Perils of sharing a single PACS can be resolved

While hospitals and radiology practice groups show growing interest in sharing single PACS, most discussions involve resolution of macro financial and technical bandwidth issues.

Sometimes micro barriers can be just as critical. Maine Medical Center, a multisite institution located in the Portland area, found that details such as resolving patient identification can be perplexing.

"It is not impossible to share a PACS, but a number of barriers must be overcome," said Dr. Matthew Ralston, a medical center radiologist.

All of the medical center's facilities are linked by fiber optics, so patients have a uniform numbering system. Radiology studies are registered in a single RIS and are all part of the same PACS, even though the studies originate in separate institutions.

Problems arise, however, when the medical center tries to share its PACS with groups outside its system.

"The biggest challenge is getting images from outside that don't share our patient registration system," Ralston said.

One solution was to have a mobile partner pull into the medical center parking lot twice a week and plug into the PACS. Patients get a medical center number and are routed through its RIS, just as with the medical center's other patients.

"It's a perfect solution. We force them into our model," Ralston said. "It makes work for them, but actually we're saving them money because they can stop producing film, and they get their images out on our Web server so their referring docs are happy."

Another partner site, an outpatient orthopedic facility, has come up with a halfway solution: Half the patients are not registered with medical center's RIS, yet the images are shipped to the medical center as "guest" studies.

"We can view these images on our workstations, but no integration happens - we don't get old studies, the system doesn't know this may be the same patient from medical center last week because now they have a different number," Ralston said. "It's better than nothing, but our goal is to turn this into a fully integrated solution, which means we're going to work toward getting those patients into our RIS."

The medical center is exploring ways to avoid being autocratic about the integration issues by building an interface between their RIS and others outside its system.

"The key is not so much to make them medical center patients, but to make the workflow downstream from acquisition go as smoothly as if they were our patients," said Robert Coleman, director of radiology informatics.

The medical center hopes to build a completely integrated imaging record so that no matter where the image is acquired, it is ultimately available under a single patient record in the medical center's PACS, according to Coleman.