ProHealth Physicians: Adapting to Time Demands

By Norm Robillard and Timothy Barnard

RT Image, January 2011

ProHealth beats the clock with efficient PACS upgrade

Time was ticking and ProHealth Physicians, a primary care medical group with more than 75 locations, needed to select and install a new PACS within a 1-month window. Adding to the challenge, the PACS had to meet a range of highly unusual demands to support the unique workflow of portable and fixed site locations of our diverse practice. Simultaneously, we were transitioning to a new partnership with Radiology Associates of Hartford (RAH), a hospital-based radiology reading group.

ProHealth Physicians

If we didn’t have the new technology in place at our Connecticut facilities within 30 days, our ability to treat approximately 300,000 ProHealth patients would have come to a halt and affect care.

But the project team at CoActiv and the open, flexible PACS solution EXAM-PACS® met our goals, despite significant challenges. RAH, a veteran in the world of PACS, was surprised at the speed of the implementation and impressed that the process went smoothly.

In fact, within weeks of formally starting our PACS search process and days after launching the installation, images from ProHealth exam rooms across the state were streaming directly to RAH through EXAM- PACS. In addition, reports were being turned around quickly and reaching ProHealth staff physicians within our 2-hour time requirement.

Digital reports were also being dictated directly into the PACS and through an interface with our Allscripts electronic health record (EHR) that transferred into the patient’s medical record over our IT network. Our imaging data was being stored safely and securely in CoActiv’s EXAM-CLOUD® QUAD-REDUNDANT ARCHIVE®, which duplicates data in four different locations for safety and business continuity.

The project team included the ProHealth IT department. The EHR project implementation team and CoActiv developed a quick, efficient way to complete the project on time.


As the largest primary care practice group in Connecticut, ProHealth has more than 250 medical providers, including family practitioners, internal medicine specialists, and pediatricians. In addition to diagnostic medical imaging, ProHealth also offers clinical laboratory, physical therapy, auditory and hearing care, and sleep disorder services. Our annual volume is approximately 30,000 basic imaging exams. We do not provide CT or MRI.

To ensure our imaging procedures are delivered efficiently and conveniently, the practice runs eight diagnostic imaging centers in its busiest locations and portable units at 25 to 30 smaller ProHealth sites. Onsite imaging includes general X-ray, general and vascular ultrasound, and echo-cardiology and bone densitometry. Portable units handle ultrasound exams.

While all imaging services are delivered by board-certified ProHealth physicians and technologists, they are read offsite by RAH. ProHealth stipulates that all exam results be returned to referring physicians within 2 hours of a completed procedure.

Prior to installing CoActiv EXAM-PACS, the practice stored its exams on CDs and maintained a large in-house courier staff to hand-carry them to the practice’s radiology provider. We had already begun looking into a PACS as an alternative when our former radiology reading group was acquired by a larger practice. At that point, we decided to develop a relationship with a new reading group and simultaneously install a digital imaging management system.

We had been considering the move to digital for some time. Therefore, we were familiar with the current state-of-the-art in PACS technology and had a good perspective of our needs. We had a significant volume of exams and wanted to support our highly specialized workflow. We needed a technologically advanced PACS vendor who was willing to partner with us to adapt their technology to our unique situation.


Our key goals included streamlining the workflow and IT infrastructure for our new offsite reading group, as well as our own workflow, by enabling direct transmission of radiology reports into our AllScripts EHR.

Previously, we had been manually scanning imaging reports and adding these files to our EHR – a slow and inefficient process. Because we eventually decided to create a direct interface between the PACS and AllScripts systems, this meant the new PACS, not the RIS, would have to support report dictation. This move required a significant system customization.

After seriously considering several vendors, ProHealth selected CoActiv, in part, because we felt the company was willing to partner with us to accomplish our goals. In addition, CoActiv’s EXAM-PACS was a robust and flexible solution. Our former radiology group had been using a CoActiv EXAM-PACS, so we were acquainted with the technology.

We knew we made a good choice because CoActiv’s EXAM-PACS Web-based PACS solutions integrate into facilities of any size and are scalable to support future growth. Comprised of modular software components, EXAM-PACS enables sites to customize a solution to meet its specific needs and budget. We took advantage of the EXAM-PACS components, including: EXAM-FILER® CD-burning solution; vendor-neutral, HIPAA-compliant, offsite/online cloud-based EXAM-CLOUD Quad-Redundant Archiving; patent-pending EXAM-SENDER® referring physician system; CoActiv SCAN2PACS system; and the EXAM-NET™ teleradiology suite.

In addition to the project’s technical and timing demands, the staff and the radiology reading group had to be trained to have the PACS functioning seamlessly within the 30-day window.

CoActiv was also willing to launch the installation immediately and work closely with us to ensure that installation and training were completed on schedule.


Teamwork was one of the crucial aspects of our success. ProHealth’s in-house IT and networking team, representatives of our modality vendors, and the CoActiv project group came together to ensure that the system functioned seamlessly. A comprehensive project timetable with clear, detailed deadlines played a crucial role in keeping the project on track.

CoActiv’s installation of its EXAM-PACS technology went like clockwork. The company worked closely with our modality vendors so our CR, bone densitometry, and ultrasound devices were streaming data to the system from our eight imaging sites.

Simultaneous, CoActiv focused on our goal of minimizing IT infrastructure for our reading group and the unique integration that was required. Early on, we decided that one of the most useful ways to accomplish this task was to bypass a RIS entirely and create a PACS-driven medical imaging platform. After radiologists dictated into the EXAM-PACS, reports could be submitted right to the EHR. This innovative approach helped us achieve our desired goal.

During the process, we integrated a Dragon voice dictation system directly into EXAM-PACS, complete with voice-activated templates and standard normals. As a result, radiologists could drive their workflow from a single platform for viewing, dictating, and signing reports.


Another unique aspect of the project was implementing technology to support our portable imaging locations, where exams are conducted in the ProHealth offices. Today, when sonographers arrive onsite, they plug ultrasound devices directly into network hook-ups and stream exams over fiber to communicate with radiologists as if they were all in the same facility. Accomplishing this feature required PACS customizations and cooperation between the CoActiv, ProHealth, and modality vendor teams.

Because EXAM-PACS is so pervasive throughout our multi-site practice, we purchased multiple user licenses for technologists. Two RAH radiologists are always assigned to the primary reading stations in their offices to immediately interpret ProHealth exams.

ProHealth maintains an advanced onsite training and educational facility. Once the system was up and running, we conducted thorough PACS training sessions, along with CoActiv, during evenings and weekends for more than 40 ProHealth imaging staff members to prepare for the launch. In addition, CoActiv was onsite at our radiology provider’s offices to make sure they were comfortable with the system before going live.

In the past year, CoActiv has continued to build on the new streamlined, integrated PACS-driven platform by adding the ability to create and display addendum reports in the AllScripts system. The integrated PACS/voice recognition feature has also been successful.

Eric Rosenberg, MD, chairman of ProHealth physicians’ ancillary committee, noted that he was impressed with CoActiv’s speed and professionalism while getting ProHealth up-and-running on EXAM-PACS. He emphasized the benefits of being able to offer its 75-plus provider locations with their radiology readings integrated into the electronic health records within minutes of a study’s completion. And Michael Twohig, MD, president of Radiology Associates, was overwhelmed with the efficiency of the project and was impressed with CoActiv’s participation as a willing partner in the process.

Having used CoActiv EXAM-PACS for almost a year, everyone is satisfied with the advanced, and user-friendly, customized features. EXAM-PACS has enhanced our imaging operations, as well as our overall patient care, with a new level of efficiency that will support future growth.

Norm Robillard is director of diagnostic imaging services and Timothy Barnard is senior vice president of ancillary services and recruitment at ProHealth.