What Google Maps and Radiology Have in Common

The positive impact of radiology’s move from thin-client to zero-client applications

Millions of people use Google Maps each day to find their way to restaurants, hotels, sports venues, friends’ houses, and the like. This mainstream application is well on its way to becoming pervasive. Google offers an easy way to find a location, view surrounding areas, pan to a specific point and zoom to detailed information. With a single click, you can even bring up satellite images – to see a neighborhood, view a car in someone’s driveway, or catch a bird’s-eye view of a neighbor’s pool.

Just as the Google Maps application allows people to view and manipulate images, radiologists also use technology to interact with digital medical images. In radiology, however, PACS solutions provide advanced tools to optimize clinical interpretation and streamline the numerous processes involved with reading radiology images. Advanced solutions such as CAD extend the power of technology to improve diagnosis and treatment.

Imagine what it would it be like if radiologists had an application like Google Maps. They could call up an image from any computing device and perform the window-leveling tasks required to read an image and produce a report. Furthermore, they could do this without the hassle of downloading visualization software or security patches.

Google Maps uses a technology called “zero-client imaging” to achieve its ease of use. New zero-client applications for medical imaging bring this scenario one step closer to reality, though not yet advanced to the level of PACS. Radiologists move through dozens of studies and thousands of images in a single workday. PACS solutions have evolved to systematize and streamline radiologist workflow. The benefits of increased efficiency and productivity have become critically important in recent years, as imaging organizations have faced major reimbursement declines. But a true zero-client PACS is not yet available.

So, if zero-client PACS systems do not exist today, what is real, and why is there so much talk about “thin-client” and “no-client” solutions in imaging? To answer this question, it’s important to consider the evolution of technology.

A Rapidly Changing Technology Landscape

We know that technology has been used to effectively move radiology from film to filmless – to digitize radiology practice and to speed the processing of medical images and reports. Yet radiology continues to struggle with efficiency optimization. This is especially true when considering how imaging data is shared across multiple locations in an enterprise, among referring clinicians, and even with patients themselves.

Certainly, we’ve moved past the days of patients hand-carrying large film files from one doctor’s office to another. Yet medical practitioners continue to burn CDs and still have the patients carry these around. Images are stored in jukeboxes, and clinicians experience frustration when images and reports are not readily available.

Healthcare has typically lagged behind other industries in leveraging the newest information technologies. While terms like “Web-based” and “thin-client” have been commonplace in other sectors, these terms are relatively new in the radiology field. Technical professionals in healthcare organizations are likely to understand the nitty-gritty of these geeky terms, but individuals in clinical, business, or operational roles may be at a loss in keeping up with today’s rapidly changing IT landscape

Is “Thin” Really In?

Newer technologies enable applications to run in the browser. Consider, for example, your visit to any given Web site on any given day. You may get a message asking you to download an ActiveX control or to enable a program such as Flash, so the site can show you its moving images. 

In these scenarios, a thin-client approach is typically being used. Ultimately, something is getting installed at an individual workstation. For security reasons, the user is asked to give permission for this to happen. Challenges can arise, however, if a Safari browser is used rather than Internet Explorer, for example, or if the user is running an older version. In some instances, applications can be downloaded and readily run on a PC, but not on a Mac. Other times, IT policies designed to prevent viruses and attacks will prevent a user from installing the thin client.

I’ve heard the term “chubby” used in these scenarios. This often describes a situation in which a Web browser is used to deploy a full application. From a technology standpoint, it’s easy to make something work in a single browser configuration or install via the Web, but to cover many scenarios (all browser types and versions, firewall configurations, and the like) the concept of “thin” becomes skewed. Work must be done to make the application work in the browser, and this nearly always involves an investment of time and money.

The Evolution to “Zero”

Last year, the Merge Healthcare engineering team was challenged to answer the question: “If Google can load images in the browser and offer an interactive experience without requiring the user to worry about ActiveX controls or browser type, why couldn’t we do the same thing for people who need to access radiology images?” From here, we moved ahead to create and launch our zero-client imaging platform.

I firmly believe that zero-client imaging is the wave of the future. And, while the reality of high-volume, zero-client PACS is years away for radiologists, the platform can be used effectively today in many instances. Consider referring physicians who may need an interactive imaging experience in their office settings. They may not tolerate the hassles of downloading ActiveX controls, JAVA applets, or security patches, or their IT staff may not allow it.

By overcoming some of today’s most significant challenges with radiology connectivity and interoperability, the zero-client approach will improve processes across healthcare enterprises – for radiologists, rad techs, referring physicians, business executives, IT professionals, receptionists, and beyond. Patients, as well, will have ready access to radiology images and reports in personal health records. The newest technology will enable organizations to make images more readily available and to do so in a cost-effective way – at hospitals, in medical offices, in homes, even via mobile devices, such as the iPhone.

A Bridge Between Radiology and the EHR

In Washington, stimulus monies are earmarked for healthcare providers who can demonstrate meaningful use of electronic medical records (EMRs). In theory, the EMR provides a centralized snapshot of a patient’s medical information in a computerized format. EMRs include information that is necessary for healthcare decision-making. Lab reports, for example, are readily available in most EMR solutions. Radiology data is another story. Today, because of the complexity, size, and scope of radiology imaging data, most EMRs do not connect well with PACS systems.

The zero-client platform, however, will deliver on the promise of an image-enabled electronic medical record. Zero-client imaging overcomes obstacles that have prevented smooth and efficient connectivity between PACS and EMRs. These obstacles include the issues previously addressed in this article, such as browser compatibility, security restrictions, and the like.

The zero-client approach holds great promise for enhancing patient care and improving workflow efficiency, especially across disparate healthcare providers. This approach can also help overcome challenges associated with ownership of medical information.

In healthcare today, radiologists are the primary providers of imaging care. They own and are responsible for the radiology-specific portion of a medical record (the image and the report). In some instances, organizations transfer DICOM data into their EMR. This can be cumbersome and costly. Both the sender and receiver must store terabytes of data. And, if a copy of an image is moved into the EMR, who ultimately owns this record?

In a zero-client imaging model, radiologists continue to own and maintain responsibility for the radiology-specific portion of the medical record. Technology is used to serve up radiology-specific data to clinicians where and when they need it – without transferring the assets to them. (You could draw a parallel to checking the weather on your local newspaper’s Web site. The weather data you’re seeing is not housed on the newspaper’s server. Instead, it is served up to the newspaper’s site via the owner of the information, in many instances Weather.com.)

Healthcare organizations will soon leverage zero-client technology to integrate radiology data into the EMR much more seamlessly than ever before – and to do so without the technical challenges and costs of the past. Getting the image and associated record into the EMR is critical. Enabling users to interact with an image within the framework of the EMR is also important. Now, thanks to the power of genuine zero-client imaging, we are welcoming a new era. A cost-effective approach now exists for image-enabling the EMR.

– Tim Kulbago is senior vice president of product technology at Milwaukee-based Merge Healthcare’s Fusion Division. Direct all questions and comments to editorial@rt-image.com.