Estonian hospital moves to multipurpose storage

Traditional images-only PACS solutions are under siege. Emerging rival technologies include multipurpose archiving and streaming solutions that transfer only end results or final views. This allows clinicians with low bandwidths to access all functionality and data, even via handheld mobile devices. Such solutions are not limited to radiological data, either. Summary documents from electronic patient records can be viewed as well.

East-Tallinn Central Hospital (ETCH) in Estonia is one of the first hospitals in Europe to experience this type of system, after switching from a conventional PACS to a multipurpose patient data repository that can be shared by any clinical IT system. Conventional image viewing has also been changed to streaming-based viewing, extending the clinical workplace across organizational and national borders.

Together, ETCH's six clinics treat 25,900 inpatients and 425,000 outpatients each year. A total of 145,000 radiology examinations were performed there in 2006.

The hospital is famous for being a forerunner in technology, IT, and business models. When ETCH opted in autumn 2006 to change its conventional image archive to a platform capable of storing all patient data, it was already operating a film-free environment with the latest PACS technology.

"The new archiving architecture manages virtually all types of information, not just DICOM, as part of a central storage solution, and such an approach fitted well with our requirements," said Dr. Peeter Ross, former chief radiologist and current director for R&D at ETCH. "There is a clear need for us to efficiently manage the data coming from different applications: PACS, RIS, EPR, and other departmental information systems, such as laboratory, pathology, and cardiology."

The solution installed in ETCH is the Kodak Versatile Intelligent Patient Archive from Carestream Health. The capability of the VIParchive to separate data from metadata has opened up new ways for East-Tallinn to use data for research and teaching purposes. Inclusion of metadata in search criteria can also help detect patients at higher risk of certain diseases, such as for cancer screening, for example.

"The current application-attached storage is very expensive and also hard to manage," Ross said. "The main advantage, however, is to make it easier for the clinician to gather all relevant patient information at the desktop. This is what we have achieved by connecting a multipurpose viewer to the multipurpose archiving facility."

OWNERSHIP OF IMAGES

This new type of storage solution will change the role of the radiologist and the imaging department in general. Images were previously regarded as "belonging" to the imaging department. Radiologists found it hard to hand responsibility for PACS procurement, support, and maintenance to IT. And the imaging department still had "ownership" of the image archives and special postprocessing tools. Clinicians remained dependent on the imaging department to process specific models and views.

Imaging departments still play an important role in hospitals' IT implementation, but that role is changing, and the role of radiologists and radiographers will change, too. As archives become more generic and streaming technology more common, clinicians will be able to process data themselves, without the need for radiology staff. This change may be seen in a positive light, according to Ross.

"The more the clinicians know, the more they respect us. Our role is changing to a highly appreciated consultant reachable by clinicians via network on demand," he said. Clinicians are also sharing the EPR data with us. The radiologist can now read background data and not just the referral, improving considerably the quality of care."

Clinicians have long been able to view radiological images and reports. But full PACS functionality, including specific tools like segmentation, 3D reconstructions, and fusion imaging, has remained the privilege of radiologists. East-Tallinn is taking steps to change this: Images and related patient data are to be streamed outside the hospital to family doctors.

E-RADIOLOGY ACROSS BORDERS

ETCH was one of the founders of the Baltic eHealth project, which is partly funded by the European Regional Development Fund. The project uses eHealth to enhance access to quality healthcare services in remote areas of the Baltic Sea region to counter rural migration.

A large transnational IT infrastructure for eHealth has been created, connecting over 200 hospitals and 6000 general practitioners from Estonia, Lithuania, Denmark, Sweden, and Norway. It is the first cross-border health data network of this kind.

A pilot eRadiology solution, linking ETCH with the Funen Hospital in Denmark and the Vilnius University Hospital in Lithuania, is in a trial phase. Radiologists from Estonia and Lithuania have tested electronic communication and the network infrastructure by remotely reporting studies from the Funen Hospital.

The Baltic eHealth project will continue as the R-bay project, extending the network to the U.K., the Netherlands, Finland, and the Czech Republic. An eMarketplace is being built under the R-bay project to buy and sell services for remote reporting and second opinions across borders. The eMarketplace will take care of communication and data transfer in a secure and trusted way.

"I would like to open the discussion concerning common protocols and procedures concerning eRadiology on the European level," Ross said. "We should agree on common quality measures and ways to act in order to open the market for the benefit of healthcare entities and our customers, the patients."

Dr. Pohjonen is a healthcare IT consultant with Rosalieco Oy in Espoo, Finland.

Acknowledgement

Dr. Pohjonen wishes to thank Dr. Peeter Ross of the East-Tallinn Central Hospital in Estonia.