CoActiv MEETING AN INDUSTRY NEED
While servicing and supporting the IT departments of several large, multi-site radiology practices, our engineers realized that there existed a need in the industry for a whole new method of getting radiology images, reports and other data to referring physicians. We worked with several large, and small, practices in the Connecticut and New York area to understand the specific requirements and to develop a design specification for a product to fill this need. The CoActiv EXAM-Sender® module, functioning as part of the CoActiv EXAM-Series™ of radiology application products is result of all these efforts.
Rationale
In today’s culture of "fast food" and "fast information" the need to "instantly" transmit critical patient clinical and demographic information between medical and other healthcare entities is becoming a medical requirement rather than a marketing gimmick as it has often been in the past. A surgeon or other specialist is often waiting for critical patient clinical information in order to make potentially life saving decisions regarding a patient’s immediate medical care. Often this clinical information is requested to be sent "stat", the term defines the information as being required immediately to make medical treatment decisions.
In the case of radiological images, the size of the data files are often huge and can take significant lengths of time to transmit to the treating physician’s location. Also HIPAA regulations, as well as proper professional practice, demands that this information be transmitted in a manner that maintains patient privacy and in a manner that assures that the data is securely and reliably transmitted, all without compromising the need to transmit the data in a "stat" manner.
The Challenges
While today, in many parts of the country broadband digital connectivity is becoming more readily available, and at affordable costs, this connectivity is usually not secure, sometimes unreliable, and in many cases, still too expensive to utilize and still allow a medical practice to operate profitably in the current era of diminishing HMO reimbursements and skyrocketing medical insurance costs. There exists an immediate need for a healthcare entity-to-healthcare entity communications solution that meets the following requirements - This solution must be:
- secure enough to meet both HIPAA privacy and security guidelines.
- fast enough to deliver data fast enough to meet "stat" demands.
- reliable enough to assure guaranteed delivery in a 24x7 working environment.
- affordable enough for even the smallest medical practice in the most economically depressed areas of the country.
- easy to install, maintain and monitor so that practices without IT departments can utilize the system without taking on the additional costs of staff technology employees or having to purchase expensive outside technology support.
- robust enough to allow the medical practitioners to feel comfortable that the transmission method will provide reliable medical data delivery.
- "technology flexible" in order to allow for and utilize the various types of data connectivity that are regionally available including, but not limited to:
- DSL (Digital Subscriber Lines)
- Cable Modem Services
- Fractional and full bandwidth frame relay lines.
- ISDN lines
- Point-to-point direct connect lines.
- Satellite Based communication services (ie: Hughes Digital)
- Dial-up Services (usually too slow for efficient larger digital image transmissions.
- Other services currently available and planned for the near future.
- easily upgradeable to accommodate newer and faster connectivity as it evolves with a minimal amount of technological obsolescence.
- based on non-proprietary and easily available proven transmission technologies.
- flexible enough to accommodate all types of healthcare related information and data including, but not limited to:
- All size and format radiological DICOM and other digital exam studies and images.
- All digital medical images from, and for, all medical specialties.
- Digital video studies and reports as required.
- Medical reports.
- Dictated voice files in wave, MP3 and other formats.
- Scanned patient information such as insurance cards, prescriptions, and all other pertinent patient data.
- Insurance records and capitation information.
- Medical histories and other historical medical and demographic information.
- Virtually any information that needs to be moved from healthcare entity to healthcare entity in a manner that meets all of the above required restrictions.
The Solution
The CoActiv EXAM-Sender meets all of the above challenges and can be coupled with other CoActiv EXAM-Series modules including the CoActiv EXAM-Filer® to create secure CD storage disks for use by the imaging center, the patient, the referring physician and for archival storage, as well as the CoActiv EXAM-Vault®, the first cost effective solution to off-site, redundant, secure and instantly available bulk storage of critical healthcare information, digital exams and medical records.
The Technology
CoActiv has created a system that incorporates a combination of state-of-the-art PC hardware technology, coupled with a library of custom developed DICOM and other software modules to automatically transmit healthcare (and other) data in a wide variety of formats, sizes and numbers to one or more remote locations on a global basis. These remote locations can be other locations of the same healthcare entity, referring or affiliate healthcare entities or secure data-center archival record storage facilities.
Determined by the specific digital data connectivity required to meet a client’s unique size, budget, geographic location, transmission bandwidth requirements as well as available data connectivity choices, CoActiv utilizes specific hardware and various custom software combinations that allow healthcare information to be either automatically "pushed" or "pulled" between entities. What this means is, that for the first time, secure, protected healthcare information can be moved between entities, automatically in a "background mode" in order to appear almost by magic on a physician’s desktop.
A Case Study
One example of the current utilization of this CoActiv EXAM-Sender technology is in the radiology field. This medical field certainly has the most demanding need for this exciting new technology. In the past, if a referring physician needed to view a patient’s radiological exam images on a stat basis, the method of getting these images to the doctor followed an antiquated procedure which included; producing additional copies of hard-film X-Rays, CT or MRI images (an expensive process) and sending them via messenger or courier service (another expensive process) from the imaging center to the doctor’s office. If the two locations were in the same neighborhood, this procedure was often the only solution, and it has been used for years. If the two locations were distant, an overnight courier service (also expensive) was utilized.
The recent conversion of many radiology imaging centers from film-based modalities to digital DICOM compliant modalities now allows for the creation of Digital radiological images. While less expensive to produce and manage than film, these digital images and studies must somehow still be delivered to the referring physician in a speedy and cost effective manner. Current technology has permitted the development of two new improved methods of moving this medical information, both of which have addressed only some of the earlier issues and concerns.
The first method entails the producing of a CD containing the patient’s images and usually some type of viewer that can then be used by the referring physician to view and analyze these images. One of these CD solutions, the CoActiv EXAM-Filer product also includes the voice clips available from within some PACS systems as well as image-montages and the radiologist’s diagnostic report, either in a first-impression form or in a final report form on the actual CD, along with the required appropriate access software. The EXAM-Filer is the only one, to our knowledge, that produces completely self-contained exam CD’s that can be access by virtually any CD or DVD equipped PC without have to install anything on the PC itself which is an undesirable process that often creates a whole new set of potential technology problems for the doctor.
It is far less expensive and much quicker to burn an exam CD for less than $1.00 than it is to produce copies of hard-film studies. It is also much more convenient for the doctor to file the small CD in the patient’s file jacket, than it is to store large, cumbersome and bulky film studies. However, the problem of speedy delivery to the referring physician still exists and is currently solved by the traditional method of courier, messenger or overnight delivery service.
This brings us to another new method of making the radiological information available to referring physicians. This second method entails making the images (and sometimes other information) available on a web-based server and then giving the doctor the ability to securely (hopefully) login and view this information from a remote location.
While this method addresses some of the existing concerns, such as potentially dealing with the speedy delivery issue (depending on the doctor’s Internet connection), it does so at an often-unacceptable cost in other areas. Usually these web-published images are compressed to a degree that usually makes them of too low a resolution to do a primary diagnostic read, which is sometimes acceptable, since the referring doctor depends on the diagnostic radiologist to perform this function and only requires the images for referral purposes or to show to a patient.
However, certain specialties, such as orthopedic surgeons, cardiologists, neurosurgeons and some others usually require the high-resolution original radiological images to perform their procedures with any level of confidence. However, even if slightly compressed, it can still take a significant amount of time to transmit and view these images across the Internet, especially if the doctor has a slower type of Internet connection. There have also been several concerns raised by HIPAA regarding the security and privacy of this method of information delivery.
The new CoActiv EXAM-Sender successfully addresses all of the existing concerns discussed above. This system utilizes unique CoActiv developed technology to deliver the images to the referring physician’s office, (or other previously mentioned locations) without the need for the normally expensive and cumbersome VPN (virtual private network) connections favored by others. Our system utilizes a newly developed CoActiv process that publishes the full-size, uncompressed images (unlike other web-based systems) to a CoActiv EXAM-Server at the imaging center and automatically delivers the images to the doctor’s remote desktop, once again at full resolution and in background-mode without the doctor’s intervention.
This method utilizes the CoActiv EXAM-Console-Lite application module that automatically polls the imaging center’s EXAM-Server, also in background mode, and instantly starts to upload any new studies designated for that particular doctor, still in background mode, to the doctor’s desktop where he is then notified of their local availability on his PC. This process takes advantage of Secure Socket Level (SSL) HTTPS web technology to assure the required privacy and security. This system also employs Department of Defense 128bit data encryption to effect all data transmission. The only elements installed on the doctor’s PC is the EXAM-Console-Lite module which uses the doctor’s existing Internet connection in a secure manner to accomplish data transfer, and the CoActiv EXAM-Viewer-Lite DICOM clinical viewer. A minimal DSL connection, Cable Modem or ISDN connection is recommended, however this system will work with a simple dial-up connection in an emergency, though at a significantly reduced speed.
These images are compressed using lossless compression and encrypted before sending, transmitted securely, and then un-encrypted and un-compressed when they arrive at the doctor’s PC. And, all of this is taking place in a background mode, transparent to the physician.
The busy doctor does not have to wait while the image is transmitted to either view or store the image locally. The EXAM-Sender automatically pops up a bubble telling the doctor that new studies have arrived, and even flashes a desktop icon to call his attention to the information arrival. The doctor can click on the bubble to immediately view the un-compressed high-resolution images with the pre-installed EXAM-Viewer or choose to view them at a later time. The small tray icon continues to flash until the images are actually viewed by the doctor. This system is completely automated and requires absolutely no action on the doctor’s part other than clicking a button to instantly view the newly arrived exam(s).
The doctor then has the option of keeping the exams(s) in the proscribed data directory, transferring them to a specified storage area on his Local Area Network, deleting the study to free-up disk space, or (optionally) even burning them locally to a CD for insertion on the patient’s file jacket, or to give a copy to the patient - or both!
