Lab Soft News

Minimum Prices on Alcoholic Beverages in U.K. May Serve to Curb Binge Drinking

One of the identified causes of binge drinking in the U.K. is the ready availability of cheap alcoholic beverages in supermarkets (see: Binge Drinking in Wales; Trends in Alcohol Consumption Across OECD Countries). Some efforts are now underway to try to correct this problem (see: Tesco Supports U.K. Alcohol Rules; subscription required). Below is an excerpt from the story:

Britain's biggest supermarket said it supports the U.K. government's plan to ban the sale of alcohol at prices below cost, in response to proposals designed to curb binge drinking and rowdy behavior. Tesco,...the country's biggest retailer by market share, also said it would support any government move to set minimum prices on beer, wine, alcoholic cider and spirits—a measure that has been much-debated in the U.K., but not explicitly proposed by the country's new coalition government. The U.K. has been struggling with a rise in alcohol consumption that many people contend is fueling public disorder and violence. Health experts say cheap supermarket alcohol, irresponsible barroom promotions and longer pub opening hours have contributed to the problem. Binge-drinking became an issue during the election campaign, with all the parties vowing to crack down. The government this week said it would take a range of steps to curb alcohol abuse, including banning below-cost sales; giving police stronger powers to yank licenses from pubs that over-serve customers; and allowing local councils to permanently close any shop or bar "persistently selling alcohol to children."

A friend suggested to me that the litigious and tort law environment in the U.S., when compared to that in the U.K., may serve as a brake on binge drinking in bars in this country. The reason is that bar owners here can more easily be sued for allowing patrons to overindulge and then cause harm by drunk-driving or other acts. I am not sure whether this theory stands up to close scrutiny.

I'm personally very enthusiastic about having our states pile on higher alcoholic beverage and cigarette taxes as a means to raise revenue and also decrease consumption. Of course, this will be only short-term solution. Similarly, I am pleased that the Brits now understand that there are both heath and social consequences from selling alcoholic beverages below cost in supermarkets. It would also help if the British legal system treated public inebriation in a more serious fashion (see: Britain's gone soft on drunks: Shame of being found paralytic in street disappears as convictions fall by 75%). It is said that there is much less public stigma for drunkenness there and the excerpt below from this article suggests that this is true:

Drunken behaviour is raging unchecked because offenders are escaping with a 'slap on the wrist'. A dramatic collapse in prosecutions has been blamed  for removing the shame of being found paralytic in the street. Doctors' leaders expressed alarm at figures showing the number of those convicted of or receiving a police caution for drunkenness has slumped by more than three quarters in the last 30 years. In the past, those found drunk would have been prosecuted, leading to the shame and publicity of a court appearance, or given a police caution. Both of these alternatives would have led to a criminal record. But in many cases nowadays they are either being let off completely or given fixed-penalty notices owing to intense pressure on frontline officers to hand out fines as a 'quick-fix solution'....Just 17,421 people were convicted of drunkenness in 2007, compared with 97,165 in 1981, the last year for directly comparable figures.

Pathology Visions Conference Presented in San Diego on October 24-27 by the DPA

Take a look at the Pathology Visions Conference web site. This excellent conference, now sponsored and managed by the Digital Pathology Association, will take place October 24-27, 2010, at the Sheraton San Diego Hotel & Marina. Five difference components of the digital pathology field will be emphasized: Clinical, Drug Development, Research, Education, and IT. Here's a list of current exhibitors. You can register on-line. Applications for oral presentations and poster are being solicited.

Persistence of the MUMPS Programming Language in Healthcare Applications

One of the interesting and unique aspects of the EMR world is that some of the major vendors use a programming language, MUMPS, that is virtually unknown in other IT business sectors because it was developed so long ago. There is no other industry that worships "new and novel" more than IT. Hence, the question arises about why this language persists among some of the leading EMR software vendors. Mr. HIStalk recently posted a reader comment about MUMPS and responded in the following way:

From Limber Lob: “Re: MUMPS and Cache’. MUMPS takes hits because it’s still around after 30 years and many of the ancient MUMPSters are coding the way they did 30 years ago. Old COBOL, RPG, and Pascal programmers have all passed on instead.” 

Reply from Mr. HIStalk: I like that analysis and will extend it: companies like Epic and Meditech hire trainloads of noobs and train them on a language they’ve surely never heard of even if they majored in computer science. Since it’s more of an apprenticeship, they can also train them to follow their own internal programming standards and utilities, which are arguably more important than the choice of programming language anyway. It may be true that only in healthcare would a robust market still exist for applications written in something that quirky and old (or “industry-specific” and “time-tested” if you’re a glass-half-full type). Bottom line: it works, the vendors can support it, and customers shouldn’t (and apparently don’t) care about the invisible underpinnings.

I have posted a number of previous notes about both Epic and Meditech including comments about the similarity between the two companies (see: Some Additional Insights into the Epic Corporate Culture), Both have been run with a heavy hand by their founders, neither places any value on marketing, and neither permits any tinkering with the software by their hospital client sites. This enables a high installation success rate as well as relatively easy software updates. Innovation and change is hence controlled by the vendor and not by the clients. As noted above, this results in the happy circumstance that the vendors can support the software and the customers can't. This is enforced by both legal contracts and the continuing use of MUMPS for the product.

So the answer to the MUMPS/healthcare conundrum has been hiding in plain site from me all of these years. MUMPS continues to be a mainstay of healthcare computing for Epic and Meditech not in spite of the face that it's old and antiquated but because it's old and antiquated. As Mr. HIStalk opines above, the hospital CEOs don't have any particular inclination to look under the EMR hoods and continue to be happy with the products. Judith Faulkner, the CEO of Epic, is certainly happy with the success of her company. The only losers are the Epic programmers who may need to go on welfare if they loose their jobs.

A Practical Strategy for Introducing New Molecular and Genetic Tests

The Dark Daily has just published an article addressing the complexities of introducing a new genetic or molecular diagnostic test (see: New Genetic Laboratory Tests Face Complicated Hurdles to Win Reimbursement). It quotes Rina Wolf extensively, who is Vice President of Commercialization Strategies for Consulting and Industry Affairs, XIFIN, San Diego, California. It was so good that I repeat a portion of it below:

As physicians learn about the new laboratory test and want to order it, payers do not have policies in place to reimburse for this new genetic test—even when it delivers substantial clinical benefit to the patient. It is the chicken-and-egg conundrum: what comes first? Is it physician demand for the test (which convinces payers that it is clinically useful) or is it payer coverage and reimbursement policies (which assure physicians that, when they order the test, the patient’s insurance will reimburse for it)?

“The lessons of the marketplace over the past decade are compelling,” noted Wolf. “Every successful launch of a new molecular test has come because of a dual market introduction strategy. One side of the strategy is to provide physicians and patients with the knowledge and education they need to understand how to order the test and respond appropriately to the lab test results. The other side of the strategy is proper preparation to address all the issues raised by health insurers.”

Understanding the business pathway is critical in this process, as is persistence in the appeals process. Wolf described an interesting approach which she called “creating a reimbursement sandwich.” “The top slice of the reimbursement sandwich is the steady growth in demand by physicians who order the test appropriately—and pressure payers,” explained Wolf. “The bottom slice of the reimbursement sandwich is the persistence of your laboratory company in the appeals process. This provides an alternative pressure which is often an effective way of convincing payers to cover the new molecular test.”

I can't add anything of value beyond this quotation so I present is as originally published. The metaphor of the "reimbursement sandwich" is both useful and colorful. I will certainly refer to it in the future.

The Need for the Coordinated Efforts of Technololgy Evangelists in Digital Pathology

Here's a question for all of the readers of Lab Soft News. Do you think that pathologists in particular, and physicians in general, are more or less accepting of new technology than other professionals of the same educational level and income? I don't know the answer to this question but I do believe that the adoption of digital pathology has been much slower than I would have predicted a year or two ago. There are are number of compelling reasons for this, some of which I have documented in this blog. However, I come away with the following idea: most pathologists are very receptive to new science but not necessarily to new technology based on this science, particularly when the technology disrupts established lab workflow or invokes changes in the status quo (see: Major Drivers for the Conversion to Digital Pathology in Teaching Programs). Digital pathology definitely falls into this latter category.

Interestingly enough, many high-tech firms in Silicon Valley face similar issues relating to the adoption of new technology. Executives and engineers working in these firms, when faced with the question of  adoption or rejection of an emerging technology, will often reject it in favor of the tried and true. Sometimes they will even try to "smother" new technologies in their companies if and when they threaten the budgets that they control. To combat this problem, a new type of professional is arising in these companies called the technology evangelist. Here is a definition of the term:

A technical or technology evangelist is a person who attempts to build a critical mass of support for a given technology in order to establish it as a technical standard in a market that is subject to network effects. Professional technology evangelists are often employed by firms which seek to establish their proprietary technologies as de facto standards or to participate in setting non-proprietary open standards. Non-professional technology evangelists may act out of altruism  or self-interest (e.g., to gain the benefits of early adoption or the network effect). Technical evangelists may act, officially or unofficially, on behalf of a company or organization, or on a personal basis, for instance open source evangelism. An evangelist promotes the use of a particular product or technology through talks, articles, blogging, user demonstrations, recorded demonstrations, or the creation of sample projects....Technology evangelism is sometimes associated with an internal employee assigned to encourage new ways of doing things within a large organization.

Taking the more rapid adoption of digital pathology as a desirable goal, I would suggest that there is a need for the coordinated efforts of both professional, technical, and informal evangelists to carry this message to the thus far uncommitted pathologists. We already have an organization, the Digital Pathology Association (DPA), that can direct and coordinate this effort (see: Software as the Core Competency of Digital Pathology Companies). We also have pathology blogs specializing in digital pathology such as the Digital Pathology Blog and The Daily Scan, the latter developed by Aperio. There is also a cadre of pathologists working in the field who  have already successfully deployed the technology. This is a very good start.

What I think that we need now, and this is what I had in mind when I cited the need for coordinated efforts, is an "evangelistic" agenda from DPA. This is different than the marketing plan for each of the companies that support the DPA. What I have in mind is the identification of pathologists in various communities who are enthusiastic about digital pathology and are active users of this technology. Their help would then be enlisted to promote the adoption of the technology in a general way rather than the promotion of individual companies.

The Medical Conference as a Collective Enterprise Resulting in Innovation

For most of my career, I have been involved in the planning and management of pathology conferences. Such events obviously have value and staying power as evidenced by their continuing popularity. If you were to have previously asked me about the basis for this popularity, I would probably have replied with two words: learning and networking. I tend to use this latter term to describe the social and educational interactions that occur among conference attendees. However, a recent article on the "triumph of humans" provided me with some additional insights into the value and purpose of medical conferences (see: Humans: Why They Triumphed; subscription required). Below is an excerpt from it:

But the sophistication of the modern world lies not in individual intelligence or imagination. It is a collective enterprise. Nobody—literally nobody—knows how to make the pencil on my desk ....The knowledge of how to design, mine, fell, extract, synthesize, combine, manufacture and market these things is fragmented among thousands, sometimes millions of heads. Once human progress started, it was no longer limited by the size of human brains. Intelligence became collective and cumulative. In the modern world, innovation is a collective enterprise that relies on exchange....We tend to forget that trade and urbanization are the grand stimuli to invention, far more important than governments, money or individual genius. It is no coincidence that trade-obsessed cities—Tyre, Athens, Alexandria, Baghdad, Pisa, Amsterdam, London, Hong Kong, New York, Tokyo, San Francisco—are the places where invention and discovery happened. Think of them as well-endowed collective brains.

Stimulated by the ideas in this article, it occurred to me that a medical conference can be viewed as a "transient village" located in a hotel or conference center and populated by people of like interests. Attendees can be viewed as traders, if you will, in specialized knowledge. Some of the ideas circulating in these transient villages are contributed by the manufacturers of new products such as drugs, medical devices, or lab software and computers in the case of the conferences that I work on. Also participating in the dialogue are the purchasers of new products, hospital-based pathologists and lab scientists in my case. Faculty members deliver lectures to the group. They describe their new ideas and approaches to a common set of problems. The lecture hall can be viewed as the village square where people congregate to learn.

In my view, one of the inefficiencies of a medical conference is that so much time is devoted to formal lectures rather than discussing new ideas, which would seem to be more efficient. Ideally, one could ask the participating faculty members to present their most important ideas in, say, ten minutes. The remainder of the time could be then spent assessing their value and relevance. However, I think that the standard 45-minute faculty lecture will persist for the near future. The value of this longer lecture assigned to the faculty members is to provide background information about their ideas and then try to convince the group that they are worthy of adoption -- in essence, to "sell" the new ideas.

Our Growing "Addiction" to Digital Network; Is This the Right Term?

The word addiction is always used in the pejorative sense -- no one brags about their addiction to anything at cocktail parties. Nick Carr, who blogs over at RoughType, takes on the contrarians and social critics who bemoan the addiction of many/most of us to the web. social networks, blogs, on-line news, or on-line games (see: Not addiction; dependency). Here is an excerpt from his note:

The problem with the addiction metaphor [to describe use of digital networks and social media]...is that it presents the normal as abnormal and hence makes it easy for us to distance ourselves from our own behavior and its consequences. By dismissing talk of "Internet addiction" as rhetorical overkill, which it is, we also avoid undertaking an honest examination of how deeply our media devices have been woven into our lives and how they are shaping those lives in far-reaching ways, for better and for worse. In the course of just a decade, we have become profoundly dependent on a new and increasingly pervasive technology. There's nothing unusual about this. We routinely become dependent on popular, useful technologies. If people were required to live without their cars or their indoor plumbing for a day, many of them would probably resort to the language of addiction to describe their predicament.....What's important is to be able to see what's happening as we adapt to a new technology - and the problem with the addiction metaphor is that it makes it too easy to avert our eyes.The addiction metaphor also distorts the nature of technological change by suggesting that our use of a technology stems from a purely personal choice - like the choice to smoke or to drink...But while it's true that, in the end, we're all responsible for how we spend our time, it's an oversimplification to argue that we're free "to choose" whether and how we use computers and cell phones, as if social norms, job expectations, familial responsibilities, and other external pressures had nothing to do with it. The deeper a technology is woven into the patterns of everyday life, the less choice we have about whether and how we use that technology.When it comes to the digital networks that now surround us, the fact is that most us can't just GTFO, even if we wanted to. The sooner we move beyond the addiction metaphor, the sooner we'll be able to see, with some clarity and honesty, the extent and implications of our dependency on our networked computing and media devices.

He's right, of course. Calling our increasingly ubiquitous use of digital networks an addiction causes us to "avert our eyes" and stops conversation, This inhibits us from achieving a deeper understanding of how these trends are affecting our lives. Young adults today use Facebook and instant messaging to keep abreast of a much wider circle of friends than was possible in the past and make plans with them. This is not something that I or friends in my age bracket are in the habit of doing. We use other technologies to achieve the same purpose, mainly cell phone calls and email. Both they and my age cohort would be loathe to return to former ways. Carr is right when he says that we "can't just GTFO even if we wanted to." 

If you think that almost uninterrupted access and use of digital networks is common now, you haven't seen anything yet. I have posted a number of previous notes about the use of smartphones and particularly their use in a healthcare context. Such portable devices increasingly make access to the web just as easy and efficient as with a PC. A recent article tracks the astonishing growth curve of smartphones (see: AdMob: Smartphone Usage Up, iPhone and Android on the Rise):

AdMob’s Mobile Metrics report for February [2010] focuses primarily on smartphones, a category of mobile phones that has seen tremendous growth in the last year. In February 2010, smartphones accounted for 48% of AdMob’s worldwide traffic, up from 35% in February 2009. The really big news, however, is the stellar rise of iPhone OS and Android. In the past year, [operating system] Symbian’s share of requests fell from 43% to 18%, while iPhone’s share of request rose from 33% to 50%. Android, [Google's cell operating system], fared even better, rising from 2% of smartphone requests in the AdMob network in February 2009, to 24% in February 2010.

UC Berkeley Offers DNA Testing to Incoming Freshmen; Does This Make Sense?

For some reason, the news about genomic testing keeps getting stranger and stranger. I have the impression that this does not bode well for the future of such testing. In a recent note, I discussed how the retail drug store chain Walgreens was going to sell specimen collection kits that enable genomic tests from Pathway Genomics (see: Walgreens to Offer Genomic Test Collection Kits from Pathway to Customers). Within 24 hours and as noted in my two updates to the note, Walgreens had reversed its decision to offer over-the-counter genomic testing. Now comes the news the UC Berkeley will offer, on a voluntary basis, DNA testing to incoming freshmen (see: College Bound, DNA Swab in Hand). Here is an excerpt from the article:

Instead of the usual required summer-reading book, this year’s incoming freshmen at the University of California, Berkeley, will get something quite different: a cotton swab on which they can, if they choose, send in a DNA sample. The university said it would analyze the samples, from inside students’ cheeks, for three genes that help regulate the ability to metabolize alcohol, lactose and folates.Those genes were chosen not because they indicate serious health risks but because students with certain genetic markers may be able to lead healthier lives by drinking less, avoiding dairy products or eating more leafy green vegetables. Berkeley’s program for the class of 2014 is the first mass genetic testing by a university. Jasper Rine, the professor of genetics who is leading the project, said it was designed to help students learn about personalized medicine and identify their own vulnerabilities....The testing will be voluntary and confidential, with no one at Berkeley knowing which sample comes from which student....But some bioethicists say the whole idea of genetic testing outside a medical setting is troubling.“It’s a bad precedent to set up mass testing without some sort of counseling support,” said [a bioethicist]. “I’d rather people get their results in a medical setting, where they can ask questions about the error rate or the chances of passing it on to their children, and not just see it posted on some Web site.” [A university spokesperson] said that he understood the concern about counseling but that he believed it applied mostly to testing for genetic diseases, not necessarily the relatively innocuous gene variants that Berkeley is looking for....Berkeley has not yet chosen a company to analyze the DNA samples....Estimates are $35,000 to $40,000 per 1,000 samples.

So here's what I take away from this story. UC Berkeley is planning to offer testing for genetic defects relating to the metabolism of alcohol, lactose, and folate to incoming freshmen. These genetic variants are described by a university spokesperson as relatively innocuous and unrelated to the identification of serious diseases. Estimated costs for the program will run about $35,000 to $40,000 per 1,000 samples.The goal of the program is to foster better eating habits among the students including the consumption of more leafy vegetables. A medical ethicist commented, in relation to the program, about the emotional trauma that could be incurred upon learning of one's inability to digest spinach outside of a calm, nurturing counseling environment.

I personally can only imagine the angst that would occur when an 18-year-old student learns on the web that he is lactose intolerant and must avoid milk whenever possible. In response, I might turn to healthier beverages like beer. I am also wondering if the money allocated to this genomic testing program would be better spent on health eduction programs relating to sexually transmitted diseases such as chlamydia, the long-term effects of binge drinking, or the perils of fast food addition. This whole project sounds to me like it was cooked up in the mind of a UC Berkeley professor with an interest in genetics and who views the entire freshman class as potential lab rats.

::Update on 5/21/2010 at 10:15 ET

See: UC Berkeley plan to test freshmen DNA criticized

Telephone Calls and Emails as Key Components of Primary Care

This news will come as no surprise to readers of this blog. KevinMD reports that telephone calls and e-mails occupy a large component of the time of a primary care physician according to a recent paper in the NEJM (see: Calls and e-mails to patients is a big part of primary care). Below is an excerpt from his note:

There’s been a lot of commentary on a recent article from the New England Journal of Medicine, detailing the undocumented tasks that a typical primary care physician performs. For those who haven’t read the piece, entitled, What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice....To summarize, primary care doctors are responsible for much more than seeing patients in the exam room. In the cited practice, which has a fairly typical makeup, physicians were responsible for an average of over 23 telephone calls and 16 e-mails per day. Many practices don’t engage their patients over e-mail, so it’s conceivable that the number of telephone calls is lower than average here. It’s interesting that this practice, until recently, employed no nurses (they hired one to do “information triage”)....It’s also important to note that the doctors in the study were incentivized to communicate with patients outside the exam room, which is uncommon....[They] have redefined “full-time physician” as one who offers 24 scheduled visit-hours per week, and our internal compensation system now recognizes telephone calls and e-mails as part of our productivity metric. This piece quantifies the bureaucratic responsibilities that primary care doctors increasingly face. Many of these services are not valued by Medicare or most private insurers, who pay doctors based solely on face to face visits. Consider that primary care practices are often run like small businesses, and most are not financially viable without help from an associated hospital or large health system. So, for patients who wonder why it’s so difficult to communicate with their doctor, hopefully this study will starkly illustrate the uncompensated pressures they face.

Here are some of my off-the-cuff reactions to some of the ideas in this note:

• I am impressed with the job description of "information triage" for an office-based nurse who provides front-line triage for all incoming patient calls and emails. My guess is that such an employee could manage a large percentage of all queries and thus be an invaluable resource for satisfying requests and referring patents to relevant medical articles on the web.
• I am obviously enthusiastic about the concept of "incentivising" physicians to "communicate with patients outside of the exam room," which is to say via telephone and email. So.we need to substitute the concept of patient-contact-time, regardless of the type, with face-time for reimbursement purposes. As noted in the first point above, nurses should function as the initial triage agent for all incoming queries and turf to physicians the more complex or critical issues.
• I believe that patient communication with a nurse/physician team via email and telephone can and will be more effective for many patients. Sitting in an exam room, patients can interpret a multitude of non-verbal cues that the physician is rushed and wants to complete the visit as quickly as possible. Significant issues may not be addressed. Nurse and physician responses via email provide a slower-paced exchange during which a patient can ponder the responses and even engage in web searches to better understand issues such as adverse drug reactions or the signs and symptoms related to a particular disease.
• Although the blog note quoted above did not make reference to patient-physician/nurse interactions via video calls, I personally believe that this will become the norm for many patient "visits" in the future. Such calls enable a rapid assessment of the anxiety level and body language of a patient. They could be also recorded such that the patient, or physician, could review them  later if part of the discussion needs to be reinforced or recalled. I will resist the temptation to call such interactions telemedicine because the term carries so much unnecessary baggage. The sooner we can refer to this as simply an "office visit" the better off we will be.

A "RIS-less" Teleradiology Solution: A New Vocabulary Takes Hold in Radiology IT

I frequently scan press releases from healthcare IT vendors in order to understand the vocabulary that is used to describe new products. A recent one provided me with some useful insights (see: Imaging On Call Achieves Full Speech Recognition in RIS-less Environment with Integrated Document Solutions).

Integrated Document Solutions,..., a provider of web-based, modular health documentation solutions and Imaging On Call (IOC), an industry leading teleradiology provider, today announced the successful implementation of a groundbreaking RIS-less teleradiology solution using 100 percent speech recognition and template-based reporting....Using a thin-layer, cloud-based approach, IDS and IOC were able to deploy, in less than 30 days, a solution that automates report creation, advanced formatting and distribution that today supports more than 30 radiologists around the world serving more than 70 ERs, hospitals and medical facilities. IDS stated that similar server-less and RIS-less implementations are rare in the marketplace....Previously, IOC radiologists had to invoke separate applications, cut and paste text into the PACS and help route the report back to the right parties. The IDS solution features highly individualized and automated web-based accounts, frees radiologists from performing numerous manual steps and provides a single point for managing templates, among other proprietary features.

To set the stage, Imaging On Call is a teleradiology provider that turned to Integrated Document Solutions to provide a web-based radiology reporting and routing system for the 30 radiologists it employs around the world. Obviously in such a setting, a premium is placed on template-based reporting as well as speech recognition. The former feature is obviously an advantage for such a far-flung operation in order to maintain the quality control of image interpretation and reporting. I think that the very short time cited above to deploy the new system can be explained, in part, by the somewhat limited functionality of the new system compared to a standard RIS. However, I don't want to diminish the value of the achievement. Here are some of the phrases in the press release that stuck me as worthy of note:

• Wed-based modular health documentation solution: A teleradiology company does not require the patient management and scheduling applications that are necessary in a standard RIS deployed in the hospitals generating the images that are then interpreted by the teleradiologists. Hence, a company like IOC can turn to a company specializing in "documentation" to provide a global web-based reporting and routing system.
• RIS-less teleradiology solution: As noted above, the IOC teleradiologists make use primarily of the reporting and routing functions of an RIS so the company has the luxury of migrating these functions to the web and achieving a so-called RIS-free state. I do object, perhaps prematurely, to the potential and future use of the term LIS-less in press releases. It sounds too much like listless.
• Thin-layer, cloud based approach: I have posted a number of previous notes about cloud computing, which I think will be an irresistible architecture for digital imaging in both pathology and radiology. I take the use of "thin-layer" in the press release to mean that the IOC radiologists around the globe access their new web-based system using PC-based browsers.

For a teleradiology company, having web-based reporting and routing system is a necessary but insufficient condition for ensuring that its radiologists operate efficiently and effectively. Obviously, also having PACS functionality is a necessary component, as referenced in the article above. Luckily, a number of companies already provide a web portal for PACS functions including Aurora Interactive.