BLOG: Remote Reading Positions Northwell Health for Success During COVID-19 Pandemic and Beyond

Like many other healthcare providers across the country, Northwell Health, New York State’s largest healthcare provider with 17 imaging centers across New York, saw a surge in COVID-19 patients at the start of the pandemic in 2020.

Northwell braced for the worst, setting up intensive care units and acute care floors, including units in lobbies to manage the tidal wave of COVID-19 patients.

While the need for intensive care units swelled, outpatient imaging decreased as non-acute care came to a halt. Overall and inpatient radiology volumes also went down; however, there was an obvious concern that radiologists were at risk simply by being in the hospital. Thus, Northwell, which typically has over 200 radiologists interpreting more than 2 million medical scans a year, decided to move many of its radiologists to read from home.

Virtual Collaboration

Enabling radiologists to work remotely is not that simple. It requires looking at several aspects such as security, efficiency and quality, and figuring out how to translate everyday workflow from state-of-the-art reading rooms designed for collaboration to the radiologists’ home environments.

Strengthening or building the technical infrastructure to support remote workstations securely while guaranteeing efficiency, quality and performance for the radiologists present another big hurdle.

“Nobody taxes the hospital’s network the way radiology does, we’ve got the heavy data, we’ve got images,” said David S. Hirschorn, M.D., and chief of division - radiology informatics for Northwell Health. “There’s no question that COVID is yet another piece in what has been an ongoing story for the past 20 years, which is that radiologists work remotely. We lead the way in terms of internal network requirements for the hospitals themselves, and we are also the ones who lead the way in terms of being the most demanding for remote access.”

Fortunately for Northwell, it already had the infrastructure in place to support radiologists reading remotely. By leveraging Philips Vue PACS, which enables secure, efficient and quality reporting and collaborating from virtually anywhere, Northwell was able to rapidly deploy its radiologist to a remote working environment without compromising business and patient care.

“We were very fortunate that our infrastructure was already set up for remote work with VPN connections and we had a number of radiologists who had home reading stations. We had the model in place but on a smaller scale. Now it was a question of moving the other radiologists to read from home and keeping track of them. We had to shift into high gear, move these workstations from the hospital to the radiologists’ homes and get them set up quickly,” Hirschorn said.

Image Streaming Solution

One of the challenges typically associated with remote image reading is directly related to connectivity, specifically low bandwidth or high latency for remote users. Northwell addressed these challenges by utilizing Philips’ image streaming solution which provides significant performance benefits by loading images quickly even when bandwidth is constrained.

“One of the key criteria for the system was that it played well over low bandwidth situations. The system that we chose was well suited for that. It can figure out for itself if your bandwidth is low, and automatically adjust how to transfer the images to give the radiologist the best experience to the end,” Hirschorn said.

Communication Tools

Transitioning to a fully remote setup can also have a significant impact on collaboration, which is critical for patients when responsibilities for their care are shared between physicians. This includes the ability to review images seamlessly to provide a second opinion or to plan clinical treatments for optimum healthcare outcomes. Having a system that supports tools such as chat, live screen-sharing and other communications is very important for effective collaboration especially for radiologists in a remote working environment.

An image sharing application is embedded as part of the Philips Vue PACS radiology system. This allows radiologists to collaborate and share their screen with other users seamlessly within that environment without having to shift to a different application.

“The communications tools of our workflow orchestrator can be very useful,” Hirschorn said. “For example, the communication that takes place within the team between the radiologists and technologists. As a technologist performs the exam and a radiologist reads the exam, sometimes the technologist has a question for the radiologist or has something that they need to let you know … like the patient moved or the patient was nauseous. This is something that they can easily communicate via the chat function.”

Northwell’s forward-thinking approach to its technical infrastructure has ensured that radiologists who work remotely to prevent the spread of COVID-19 have all the features, tools and functionalities that they have come to expect when reading on-site available at their disposal, not just viewing and manipulation but the reporting aspect as well.

Results from case studies are not predictive of results in other cases. Results in other cases may vary.

Editor's note: This blog is the first in a two-part series about enterprise imaging strategy.