Telemedicine is a vital component in delivering effective patient care — particularly to those in outlying areas. Telemedicine also offers opportunities to capture efficiencies in collaborative workflows for viewing medical imaging.

When one university medical center wanted to find ways to be more effective in delivering care to possible stroke patients in outlying areas, it went in search of a solution to support viewing and collaborating on images more easily, regardless of location.

Overcoming obstacles of PACS traffic, clinical workflow and image sharing

The university was looking for solutions to better support televiewing, but they were also looking to resolve other standing challenges.

Surmounting slow, inefficient PACS

Traditional PACS experience heavy traffic from the pre-fetching of prior studies and other non diagnostic viewing requests. To reduce that traffic burden and make it easier for clinicians and staff to share images and collaborate, the university wanted to adopt a zero-footprint universal enterprise diagnostic image viewer. This would also free up IT staff from managing local client installs — which can be particularly challenging when supporting outlying communities.

Avoiding the avalanche of imaging CDs

Like many others that serve their communities, this university medical center received tens of thousands of patient CDs every year from hundreds of outside facilities. Clinicians were forced to wait as images were manually imported from the CDs — and then wait for patient demographics to be manually matched. Using VPNs as an alternative approach to the CD-sharing process created bottlenecks and incurred significant overhead. As these delays could delay patient care, a better approach was needed.

Overcoming medical research obstacles

Medical researchers in the university wanted the ability to upload, access and share imaging studies and other data while also segregating this information from active patient data and content. Researchers would sometimes turn to freeware applications that were not designed for this purpose and also posed security risks. The freeware tools were mostly client-server applications that tied a researcher to a specific a specific workstation and prohibited access to images in other locations or devices.

Gaining support for telemedicine

The university healthcare leaders considered telemedicine an important capability that would allow the center to effectively deliver care to patients in outlying areas as well as support improved collaboration with referring providers. As an important component of this capability, the center was looking for a televiewing solution.


True, zero-footprint enterprise diagnostic viewer as a foundational viewing platform

The medical center moved its enterprise users to NilRead, the Hyland Healthcare zero-footprint enterprise diagnostic viewer, with the NilFeed extension that allows a secure connection using SSL and https — without a VPN. This provided efficiencies for faster access and viewing of images.

This change dramatically reduced the traffic workload on the main PACS — which would be primarily used for diagnostic reads within radiology department. University physicians gained the flexibility of a web-based viewer that allowed them to view images simultaneously and use collaboration tools from any location. The change also freed IT staff from managing local client installs.

Hyland Healthcare’s NilRead enterprise diagnostic viewer and Acuo VNA offer numerous uses for supporting the growing volume of imaging and improving how the university accesses and shares patient content. These enterprise imaging solutions impact patient care and create workflow efficiencies.

Reduced CD workflow

The ability to ingest images using NilRead allows the images to be stored directly in the VNA. With this functionality, the university was able to directly transfer patient images from referring institutions instead of waiting for CDs to be produced, transported and ingested into the university system.

While CDs have not been completely eliminated from all locations, the workload from high-volume CD senders was significantly reduced. This reduced work queues for imaging library staff and sped up the turnaround time for CDs sent to the department.

Data management for clinical research

Now, clinical researchers from outside the university could easily send imaging data, streamlining the process. Storing images in Hyland Healthcare’s Acuo VNA also provided sophisticated tools that allowed the research imaging data to be segregated from live patient data.


The university gained more than a robust, diagnostic-quality viewer — they gained the flexibility to access images from remote locations and portable devices. This, in turn, allowed them to create a teleneurology program to serve the outlying areas.

The birth of an innovative teleneurology program

Among the most innovative uses of NilRead’s power is managing urgent neurology consults from a remote location — in other words, teleneurology. Since the start of the teleneurology program, patients around the region gained faster access to specialists for stroke diagnoses. Patients deemed not to be experiencing a stroke no longer had to be transported to the university hospital for further care and assessment. This freed up beds, eliminated travel demands on patients and their families and decreased unnecessary testing on patients. By the same token, patients that were indeed experiencing a stroke per the collaborative consults were sent immediately to the university for care. The teleneurology process also saves time on the stroke protocol pathway for patients upon their arrival.

The referring facilities can now treat patients locally, keeping them close to family and familiar caregivers while preserving beds for patients with severe cases.

By implementing a telestroke program, patients can receive faster access to specialists for diagnoses, which greatly impacts patient outcomes. With the success of the teleneurology program, telemedicine capabilities have been extended to other service lines through enhanced image sharing.