Physicians in New Jersey and neighbouring states do not need to send their patients to the hospital for testing. Bergen Medical Imaging (BMI) recently has optimised its services towards doctors and patients through the design of an innovative teleradiology system. This imaging centre receives the patient in a comfortable, relaxed and private setting for efficient, smooth and swift digital image acquisition. The results are directly made available to the physician for remote viewing from his office, home or notebook computer via an Internet connection. Transmission of the data to a separate folder, which is strictly assigned to the responsible doctor, safely protects the patient's privacy.
BMI has built a sound reputation in diagnostic equipment for cardiac, thyroid and bone disorders, ranging from ultrasound over full nuclear medicine applications to bone density machines. Even hospitals are referring their patients to the imaging centre because of its sophisticated procedures and timely results. Nonetheless, the BMI team experienced a growing need to increase the value of the delivered services to meet the challenges of ever more strong competition. Therefore, they decided to focus on teleradiology, which would enable physicians to immediately view their patients' radiographic images from a remote location.
Implementing this telemedical approach at the facility seemed a difficult and costly task to perform. To set up a PACS or Photographic Archival Computer System, the way it is done in many hospitals, meant too high a price to be paid. In fact, there are two ways to obtain a digital equivalent of X-ray film: whether you design a fully digital machine, or you digitise the conventional films or images by translating them to computer images. The first method outperforms the latter. Since PACS-like teleradiology implies enormous storage devices and high-speed communications, it was not at all suitable for the imaging centre, so the BMI team started software development on its own.
The specific purpose was to design a user friendly interface on a Windows 95 platform, allowing to transfer images to physicians at whatever location they might be. Since the system had to be easy to operate and to maintain, the choice fell on the Internet as the ideal delivery medium. Finally, the system comprises only two components, namely the hospital server, based on a standard Windows NT platform, and a client programme, which is installed at the remote location. The client software downloads the required images from the physician's protected private folder, situated on the Internet, to the requesting PC at his home or office. The only load on the network is the image transmission to the protected folder on the Internet site.
As far as security is concerned, the physician can only retrieve the images, which are stored in a proprietary format, when using the special BMI software. For that purpose, he has to introduce a username and password algorithm. In addition, the demographic patient information has been encrypted. In this way, "hacking" costs rise sufficiently high to keep unwelcome visitors out. In order to transform the output from the various devices at the imaging centre into digital images, the team has designed a set of so-called "conversion wizards" or applets, which connect between the image server and the different cameras.
Incoming images are intercepted by yet another "conversion wizard" in order to analyse, compress and adapt them for storage. Meanwhile, Tiran Dagan, head of software development at BMI, states that a kind of virtual physician network has been organised, in which images and reports are transferred from BMI to the interpreting physician, to an over-reading colleague, and back to the referring doctor. Reports from each practitioner are transmitted back to the imaging centre for reasons of progressive quality control management. This brings us back to the initial company's creed of continuous service improvement towards the customer.