed by radiologists and technologists per year and compared the numbers with data from previous years. Siegel found that productivity increased by 50 percent per radiologist and 40 percent per technologist across the board.

In many cases, switching to digital imaging or improving an existing digital system can result in new income streams that add to a facility's revenue. Austin Radiological Association in Austin, Texas, collected additional revenue by offering their newly-minted PACS to small hospitals.

"Hospitals that can't afford their own PACS can have access to a PACS through us," says Austin Radiological's CIO R. Todd Thomas. "Plus, they can also use our radiology staff. We package the deal as a whole; we can bring PACS into their hospital and also bring the radiologists."

There also are intangible benefits. Many survey respondents noticed benefits that cannot be measured, such as enhanced physician job satisfaction and better quality of life. A digital imaging system also can be an enormous competitive advantage, according to Matt Ebaugh, senior vice president and CIO of Commonwealth Health Corp. "We have a competitive hospital in our backyard," he says. "We can demonstrate to our referring physicians that we're more innovative and keep - and even increase - market share."

Of course, the impact on patient care is significant, but often inestimable. "The reason we decided to create an all-digital paperless environment was patient-driven," says Dave Furst, CIO of The Indiana Heart Hospital, the first hospital in the world to be designed and built completely without paper or film. "The patient focus is a very important part of our mission, and delivering faster patient outcomes is a critical part of that."

Patient benefits of a digital imaging system include less time in the radiology waiting room, less time to obtain exam results, and the ability of physicians to order additional images while the patient is still on the table. Finally, digital imaging has drastically lowered the number of lost images, which means an end to duplicate exams.

Workflow Changes

Some experienced informatics administrators argue that ROI is a limited approach to measuring success. Osman Ratib, M.D., Ph.D., professor and vice chair of information systems at UCLA's Department of Radiology, contends that workflow changes are the most accurate way to measure the value of PACS. "The cost of a PACS environment is much higher than the ROI," Ratib says. "The PACS is therefore most valuable in creating operational efficiencies and improving workflow."

Monte Clinton, director of radiology of Dartmouth Hitchcock Medical Center, agrees. "[PACS ROI] is not traditional, because the benefits one sees are subjective," he says. "I would caution those who measure ROI only by film costs and film library costs. Other factors are in play."

"Everything in radiology changed in terms of workflow," added Daren Burns, PACS administrator for Providence St. Joseph Medical Center. "The handoff from the technologist to the radiologist is different."

Clinicians no longer make multiple trips to the radiology department to view films. Technicians spend less time on clerical duties that are now managed by the hospital information system (HIS) or the radiology information system (RIS). Reports can be transcribed immediately after dictation. The overall result is that staff members spend more time on job tasks that help the facility increase revenue.

PACS changes the way physicians read cases and essentially transforms the way radiology is practiced, noted Bill Smith, M.D., chief of radiology at Detroit Medical Center (DMC). "Before, the really good CT readers essentially created a 3D picture in their head," he says. Using stack mode in PACS, a doctor can see a more accurate 3D image instantly. "It's a whole different way of looking at images," says Smith. "You can try to reconstruct a 3D image in your head, but it's much faster doing it this way. It takes out the guesswork."

Don Ragan, Ph.D., senior vice president and chief information officer at Detroit Medical Center, agrees with his colleague. "It's important to look at the historical progression of disease," he says. "With PACS, it's easier to look at past history. All of the historical information is available in a fraction of the time." Innovative facilities use data gleaned from digital imaging systems to drive organizational re-engineering. Massachusetts General Hospital (MGH) extracts data from its PACS and uses them to build business cases for additional funding and new operational procedures, according to Alan Schweitzer, senior project manager for MGH's radiology department and CTO of Radiology Consulting Group, a management consulting firm. "For example, as CT scanners increase in speed, we have to add technologists to get better throughput so the equipment isn't idle," he says. "We can use data to help us make workflow readjustments."

Staffing Shortages

Innovative radiology administrators are increasingly turning to technology to solve staffing shortages. Job satisfaction among radiologists who cover evening and night ER shifts is particularly difficult, because the number of hourly calls to oncall physicians has escalated drastically with the advance in complexity of modality technology.

Practices and hospitals with an efficient digital imaging management system are more competitive employers than those without; their PACS can be touted as an employee benefit. For example, if a film-based, multi-site practice has only one neurology radiologist, that clinician can expect to be stretched thin by traveling between sites to read cases, says Scott Nadel, M.D., president of Northeast Radiology. "Now we move images instead of radiologists," he adds, a change that has increased job satisfaction and retention.

Some practices and hospitals employ the services of "nighthawk" services to cover evening and night emergency room shifts. Virtual Radiologic Consultants (VRC) is helping alleviate staffing shortage concerns by connecting radiologists based anywhere in the world with U.S. practices and hospitals with a lack of physicians. VRC says that approximately 150 hospitals and practices have engaged its radiologists to cover emergency room evening and night shifts.

Physician Support

The challenge of buy-in from staff and referring physicians should not be taken lightly. The best organizations carefully plan the process of physician communication, education and training before introducing a digital system.

Most of our respondents reported that staff physicians received new imaging systems enthusiastically, because they immediately recognized the ease of use of the system and appreciated the workflow changes. However, in many cases, a small number of physicians were reluctant to make radical adjustments and learn new technologies. Most observers agree that the solution is sufficient advance notice and training sessions.

"We provided a lot of advertisement and opportunity for physicians to train," says Dan Robins, CIO of Providence Healthcare System, "but there were some key physicians who weren't prepared for the change, and they required more one-on-one."

An imaging facility's relationship with its referring clinicians is tremendously important. No matter how sophisticated the digital imaging system, a practice or hospital must deliver film if requested by a referring physician. Approximately one-fifth of Austin Radiological's 2,500 referring physicians have signed up for user IDs and passwords on its three-year old digital system. "Some can't get used to the technology. We can't just cut it off, because we have to serve them," says Austin Radiological's CIO Thomas. "It's a slow process. There's lots of education involved."

Technology Gaps

Digital imaging systems aren't perfect. Our respondents do hope for fixes of the most apparent problems in the near future. Siegel, of the Baltimore VA, laments the inability of PACS to manage inter-hospital image transfers. "More hospitals have transferred to PACS, [but] the major problem is there's still no easy way to transfer images from one PACS to another." Siegel advocated the development of an IHE profile for existing technology standards — such as DICOM and HL7 — which would enable patient information to be transferred from one system to another. A PACS at one hospital could view the information from a PACS at an unaffiliated hospital without downloading it. "Lots of studies are unnecessarily repeated when patients move between hospitals," adds Siegel.

Others are waiting for a complete patient record that resides in a single database. Much patient data are still stored in disparate systems. For example, data collected from pacemaker or physiological monitoring systems cannot be integrated into the patient record. Other technology challenges include load-balancing the system so that no single server is overburdened; implementing efficient, fast and redundant storage solutions; and creating 100 percent availability and reliability within radiology systems.

On the Horizon

What technologies are our innovators keeping their eyes on? IT administrators have their short-term sights on efficiencyenhancing trends, such as image distribution via on-site wireless access; more advanced storage options; integrated access to 3D and multiplanar images; and improved redundancy for imaging systems.

In the longer term, technology administrators are looking for better solutions for integrating imaging data with other clinical data, such as EKG readings. Some facilities are watching to see how artificial intelligence and computer-aided detection and computer- assisted diagnosis will help ease physician staffing shortages. Price-conscious facilities are waiting for technologies, such as digital radiography, to become more affordable.

Measuring Success

The right combination of objective and subjective data was not as elusive as our editorial team thought when we first began the project of determining Health Imaging & IT's Top 10 Hospitals and Top 5 Specialty Facilities. We learned what the most innovative hospitals and radiology practices already know — that successful digital imaging has a wide range of definitive and measurable benefits. And, in many ways, healthcare providers have only begun to explore the vast potential of IT's capabilities. Congratulations to the winners.

TOP 10 HOSPITALS

Baltimore VA Medical Center, Baltimore

Baltimore VA Medical Center (BVAMC) installed the nation's first enterprise-wide PACS in 1993. BVAMC's clinical PACS is GE Pathspeed, and it plans to upgrade to GE Medical Systems Information Technologies' Centricity this fall. The PACS is integrated with VISTA (Veterans Health Information Systems & Technology Architecture), the VA's system-wide HIS that has its own imaging capability for radiology and other subspecialties.

BVAMC has been particularly diligent in studying and measuring ROI and departmental productivity since making the digital transition. Research studies compared projected film-based costs to actual digital costs and found that the cost per study decreased by 25 percent. The result? BVAMC's original PACS paid for itself after four years.

Since installing its PACS, BVAMC's overall departmental productivity has increased by nearly 50 percent. Research using national data from American Healthcare Radiology Administrators shows that before the digital transition, BVAMC productivity was a little less than national norms. Comparing the same data after the transition shows that BVAMC productivity increased to well above the national averages.

• RIS: Vista
• PACS: GE Centricity
• CR: Fujifilm AC-3/Smart CR
• Storage EMC Clarion & EMC Centera
• Server: Vista
• HIS: Vista
• Other: Agfa TalkTechnology

Commonwealth Health Corporation, Bowling Green, Kentucky

With three hospitals serving south central Kentucky, Commonwealth Health Corp.'s (CHC) quest for filmless imaging grew out of the dual need to improve patient care and increase referring physician satisfaction. CHC's digital imaging system centers on a Synapse PACS from Fujifilm Medical Systems USA, Inc. with EMC Corp. SAN storage integrated with a Meditech RIS.

Since their new imaging system went online in March, CHC's patients have benefited from more technician attention as they go through the exam process and faster exam results. And the number of referring physicians who want access to CHC's web-based PACS keeps growing - which gives CHC a competitive edge over the area's other local hospital, according to Senior Vice President and CIO Matt Ebaugh. CHC also has seen an increase in patient throughput and an 85 percent reduction in costs.

• RIS: Meditech
• PACS: Fujifilm Synapse
• CR: Fujifilm
• Storage EMC SAN
• Server: Dell
• HIS: Meditech

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

The first clinical x-ray in the United States took place at Dartmouth College more than 100 years ago. Today, Dartmouth-Hitchcock Medical Center (DHMC) performs more than 175,000 radiological exams annually.

DHMC's RIS/PACS is vnetix from IDX Systems Corp. In choosing a RIS/PACS solution, an important factor was the ability of the vendor to effectively utilize the hospital's existing 10MB backbone instead of rewiring the entire hospital. Because IDX sold vnetix to DHMC on an ASP (application server provider) model, DHMC pays per exam which allows it to cover expenses for its imaging system out of its operating budget instead of its capital budget.

"We have a huge draw on capital dollars already," says Monte Clinton, director of radiology. "The chance of us getting an extra $10 million for a PACS was pretty remote."

"When we converted, our radiologists came in the next day and started to read," Clinton continues. "Work that would have taken a full morning took two hours. It's been an overwhelming success. Even the skeptics are happy."

• RIS: IDX vnetix
• PACS: IDX vnetix
• CR: Philips
• HIS: IDX
• Other: Dictaphone

Detroit Medical Center, Detroit

With two nursing centers, more than 100 outpatient facilities, and 2,000 beds at seven hospitals, the Detroit Medical Center (DMC) is the largest healthcare provider in southeastern Michigan. DMC performs more than 600,000 digital exams annually, managing them with Cerner's RadNet RIS and ProVision PACS.

Over the last several years, DMC has significantly enhanced its patient care and clinical operations by deploying technology-based clinical solutions. The tightly integrated RIS/PACS is only a single part of the unified Cerner HNA Millennium solution, which provides physicians with the ability to review patients' charts, order tests and medications and evaluate results online.

According to Don Ragan, Ph.D., CIO, DMC still has a lot of implementation and expansion before ROI can truly be measured. Ragan contends that PACS is no longer just about ROI - it's simply the way that radiology must be practiced in today's environment of multi-image modalities.

• RIS: Cerner RadNet
• PACS: Cerner ProVision
• CR: Fujifilm
• Storage Hewlett-Packard
• Server: HP, Sun, IBM
• HIS: Cerner

Massachusetts General Hospital, Boston

Massachusetts General Hospital (MGH) is the third-oldest general hospital in the United States and the largest teaching hospital of Harvard Medical School. In 1994, MGH joined forces with other area medical centers to form Partners HealthCare System Inc.

An early adopter of PACS, MGH recognized and accepted the risks in pioneering digital imaging, according to Alan Schweitzer, senior project manager for MGH's radiology department and CTO of the Radiology Consulting Group, a management consulting firm.

"The risk was worth it from a variety of perspectives," he says. "There are benefits that were unseen at the time." MGH is currently breaking new ground in using data collected by its technology systems to develop business plans and drive operational change.

MGH uses an Agfa Impax PACS with IDXRad RIS. Agfa TalkTechnology Talkstations, used for speech recognition, have significantly reduced the amount of time spent transcribing exam reports. An early proponent of web-based teleradiology, MGH uses Amicas web distribution software to enable referring physicians and satellite clinics to access the imaging system from any Internet-enabled PC.

• RIS: IDXRad
• PACS: Agfa/Amicas
• CR: Agfa
• Storage EMC
• HIS: IDX & Others
• Other: Agfa TalkTechnology

ProMedica Health System, Toledo, Ohio

Comprised of 11 hospitals and more than 200 ambulatory and diagnostic sites, ProMedica Health System serves 23 counties in northwest Ohio and southeast Michigan. The ProMedica PACS project encompasses five hospitals and two imaging centers that share a Philips Medical Systems PACS, Cerner QuadRIS, and StorageTek Powderhorn archive.

Bay Park Community Hospital, which opened in 2001, was the first ProMedica facility to support a PACS. The Toledo Hospital, ProMedica's tertiary care hospital and home to the Toledo Children's Hospital, houses the StorageTek archive. In 2002, it installed the Philips PACS as a way to provide soft copy reads for its DR rooms and CT scans. By 2003, the system had expanded to include the entire radiology and imaging department.

Other facilities that are now linked to ProMedica's digital imaging network include Flower Hospital, Sunforest Imaging Center, and Perrysburg Imaging Center. Future plans include adding CR to the remaining nine imaging sites and connecting the other five ProMedica hospitals to the network.

• RIS: Cerner QuadRIS
• PACS: Philips
• CR: Fujifilm
• Storage StorageTek Powderhorn
• Server: Hewlett-Packard

Providence Health System/St. Joseph Medical Center & Holy Cross Medical Center, Burbank & Mission Hills, California

When planners at St. Joseph Medical Center and Holy Cross Medical Center in southern California began contemplating a digital imaging solution, one of their primary criteria in selecting a vendor was the ability to provide an enterprise-wide versus a departmental solution. Other key criteria were the ability to prove positive ROI within a year and the ease of use of the web-based interface.

Providence Health Systems ultimately selected Stentor's iSite Enterprise product, and the two medical centers went from analog to digital in four months. Since the system went live in March, film usage has decreased by approximately 90 percent and the hospitals have benefited from the cost reductions that accompanied the decrease in film processing.

In addition, the workflow of the entire radiology department has changed, according to PACS Administrator Daren Burns. In fact, the physician that protested the most about switching from film to digital approached Burns after the transition and congratulated him on its success.

• RIS: Cerner MARS
• PACS: Stentor
• CR: Kodak CR 800/900
• Storage Stentor RAID
• Server: IBM Netservers
• HIS: Eclipsys

Sarasota Memorial Hospital, Sarasota, Florida

At 845 beds, Sarasota Memorial Hospital is Florida's second-largest public hospital. SMH's radiology facilities include a full-service radiology department at the main hospital campus and five outpatient centers throughout Sarasota.

To connect the six facilities and provide its radiologists and clinicians with web-based access to digital images, Sarasota Memorial uses a digital imaging system based on Siemens MagicView PACS, Kodak CR and IDX Systems' RIS. Currently, Sarasota Memorial provides its referring physicians with CDs but is in the process of converting to Siemens MagicWeb, which will allow password-protected access to images maintained on the PACS from any Internet connection.

Sarasota Memorial has been digital since 1995. The benefits seen by the hospital since implementing digital imaging include a reduction in film costs, a drastic decrease in the length of time it takes to obtain exam results, and better system redundancy.

• RIS: IDX Rad
• PACS: Siemens MagicView
• CR: Kodak CR 800/900
• Storage StorageTek
• Server: Sun
• HIS: Eclipsys

UCLA Medical Center, Los Angeles

UCLA Medical Center is the primary teaching hospital for the David Geffen School of Medicine at UCLA. Its facilities include Santa Monica - UCLA Medical Center, Mattel Children's Hospital at UCLA and the UCLA Neuropsychiatric Hospital.

Another early PACS adopter, UCLA is a highly regarded radiology informatics research site. UCLA has gone through several generations of PACS and is in the process of upgrading to GE Centricity PACS. Its RIS is from IDX Systems. UCLA Medical Center has adopted the ASP model for warehousing and storing its imaging data, outsourcing its data storage to GE Medical Systems Information Technologies. Current projects include integrating the PACS, RIS and HIS and developing an integrated electronic patient medical record with advanced capabilities.

UCLA's digital infrastructure has decreased operating costs while increasing the efficiency of staff physicians, particularly subspecialty radiologists. "What is important to us is the power of efficiency inside the hospital," says Osman Ratib, M.D., Ph.D., professor and vice chair of information systems at UCLA's radiology department. "Replacing the traditional film and paper trails has great value."

• RIS: IDX Systems
• PACS: GE Medical
• CR: Fujifilm
• Server: Dell/HP/Sun/IBM/Compaq
• HIS: Internally developed
• Other: CT: Siemens Somatom

University of Pittsburgh Medical Center, Pittsburgh

As the largest healthcare system in western Pennsylvania, the University of Pittsburgh Medical Center (UPMC) performs more than one million radiographic studies per year at 20 affiliated locations. Unsatisfied with UPMC's initial PACS effort, Paul Chang, M.D., director of radiology informatics, invented a new technology called dynamic transfer syntax (DTS) that allows the user to see only the amount of imaging information needed at a given time. DTS significantly reduces necessary computing power as well as the cost of the workstation needed to view an image, which allows workstations across the enterprise to have the same functionality and image quality.

DTS was so successful that UPMC patented the technology, and with the support of UPMC venture capital, created a company called Stentor Inc. to develop a commercial product. UPMC licensed DTS technology to Stentor and continues to serve as Stentor's research and development lab.

UPMC's digital imaging system, based on Stentor iSite running on IBM servers and storage. Since 2000, UPMC has accumulated more than $14 million in savings, completely paying for its PACS investment.

• RIS: IDXRad
• PACS: Stentor
• CR: Fujifilm/Agfa
• Storage Stentor
• Server: IBM eServers
• HIS: Cerner
• Other: DR: GE Medical

HONORABLE MENTIONS

Thibodaux Regional Medical Center, Thibodaux, Louisiana

Thibodaux Regional Medical Center made the switch from film-based to digital imaging in September 2002. With less than 150 acute-care staffed beds, Thibodaux Regional is a perfect candidate for NovaPACS, which specializes in providing affordable digital imaging for small- and medium-sized hospitals.

Since the PACS has been operational, Thibodaux Regional's radiologists and physicians report significant productivity increases. In addition to providing faster diagnostics, recent studies show that the monthly fee for the NovaPACS is less than half of the facility's monthly budget for film and processing costs.

• RIS: Meditech
• PACS: NovaPACS
• Storage Dell Raid 5 Array
• Server: Dell PowerEdge
• HIS: Meditech
• DR: GE

Frankford Hospitals, Philadelphia

With three hospitals and three outpatient sites, Frankford Hospitals serve patients throughout northeast Philadelphia and Bucks County. In 1996, Frankford's radiology department began transitioning to digital with the goal of increasing efficiency and achieving a better workload balance between its six sites.

• RIS: Cerner
• PACS: McKesson
• CR: Kodak
• Storage Dell/Qualstar
• Server: Compaq
• HIS: Eclipsys

TOP 5 SPECIALTY FACILITIES

Austin Radiological Association, Austin, Texas

With 14 outpatient imaging centers in central Texas, Austin Radiological Association (ARA) performs more than 320,000 exams per year. Using a Fujifilm Synapse PACS with the IDXRad RIS, ARA also provides radiology services to 10 area hospitals.

Because ARA wanted a consistent interface for staff and referring physicians, they selected a web-based RIS, which drove the PACS decision. For storage, ARA chose EMC's Symmetrix platform for short-term storage and its Centera product for long-term archiving.

Traveling between 14 centers to read cases was a nightmare for ARA's subspecialty radiologists - a problem solved when ARA implemented digital imaging in 1999. ARA also can provide access to its imaging system from any PC that's connected to the web and is actively involved in educating its referring physicians and marketing the service to them.

ARA offers use of its PACS to small hospitals in rural areas which cannot afford their own imaging system. "We are quite surprised by how many of the rural hospitals want to get on the system," says R. Todd Thomas, CIO.

• RIS: IDX Rad
• PACS: Fujifilm
• CR: Fujifilm
• Storage EMC
• Server: HP/Compaq
• Other: Cisco: Networking

Breast Imaging of Oklahoma, Edmond, Oklahoma

Breast Imaging of Oklahoma, a free-standing imaging center dedicated to breast health, is one of a small but growing number of U.S. facilities approved by the FDA to use digital mammography equipment in its facility.

Despite the debate in the medical field about the benefits of digital mammography versus the equipment costs, radiologists at Breast Imaging of Oklahoma have fully embraced the technology. "Our doctors would never go back to analog," says Debra Mitchell, M.D., CEO and managing physician. "In our opinion, the functionality is much improved. For example, you have the ability to manipulate and magnify the image and it gives the radiologist much better detail."

Using a GE Medical Systems Senographe 2000D that feeds images to a GEMS Information Technologies' Centricity PACS, mammography at Breast Imaging of Oklahoma is completely digital.  According to Mitchell, one digital mammography machine can do the work of two to three analog systems, which significantly increases the productivity of the clinic's three physicians.

• RIS: MagView
• PACS: GE Centricity
• Storage RadStore
• Server: Dell
• Other: GEMS Senographe 2000D

Northeast Radiology, Brewster, New York

Northeast Radiology (NERAD) operates seven free-standing imaging centers in New York and Connecticut and provides radiology services to several local hospitals. NERAD, which uses a DR Systems PACS, has a long-standing relationship with AMSYS, Inc., an IT services provider. When Scott Nadel, M.D., NERAD's president, needed a solution for remote image viewing, he turned to AMSYS to develop a cost-effective teleradiology solution.

Working with Nadel to meet his rigorous requirements, AMSYS created an electronic push process that automatically dispatches images, reports and other patient information to the desktops of referring clinicians. There's no need for physicians to log onto a website to see if their cases are ready because their physicians are automatically notified.

The solution that NERAD provides doesn't require special workstations or equipment to be installed; NERAD simply sends its referring physicians a CD with an application and viewer. "We're more productive, more efficient, and able to provide a depth of service for smaller hospitals that we would have never been able to provide," says Nadel.

• HIS: HBOC/Meditech
• PACS: DR Systems

The Indiana Heart Hospital, Indianapolis

The Indiana Heart Hospital (TIHH) is the first all-digital hospital ever built. Open since February, the hospital is completely paperless, filmless and wireless.

With GE Medical Systems as its clinical technology partner, TIHH provides its patients with a clinical EMR that can include images, text, data and cardiac waveforms. At the core of TIHH technology is GE Medical Systems' Centricity Clinical Information Systems, which integrates patient information with other clinical data from advanced modalities, such as a digital cardiovascular imaging system, an ECG system and an advanced CT system.

Because TIHH never had to manage a transition to digital technology, its interior design is based on a digital workflow. For example, gone are the traditional nursing stations and patient record and film storage rooms. Patient records are accessible from each patient room and data are wirelessly input into an electronic medical record at patient bedside.

• RIS: IDX
• PACS: GE Centricity
• Storage Sun
• Server: IBM/Dell
• HIS: GE Centricity

Virtual Radiologic Consultants, Eden Prairie, Minnesota

Virtual Radiologic Consultants (VRC) connects radiologists with U.S. practices and hospitals experiencing physician staffing shortages. The company's radiologists live in diverse locations, such as Australia, France, Germany, Hawaii, Hong Kong and India.

VRC employs board-certified, state-licensed radiologists who can live almost anywhere they can access a high-speed Internet connection. A VRC doctor may read cases for a single hospital, a specific geographic area or even multiple locations, but he or she must first obtain all the appropriate state licenses and credentials - a paperwork-intensive process that VRC manages. Nearly 150 hospitals and practices have engaged VRC to cover emergency room evening and night shifts.

VRC provides each of its physicians with a workstation for reading images and another one for RIS utilization and voice recognition, as well as an IP phone that's connected to VRC's intranet. And as long as a hospital or practice has access to a scanner that can send DICOM data to a network destination, it can securely send its cases to VRC.

• RIS: Fujifilm

Health Imaging & IT found that our interviews yielded anecdotal data that painted a comprehensive picture of the issues surrounding the digitization of patient images. Recurring themes were ROI, improved workflow and productivity gains, staffing shortages and physician acceptance of new technologies.