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CoActiv’s EXAM-PACS is a full-featured, full-function, enterprise-class system for large imaging centers and hospital facilities that allows radiologists to read from multiple sites. 

The company has introduced two versions of EXAM-PACS capabilities on Apple’s iPhone™. rt image talked to CoActiv’s president and CEO Edward Heere about these developments.

Q rt image: When was EXAM-PACS for iPhone introduced?

A Edward Heere: We introduced version 1 right before [the Radiological Society of North America’s (RSNA) annual meeting in November 2009], and it was based on using the WiFi connectivity of the iPhone within the facility. It was limited, but it was very functional within the facility. If a radiologist was in a meeting, and he had a fellow radiologist read an exam and wanted toget a second opinion from the doctor, they could send him the exam on his iPhone. He could bring it up on the iPhone, take a look, and send back a message saying, “I agree or I disagree with your findings.”

But it had some limitations, and while we were at RSNA, our developers had actually finished version 2, which now allows us to send fully HIPAA-compliant exams and reports across the 3G and EDGE networks, basically anywhere in the world. It uses Virtual Private Network [VPN] technology.

Because of the limitations of the iPhone operating system, the only way you can do HIPAA-compliant messaging and image management is by using the VPN client that’s built in as part of the iPhone operating system.

That’s the limiting factor to what we can do. Of course, as Apple increases the operating system and makes advances in the operating system of their iPhone, we’ll have more functionality.

Q image: Can you describe the functions of EXAM-PACS for the iPhone?

A Heere: It allows a doctor, from anywhere in the world, to log onto his server in his facility and look at a current exam list and query that list by patient name, by the accession number of the exam, by birth date of the patient, by modality, or by the acquisition date, or any combination of those, to specifically find an exam he’s looking for.

He’ll get a list of all the exams that are there; he can pick the one that he wants and download it to his phone. Then, he can log into the exam and look at an image from each one of the series, select that image, and have the whole series appear instantly on the screen. The exams completely download to the phone. He can scroll through the images with one finger, and do bothlinear measurements and areas-of-interest measurements.

He can then hit one button, and it saves a copy of the image that he just generated with a measurement on. It saves it to the photo directory in his iPhone. It asks if he wants to take off the patient’s name, because he’s going to be sending that to other people via unencrypted e-mail. The screen wrap of the image with the measurement appears in his photo section, and then hejust clicks the button beneath that, and it takes him right to his e-mail. He selects from his contact list who he wants to send it to, and it immediately appears there. He can type in a little message if he wants, hit the send button, and it’s then sent to thosepeople on their phone. When they get it on their phone, they have the ability to magnify it and pan back and forth.

It’s a full-function PACS viewer, and it runs at the native resolution for the iPhone, which is 1024 by 1024 pixels. If you’re looking at an MRI, a CT, or an ultrasound, you’re looking at it in the resolution at which it was captured.

We don’t recommend its use for diagnostic purposes, because of the screen size. However, for a wet read, a quick read, a confirmation, a second opinion, for the radiologist, it’s fantastic. Its real use, from the feedback we got at RSNA and since then,was for referring doctors.

Q image: What can you say about CoActiv’s approach to this technology?

A Heere: What other PACS companies have done is say they have an iPhone work-in-progress and tried to write a new app for the iPhone.

We thought that was really done, because there’s a phenomenal app already written for the iPhone by OsiriX. It’s an opensource product, which is user-supported, and it’s been around for the Mac for years. It’s phenomenal viewing and PACS application software.

We said, “Let’s use their viewer, and instead of writing our viewer, which is very time-consuming – and then you’ve got to do all the approvals – why don’t we just do a deep-level integration with the OsiriX app on the iPhone?”

So we took the best of two worlds. We took the phenomenal technological capability of the iPhone – and probably one of the best viewers that has been or will be written for any Mac product – and we coupled them together and did a low-level integration with them so that’s available from our PACS.

[As a result,] it let us get to the market first. As more and more functionality is added to the iPhone app, either by our developers or by other developers in the open source network, that functionality will just increase the usability of the viewer portion of our EXAM-PACS for iPhone.

Q image: What are the advantages of iPhone connectivity for referring doctors?

A Heere: In the imaging center market, which are independent imaging centers, the referring doctor is king. Imaging centers depend on their referring doctors. If their referring doctors don’t send patients to them for exams, they starve, because they don’t have a captive market like a hospital market. 

So imaging centers – especially as their compensation is being cut back by the government, insurance companies, and Medicare in terms of how much they get paid to do a procedure now that’s been cut back almost 30 percent – are striving to get all the patients they can from their referring physician network. The way they do that is by giving their referring physiciansproducts to view the end results of those exams easier, faster, with fewer problems, and more conveniently. These referring doctors are generalists. They may be seeing 150 patients a day to survive. They don’t have time to go log on,search, and get the results, especially on a critical exam that they’re waiting for. With most PACS systems, it takes a while toget that information.

However, with our system, we have the ability to automatically send results from the exam, including the report, right to the referring doctor, automatically, as soon as it’s completed at the imaging center. The doctor doesn’t have to do anything.

We wanted to bring that capability one step further by letting them get those results if they’re out for lunch, or if they’re home at night and waiting for this result because they have to make a decision [about putting] the patient in the hospital, or a surgeon has to make a decision as to what he wants to do.

Now, their phone will beep. They’ll click on it, and there’s an exam sitting there along with the results.

Q image: What can you tell us about the pricing structure?

A Heere: For any user of the CoActiv EXAM-PACS system that’s already a customer, using the iPhone app is free. The only cost to them is they have to download the OsiriX viewer from the phone store, which is $19.95.

As part of EXAM-PACS in a hospital or imaging center, any upgrades or additional functionality we bring to the PACS during their contract period, which in most cases is five years, is theirsfor free.

Q image: Do you have any plans for the next upgrade to EXAM-PACS for iPhone?

A Heere: Right now, we are utilizing 100 percent of the connectivity and capabilities of the iPhone as a product. As Apple introduces more connectivity and functionality, very shortly after that – maybe within a day or two – we will announce a new version of the EXAM-PACS for iPhone. That’s how fast we can respond.

Q image: Is there anything else you want to add?

A Heere: We just think it’s exciting. We think is going to be a significantly important utilization and method of distributing medical imaging in a marketplace where speed and availability of results can mean life and death. And we think it should be taken that seriously.

Source: CoActiv Medical

See more about iPhone Medical Apps, iPad PACS Viewer