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More orthopedists using filmless technology
Achieving picture perfect x-rays using digital imaging is available, affordable, and can enhance orthopedic quality of care.
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In this third article in our series on the paperless electronic practice environment, Orthopedics Today will discuss integrating filmless radiology (also referred to as filmless or digital imaging) with an electronic medical records system.
(This is part three in a five-part series on the paperless, electronic practice environment.)
Part 1: [The paperless office: Taking the plunge]
Part 2: [Benefits of implementing an EMR outweigh barriers]
Part 4: [The paperless office: Taking the plunge]
For years, orthopedists have relied on film radiographs, but more are turning to filmless technology where data are displayed on a monitor and the digital X-ray image can be manipulated, duplicated, transmitted and saved within seconds, noted Herbert Alexander, MD, chairman of the American Academy of Orthopedic Surgeons (AAOS) Internet Communications Committee, in an AAOS Online Bulletin article.
Two filmless radiology systems – digital and computed radiography (DR and CR, respectively) — offer multiple advantages over old technology. DR, considered one of the most significant breakthroughs in X-ray imaging, is a “technology where the X-ray image is exposed on an electronic apparatus and the X-ray beam is converted directly to a digital image without the use of a cassette or exposing a plate of any kind,” H. Alexander said. Expensive, specialized DR hardware is required for this to happen.
CR uses an imaging plate coated with storage phosphors that are activated with a low-energy laser to capture X-rays. A CR reader converts the X-ray into a digital image. Like film, phosphor plates are stored in cassettes and can be used with conventional X-ray equipment.
“The choice of DR or CR is up to the customer,” said Patrick Culley, vice president of marketing for eTrauma. “DR is most cost-effective at 100 studies/day or greater, so most clinics choose CR due to the lower cost of the equipment. The image quality is virtually the same, but DR delivers images more quickly and with less handling.”
A picture archiving and communications system (PACS) includes software that allows users to retrieve, manipulate and view the images created with DR, CR or other imaging modalities, like MRI, CT and ultrasound. PACS requires a server to store images for immediate retrieval, an off-site backup storage system, a workstation with a high-resolution monitor, and network communications equipment to unite all of the components. Although images can be accessed via the Internet from, say a radiology group’s PACS, most orthopedists opt for in-house PACS. This allows real-time access to the image while the patient is in their office.
Going digital
Additional advantages of a PACS include reducing, if not eliminating, expenses associated with film developing, handling, processing and disposal, as well as retrieval of X-rays, thus saving filing clerk cost and time. Ian Alexander, MD, physician executive for SoftMed System Inc. and faculty member for the AAOS course Information Technology and Management for the Orthopedic Practice, told ORTHOPEDICS TODAY of other benefits. “Digital imaging allows you to eliminate hard-copy film storage space and having to reclaim the silver from the films. You can copy and store outside films permanently and then immediately return them to the patient during their visit so the practice doesn’t have to mail them back. It also ends the need to copy films when a patient wants them for a second opinion.”
Digital imaging allows many viewers to immediately see copies of the original image on any computer, at the same time and at different locations. Transferring images from a hospital to physician’s office takes only seconds and can greatly improve the quality of care.
“Elimination of ‘lost’ films and retakes due to higher quality images means fewer X-rays are taken,” Culley said. “This may be a significant indirect benefit to a PACS, since it leads to lower radiation exposure and duplication costs. In addition, bad images can be improved by software image enhancing, so going digital can be also be considered safer for patients via the improved clarity of the images.”
With digital imaging, orthopedists no longer need to draw pencil lines on film to measure angles and distances; they can now use special tools and features in the PACS software. Information can be saved, deleted or redrawn on the images. “Users are easily able to zoom in on, magnify, rotate and flip images, as well as to adjust brightness and contrast (window leveling), which is a real problem with an under- or overexposed hard-copy film,” I. Alexander said. Built-in prostheses templates can manipulate and continuously adjust images.
“The main reason for adopting digital imaging is generally not financial, although return on investment (ROI) is an important consideration when making this decision,” Culley said. “The use of a PACS replaces a variable cost for such things as film, jackets and labels, with a fixed cost like a lease or license, plus a service contract, allowing the practice to better control these expenses.” The payback for most PACSs ranges from five to seven years but can be reduced if it is integrated with an EMR.
What to watch for
“You should be hesitant if a vendor tries to convince you to un-bundle a PACS into its various parts to create one on the fly, or to buy a system that is based on a someone else’s software, like those designed for a radiologist,” Culley said.
“Find a PACS designed by and for orthopedic surgeons,” said H. Alexander. You must have interoperability between a PACS, EMR and practice management system to share demographics and eliminate dual data entry. “The systems don’t necessarily have to be from the same vendor, but they do have to have a fairly seamless interface,” said I. Alexander.
Look for vendors with longevity in the industry and financial viability that will be available for long-term support. “A couple of years ago there were just a hand full of orthopedic specific vendors, but now the major players, like GE and Kodak, along with some orthopedic companies, have discovered the potential income from the sales of digital imaging systems to orthopedic offices and are aggressively going after the market,” said I. Alexander. “The distinction between an orthopedic specific and hospital systems vendor is becoming more blurred all the time. Competition in this market is fierce; if you are ready to purchase, then you can drive a hard bargain.”
When evaluating a PACS, look for security features such as firewalls and user IDs to ensure that all access complies with HIPAA regulations. Also consider a PACS with cutting-edge capabilities that will not become outdated so quickly. H. Alexander advises that before purchasing a PACS, decide whether you want to scan and digitize old film or physically store it.
As with any other large purchase, shop around, talk to other orthopedists, interview vendors, view demos and exhibits at conferences, and keep current with the latest information.
“Look at the economics in your practice,” said I. Alexander. “Determine how much standard radiographic techniques are costing you per month and then compare this number with the cost of acquiring the equipment. Once you have narrowed down your search to your top choice, perform a site visit to see the system in use. I would also try to get an idea of the level of support the existing customers are getting.”
Regardless of which system or vender you choose, “filmless radiology is here to stay,” H. Alexander said. “Its utility is proven and it is becoming an integral part of the paperless electronic practice environment.”
For more information:
- A Primer on Filmless Radiology can be found at www.aaos.org/wordhtml/bulletin/feb04/computer.htm.