Five major teaching hospitals in Perth and several of the smaller general metropolitan public hospitals are serviced by a single centralised picture archiving and communication system (PACS). Each hospital can view patient images across the entire system, an ability seen as extremely advantageous to patient care across the Perth metropolitan area.
In May 2008, the Western Australian Department of Health (DoH) and the private radiology provider Perth Radiological Clinic (PRC) undertook a pilot project to see whether a public–private PACS link could be established to facilitate electronic transfer of images between the Armadale–Kelmscott Memorial Hospital (a public outer metropolitan hospital that outsources its radiological imaging to PRC) and the metropolitan tertiary hospital PACS.
The pilot project was funded by an initial grant of $100 000 from the DoH. To implement the project, the working group initially proposed to set up a dedicated server, the Western Australian Radiology (WARAD) server outside the DoH firewall (in the “demilitarised zone” [DMZ]) that could receive images from the private sector for retrieval by the public hospital PACS. Similarly, the public hospital PACS could send images to the WARAD server for retrieval by the private sector (Box, A). However, because of security issues, an alternative model was developed whereby the WARAD server could receive images from the private sector for the public system but images for the private sector would be sent directly to the private provider’s network via secure virtual private network (VPN) links (Box, B). The VPN provides an exclusive link to the WARAD server, which is more secure than transferring data via a public internet connection.
The agreed protocol requires that patients give consent, with the sending site obtaining and keeping a written consent form (or verbal consent in emergency cases). The patient consent procedure is a difficult area that is under constant review. The working group is currently discussing with the legal branch of the DoH the feasibility of developing an “implied consent” model that would allow patients an “opt out” option when they first present. This would reduce current heavy demand on the time of authorised personnel in both private and public systems.
The pilot project was completed in May 2008. A similar exchange of digital images was introduced in Pennsylvania, United States, in 2006,1 but, to our knowledge, the system described here is the first successful link between public and private PACSs in Australia.
An audit trail regarding use of the shared system and objective evidence of reduction in radiation exposure (by eliminating repeat examinations) is being collected and will hopefully be published within the next 2 years. However, there is anecdotal evidence of reduction in repeat examinations.2
Initially proposed Western Australian Radiology (WARAD) server system compared with current system*
Abstract
The delay in transfer of imaging studies when a patient moves between hospitals and between public and private systems has been a barrier to expedient and safe patient management.
There is also suboptimal reporting when patients have serial imaging undertaken partly in the private sector and partly in the public sector, because of inability to access previous imaging for comparison.
Availability of a DICOM (Digital Imaging and Communications in Medicine) server enables sharing of health information, including imaging data, across various sites and jurisdictions.
In Perth, Western Australia, we have successfully introduced electronic image transfer between five public teaching hospitals and three large private practices with different picture archiving and communication systems.