In a small hospital in northern Minnesota, a radiology technologist completes a CT scan series of a middle-aged man who has sustained a life-threatening head injury in a fall. She immediately transmits the images over a secure network to Rural Radiology Consultants, 60 miles away in Bemidji.

She also sends a text message to Dr. Hilton Bakker, which he receives on his iPhone. He goes to his workstation, where the patient’s file, with the designation STAT (immediate), appears at the top of a list on the monitor of his Mac Pro. He clicks on it, reads the images in OsiriX Pro, a DICOM viewer, and dictates his report: an epidural hematoma. He proofreads his comments and clicks to send the file to his picture archiving and communication system (PACS) and to the hospital. He taps a number on his iPhone to confer with the attending doctor, who is watching his report come off a printer. Turnaround time: 10 minutes.
Creating a Remote Radiology Practice

Dr. Hilton Bakker, who founded Rural Radiology Consultants, trained in Minneapolis and Michigan but always wanted to practice in his home town of Bemidji. He began his professional career at Bemidji’s North County Regional Hospital.

When he decided to go into private practice, several rural hospitals in the district – one of them 200 miles from Bemidji – made it known that they wanted his services. His challenge was creating a way to serve them efficiently from his home.

Bakker focused on identifying a solution that was cost-effective and reliable. Costs for archive storage, workstations, and integration drive the price of a Windows-based PACS up to $400,000. Bakker had been running a Windows Client-based Intelerad PACS that belonged to the hospital, but was interested in the Mac, which had switched to the Intel chip. Powerful medical imaging software was available for Mac OS X, and with applications such as VMware Fusion the Mac could run any Windows applications he needed.

“I bought a Mac laptop and liked it,” says Bakker. “I decided to work on a Mac Pro – and the Mac Pro ran much more reliably than the Windows computers. I don’t have IT support; I want to be able to work. I decided to go full Mac for my PACS.” I began to replace my Windows workstations with Mac Pro systems running VMware Fusion. And they’ve been running flawlessly.”

Bakker contacted Aycan Medical Systems, an integrator that offers OsiriX Pro, the FDA-approved version of OsiriX, the Mac-based open-source PACS/DICOM viewer widely used in diagnosis. The company also offers Aycan store, a DICOM archiving solution, and provides tailored integration and immediate customer service and support.

The biggest question Bakker asked Aycan was about integration. Could they build a PACS workflow around OsiriX Pro, Aycan store, and the Mac and integrate the Windows-based MedQ radiology information system (RIS) software that the hospitals were using, along with its dictation module? And how long would the integration take? It had taken about a year for the PACS systems that were installed in his client hospitals.

Aycan engineered the integration at its own facility in just 30 days. The system included Aycan store, running on an Apple Xserve and managing a DICOM archive on a 6TB Promise RAID that can be scaled to 12TB. Aycan only took two days to install the whole system in Bakker’s office.
Aycan: Total Workflow Automation

These days Bakker’s workflow can be described as click/read/dictate/proof/click/next. MedQ, running on a Mac Pro, displays a unified worklist of studies, sent from a PACS or imaging modality by the hospitals, on a 23-inch Apple Cinema Display. One click on a study, and the dictation software launches as the images open in OsiriX Pro. Bakker reads the images on a 3-megapixel Eizo monitor and dictates his report. He views previous studies of the same patient on a second Eizo monitor. He proofs his report and clicks to send it to the hospital on a fiber optic line over a virtual private network (VPN) and then to his own archive. He clicks the NEXT button on his Phillips SpeechMike and moves on to the next case in the worklist.

“It’s so cool,” says Bakker. “I typically read about 100 exams from all modalities every day. Aycan converts the report to a DICOM file that goes off automatically with the images at no cost. We’ve been quoted $60,000 for report-image integration that is far less efficient.” When away from his office, Bakker takes his 24-inch iMac or one of his Mac laptops to run his practice remotely.

The business side of Bakker’s practice is just as Mac-centric as his radiology. His office manager uses a Mac Pro with two 30-inch Apple Cinema Displays to do appointments, insurance forms, and billing in MacPractice software. She also uses an iPhone for mobile voice and email communication and to run an application that displays the ICD-9 disease classification for billing purposes. Bakker himself uses the iPhone to communicate with his clients, especially in medical emergencies. Hospital staff members can type an email that sounds an alert on his iPhone and displays a text message.
Cost-Saving for Hospitals: Mac-Based PACS

In addition to setting up an efficient, cost-effective remote practice, Bakker has another goal: helping hospitals to reduce healthcare costs by installing Mac-based PACS systems.

“I spent $40,000 and I have a PACS that people spend $400,000 for,” says Bakker. “And it’s better. But the really nice thing is, I can help small hospitals to get into PACS with minimal cost. A little hospital that can’t afford a PACS can access images through an iMac, download OsiriX Pro, and look at images. The iMac can route those studies to me. My own hardware costs were so reasonable that I can offer to store their images at no cost.”

“In a month or so, I’m going to a hospital that was looking at buying workstations for doing CT and MRI reconstructions. I have already said to them, do not buy a workstation without letting me show you OsiriX Pro. Most DICOM workstations are $100,000 or more and a Mac running OsiriX Pro is less expensive and better than any diagnostic workstation – in my opinion.

“If hospitals can use Mac technology to do radiology cheaper, that’s my goal. Health care costs too much. If I can do my little bit to make it cheaper, that’s cool.”

Related Posts

1. Major New Version of Radiology Information System at RBMA 2009
2. Memorial Hermann shifts radiology school
3. Healthcare Information Technology Systems Market to be Worth $53.8 Billion by 2014
4. MedQuist Announces Reseller Agreement With Clario
5. Emergency Ultrasound Consultants Announces Strategic Partnership with The Sullivan Group
6. Paying for a cup of coffee with new Starbucks iPhone app
7. Georgia Hospital Health Services Selects CSC Application to Maximize Space Productivity
8. Sterling plans Rs 150 crore expansion
9. Kardia Health Systems Launches ConnectedCare(TM)
10. Ghanaians in Addis Ababa donate US$10,000 for telemedicine facilities