Digital technology lifts Thai hospital services

Thai hospital patients are these days getting higher quality diagnosis by specialist physicians from x-rays and CT scans, thanks to investment by large public hospitals in what is called a Picture Archiving and Communication System (PACS).

The large public teaching hospitals that have implemented PACS to improve their medical services include Siriraj, Ramathibodi and Chulalongkorn hospitals in Bangkok, Songklanagarind Hospital in Hat Yai and Srinagarind Hospital in Khon Kaen.

PACS enables the electronic storage of images generated by x-ray, ultrasound, computed tomography scan (CT scan) and magnetic resonance imaging (MRI), so they can be viewed on screens, helping doctors and specialist radiographers to join in diagnoses by accessing images from the hospital's database at different locations within the hospital.

The ability to simultaneously access patients' images on screens in various locations within a hospital allows instant consultation between medical specialists, delivering faster medical services and shorter, more effective treatments.

The hospitals are better able to use the limited time of their specialist radiologists whose job it is to interpret the x-ray, ultrasound, MRI and CT scan images because the system will display key images within two seconds, according to the general manager of medical equipment supplier J F Advance Med, Adisorn Thaprik.

J F Advance Med provides Fujifilm products, including PACS, digital radiography, computed radiography and dry laser imagers to hospitals.

Adisorn said there were 3,000 hospitals in Thailand, including public and private hospitals, and of these about 30 hospitals had the PACS system. The rest, especially small- and medium-sized hospitals in country areas, do not yet benefit from the system.

"The three main public hospitals - Siriraj, Ramathibodi and Chulalongkorn - make more than 1 million x-ray examinations per year. Siriraj Hospital has an average of 1,500 x-ray cases per day and currently it has more than 15 million x-ray cases stored in its PACS system," Adisorn said. 

The company is now planning to provide the PACS system to small- and medium-sized hospitals through a new business model called software as a service (SaaS). The move will allow hospitals to adopt the PACS system without having to meet the high costs of initial investment, but pay an annual fee along with charges according to use.

Adisorn said his company was offering two models of PACS on the SaaS basis. First, the company will provide a PACS system and install it within the hospital. The hospital will commit to a number of years' service and will pay for PACS services according to the number of images it generates and stores.

"Sa Kaew Crown Prince Hospital is the first customer for our PACS service under the SaaS model," Adisorn said. "We invested in the total PACS system, worth around Bt15 million, for the hospital. The hospital signed a contract for six years' service, paying Bt85 per image. Normally, it has around 50,000 image-cases per year."

He said this model was suitable for hospitals with their own hospital information system and a minimum of about 50,000 image-cases per year. There are about 120 such hospitals around the country. They are potential customers for this model and the company aims to sign up at least 10 of them by the end of this year.

Another model provides a PACS system on a SaaS basis, but the system is located in J F Advance Med's data centre. Customer hospitals send the image-cases to be processed and stored in the data centre. This model has an Internet-based technology platform. The hospitals pay annual or monthly fees as well as a fee per transaction.

This model is suitable for small hospitals that have no resident specialist radiologists. They send x-ray cases to the data centre and specialist radiologists at remote locations are able to access the system and leave diagnoses in the data centre for the hospital to pick up. This process is conducted according to a Digital Imaging and Communications in Medicine (DICOM) standard.

DICOM is an industry standard for transferring radiologic images and other medical information between computers. It enables digital communication between diagnostic and therapeutic equipment and systems from various manufacturers.

"We have now established the data centre and the PACS system with an investment of Bt20 million. The service will be launched within two months. This model will allow the limited number of about 1,000 specialist radiologists in Thailand to provide diagnostic services to many more patients," Adisorn said.

He said that normally there were four main activities in a hospital's x-ray department - plain film [x-rays images], ultrasound, CT scan and MRI. About 80 per cent of cases involve plain film, while the remaining 20 per cent is taken up by the other three activities. However, these latter activities involve the most complex image information, allowing doctors to make faster and more efficient diagnoses with the help of the PACS system. Plain film and ultrasound images normally do not require the advice of specialist radiologists, but CT scans and MRI images need a specialist's analysis.

"The PACS system requires large and stable storage, because one plain [x-ray] film [has a digital size of] around 8 megabytes and one CT-scan case has around 3,000 images. So, to provide the PACS system, we also offer EMC [brand] storage together with the services and we use Fuji Wavelet Compression software to compress the images by 20 times, while retaining the original image quality," Adisorn said.

The company's aim is that by the end of this year, more hospitals in Thailand will be benefitting from PACS technology and more patients will be getting better, faster medical treatment.