Going global: Indiana PACS spans Kenyan digital rift

The high cost of network infrastructure and high-power computing systems has prevented the benefits of medical informatics from reaching far into developing nations.

A group of radiologists at the Indiana University School of Medicine is attempting to change that situation for one hospital in western Kenya.

In January, the second iteration of a special Indiana University's RIS/PACS called ReferralPACS was installed at the Moi Teaching and Referral Hospital, the teaching arm of Moi University School of Medicine, in Eldoret.

ReferralPACS now provides a cost-effective archive for comparison studies, a teaching file, and research database.

"Two years ago, we installed the initial version of ReferralPACS in the Moi Teaching radiology department," said Dr. Marc Kohli, senior chief resident of IU's department of radiology. "If working in a film-based system is challenging in the U.S., in Kenya it's nearly impossible."

Kohli said prior to ReferralPACS, all examinations performed at Moi Teaching were archived on film. The hospital's film room had jackets tossed onto shelves with no organization. Most radiographs left the hospital with patients never to return, making comparison studies nonexistent.

"Maintenance of a teaching file was not an option due to the high relative cost of film," he said.

Two years ago, Kohli's group began digitizing these studies with a lightbox and digital camera mounted on a tripod. Photos were then combined with demographic data and entered into an Access database for later retrieval. During those two years, more than 4000 studies were archived. The Access database also gave the user the option of automatically sending an e-mail consult with the images attached for further review by IU faculty.

The new version of ReferralPACS is a client-server model written in Ruby-On-Rails (http://www.rubyonrails.org/), an open-source Web framework language optimized for programmer productivity. The implementation is documented in the 2006 Proceedings of the American Medical Informatics Association (AMIA Annu Symp Proc 2006:988).

"With the client-server model, imaging studies can now be viewed from any location on the hospital network," Kohli said.

The model also permits integration with the Academic Model for Prevention and Treatment of HIV (AMPATH) medical record system, which uses OpenMRS (http://openmrs.org), developed and maintained by the Regenstrief Institute at Indiana University.

"Utilizing open-source tools dramatically cuts the cost of operation," Kohli said.

Indiana University has had a 17-year partnership with Moi Teaching. The HIV/AIDS epidemic led to the formation of the AMPATH program, through which HIV/AIDS care is delivered to 38,000 people in Western Kenya (http://medicine.iupui.edu/kenya/ampath.html).