Healthcare facilities that have bought into digital radiography (DR) would never go back. The efficiencies gained dramatically improve productivity, allowing physicians and technologists to provide better patient care and service. Image quality is like “night and day,” end-users say. And the savings in film, chemicals, space and staffing in many cases can even outweigh the costs of upgrading to DR.
DR has bought time for the physicians at McHenry County Orthopaedics in Crystal Lake, Ill., says Administrator Manette DeCramer. Since installing DR equipment from Imaging Dynamics in 2003, the orthopedic surgeons no longer suffer with the bottleneck created by traditional x-ray systems. One physician now sees more patients in a day than he could before. Another surgeon who typically ran behind schedule now stays on schedule. One doctor uses the saved time to spend more time with each patient.
“I think that for each physician, it brings a different element to how they practice, but the one common thing is that they’ve gained time,” says DeCramer. “They can select how to utilize that time.” The time-savings also apply directly to patients. “We try to run a hospitality industry,” she says. “We believe the patient’s time is worth something. If they are waiting more than five minutes, we haven’t done our job.”
Aside from gaining time, the improvement in image quality is amazing, she says. “It’s a transformation that is hard to believe until you do it. It’s amazing how fast you can put a patient through with DR and the quality is like night and day.”
Better images and productivity
The radiologists at St. Joseph’s Hospital in Syracuse, N.Y., “absolutely loved the images” when they started using the Carestream 9500 DR system, says Robert Whitmarsh, director of radiology. The hospital participated in a North American trade trial of the system and the unit was installed in March 2007.
Whitmarsh says the system allows for views that didn’t previously exist. An example is a trauma patient with a hip problem. “With traditional cross-table lateral views, it’s always difficult to get good visualization of the femoral head and neck,” he says. The 9500 is so versatile that the patient didn’t even have to be moved off the ED stretcher. “It’s the most incredible thing I’ve seen in terms of lateral hip x-ray. We use that now as part of our teaching files to show what we’re capable of doing with this technology.”
Chest and extremity images also got better with DR, says Whitmarsh. “Everything we already thought was good got better. The 9500 allows us to make what was previously so challenging actually quite easy.”
Transitioning to DR was smooth for the St. Joseph staff because it has the same look and feel of the company’s CR systems. “That was attractive to us because we have six [Carestream Kodak] CR products,” he says. “The image processing algorithms were brought over from CR.”
Happier physicians and techs
The 11 radiologists at Schenectady Radiologists and Balltown Imaging Center in New York, also were very happy with the images when they started using the 1600 DR system from Imaging Dynamics, says James Mooney, practice administrator. “The beauty for the radiologist is that he or she has the ability to manipulate the images,” he says. “With film screen, you get what you get. With digital, you can magnify, you can change the algorithm, you can change the window and level to look at different areas. It makes them better at their jobs.”
The radiologists pushed for DR, says Mooney. One of the biggest pluses, he says, is that radiologists and subspecialists can read images from any location via PACS.
DR also allowed McHenry to reduce its number of technologists. DeCramer realized that in an analog world, technologists spend about 51 percent of their time on administrative tasks. Now, they spend maybe 1 percent on administrative tasks, she says, and can spend more time with patients. That’s important in an orthopedic practice where many patients frequently return and a good staff-patient rapport goes a long way toward patient retention.
The technologists are much happier with DR, she reports. And, when one moved out of the area, the practice decided not to hire a replacement.
Kids and containing costs
DR brought a definite increase in throughput to The Children’s Hospital in Denver, Colo., says Radiology Director Linda Wright. The hospital uses Swissray’s Combi Trauma Systems, Multi Systems, Formula Plus Systems and another two Formula Plus Systems are on order. DR was phased in in 2001 and was first deployed in the orthopedics area, a busy, demanding department. “They expect us to be really fast,” she says. With one technologist and one assistant, they could perform the same number of exams in less time with DR.
Making the best use of tight space is another benefit of DR, according to Whitmarsh. “We’re gaining tremendous efficiencies you don’t get with CR,” he says. The ceiling suspended U-arm is designed not to be limited by anything. Rather than moving and adjusting the patient, the tech simply moves the arm with the remote control. During initial set-up, all stationary objects in the room are calculated into the system so that the arm won’t ever hit cabinets or countertops. Remote positioning also helps lower the risk of repetitive motion injury to staff, Whitmarsh says.
At first glance, DR is more expensive than CR. But, “DR is where you really gain efficiency, productivity, speed, everything,” says Whitmarsh. “When you gain that much efficiency, you don’t need the same number of x-ray rooms and you don’t have to pay support on as many rooms. Although CR has less upfront costs, he points out that the cassettes and screens have a very finite lifetime and they are expensive to replace. “The cost between the two technologies all of sudden becomes not that much different when spread over five to seven years.”
DeCramer conservatively planned her return on investment, but feels that the practice broke even the day they went live. “There were so many benefits,” she says. Aside from concrete costs such as film storage and processing chemicals, there were numerous, less tangible advantages. “How do you put a dollar value on not keeping patients waiting?” she says. It’s difficult to estimate the financial damage one unhappy patient can do once word spreads.
Lessons from the trenches
To get the most out of a switch to DR, Whitmarsh recommends modifying department or facility workflow. “Forget what you know about workflow and build a new workflow that maximizes the technology.”
For example, Whitmarsh says DR is so fast that he’s been able to operate with fewer technologists and different support staff. He spent a week quantifying the actual tasks of licensed staff members and then rearranged duties so that licensed staff were only responsible for tasks that require a license. “In the ER, that resulted in a significant change in the structure of staff.” And, when a new outpatient imaging center opens this month, only one technologist will be needed to run two DR rooms.
DeCramer agrees that DR requires a change in workflow. “You have to sit down and evaluate what you do and how your practice operates and search for equipment that matches that,” she says. “If you don’t do due diligence, you’re going to be unhappy. You really have to do your homework.”
McHenry physicians decided as a group that it had to be an all-or-nothing commitment to DR. Having both systems—DR and plain film—was not going to work, DeCramer says. When the system was installed, the doctors had one day to use either analog or the new digital x-ray and then the practice went totally digital. “It’s crucial to get everyone on the same page.”
To get them all onto that page, DeCramer created spreadsheets showing all the tasks the technologists do to take x-rays and all the steps the physicians take to read those images. With DR, the tech spreadsheet decreased by about four pages. The physician spreadsheet hardly changed at all, which illustrated that “their world did not change.”
DeCramer also pointed out that film and other costs associated with analog x-ray systems continue to increase every year while, after the initial investment, the costs for DR drop to almost zero. “You still have maintenance and service charges, but you already have that with x-ray. When they looked at it that way, it was a revolution for them. They realized that, financially, making a switch to DR was the right thing to do.” Plus they had the added benefits of no lost films and the ability to enhance images—a win for the practice, the physicians, the technologists and the patients.
