PACS & the EHR: Users Love the Link

 Integrating PACS with electronic health record (EHR) systems saves time and money, eliminates the dreaded multiple system sign in, and can even help retain and attract key radiologists. Several facilities share how they went from disparate systems to direct links.

Springhill Medical Center, a 252-bed hospital in Mobile, Ala., went live with PACS in March 2004, completely filmless in September of that year, and live with EHR a month later. Administration was pushing for technological advancement, says Systems Administrator Laura Cleveland.

With the hospital’s IS effort outsourced to Eclipsys, the organization had a good reason to consider Eclipsys products. The company promised Cleveland that they could integrate imaging to EHR. “That was a big selling point. We wanted convenience for our physicians, and it results in better care for patients. To make both happy, that was great,” says Cleveland.

Direct results

The PACS-EHR integration means that when the technologist completes an order for a chest x-ray, that information goes into the EHR and sends the message out to the interface engine. The engine sees the message that the test is done, and creates a message that goes back to the Eclipsys Sunrise Clinical Manager to tell it to create the URL to link over to the PACS web server. Basically, when a user clicks on an order, the system takes the user directly to the results. “As for our referring physicians, I couldn’t take it away from them,” Cleveland says.

Even though the radiologists look at images on PACS workstations, they “absolutely love the system,” Cleveland says. “It’s cut an hour-and-a-half to two hours off of reading time every day.” She designated two hours for training and most of the radiologists were up and running in less time. And, all the hassles and frustrations of retrieving and hanging films are gone.

The facility’s administration is pleased, Cleveland says, because referring physicians are so excited about the integration and find it very helpful. “Once physicians found out that images were online, they were clamoring to get access. That attracts more customers.” In retrospect, Cleveland says they could have built secure VPN connections for each physician earlier in the process.

Jacob Tapia, clinical analyst, says the integration wasn’t too challenging even though the team didn’t have experience writing plug-ins. “With our clinical system, we already had the capability to accept results information and order updates from HL7 messages. As far as actually getting the image viewer and other applications to launch from within Sunrise, you can provide a plug-in to display the link.” Tapia says they were able to use a plug-in to display web pages or information that can be downloaded over http and displayed in a browser. That plug-in logs the clinician into PACS and automatically opens a study as if they were opening the results from the order in the clinical system.

Tapia currently is working on a custom plug-in that will give the radiologists a more integrated experience with all study results loaded and displayed and all mechanisms for manipulation available. In hindsight, he says he would have invested more time in these efforts from the beginning of the project.

A win all around

Caritas Christi Healthcare System in Boston has a single McKesson PACS for all users across six hospitals and integrated it with its Meditech EHR last spring, according to Vice President and CIO Chuck Podesta. Once a master patient index and PACS were in place at all six facilities, “it made sense to give those same physicians access to images along with textual results.”

Caritas already was a McKesson customer. “As we implemented the system, we knew eventually that we’d want to link to the Meditech [EHR] system in some way,” he says. “Once we got pretty far down the implementing path, we went to them with a proposal to do that.”

The effort has been a “win all around” for physicians, says Podesta. Often, physicians would read the test results and have a question, so they’d call the radiologist to discuss the results. With access to both images and reports, they can better understand what the radiologist was trying to say, eliminating the need for phone calls. Physicians have told Podesta that their productivity has increased. “It fits right in with their workflow so they can keep moving through their day. It’s been well received.”

Physicians hate logging into separate systems, says Patricia Cox, director of enterprise imaging for Caritas. So, setting up an active directory for all integrated systems with single sign-on was a priority. A focus on enterprise-wide systems led Caritas to McKesson. And although finding a way to allow for greater physician productivity was crucial, “it was one of the simplest integrations we’ve ever done,” she says. “It’s so easy for referring physicians to obtain access to critical patient information.” That offers decreased frustration which can’t really be measured.

As the organization adds more IT systems, they plan to also link them to the electronic record.

From an IT perspective, this has been a fairly straightforward project for Caritas since images are viewed via a web viewer that’s part of the PACS. There is no need to move images around and try to store them in the HIS.

Recruitment and distribution

Bassett Healthcare in Cooperstown, N.Y., includes four hospitals, 23 health centers and 14 school-based health centers in nine counties across 5,000 square miles of central New York. The organization has integrated McKesson PACS with both Meditech Magic for inpatient and ancillary care and with the Informatics Corporation of America EHR on the outpatient and physician side. When the organization put out an RFP for PACS vendors, one of the first criteria was the ability to develop URL integration into its clinical systems, says Vice President and CIO Kenneth Deans. In the past, physicians could only access radiology reports, not images.

Implementing PACS will save Bassett more than $400,000 in film expenses in 2008. It’s harder, however, to measure the gains from integrating electronic records and PACS. “It’s tough to measure, but talk to any clinician,” says Deans. “[He or she] will explain vast differences in their world versus three years ago.”

But the true reason for PACS was recruitment and retention of radiologists, says Deans. “Newer radiologists coming out of school have never used film.” Plus, digital imaging offers better image clarity for better diagnostics.

The far-reaching geographical range of Bassett facilities made distribution of film a huge challenge. “With PACS, that goes away. You can’t put a price tag on that, but it’s one of the largest benefits.”

Joanne Morgantini is director of business operations for InterMountain Health Group, which has 52 physicians in 33 locations in the Central Wyoming Valley of Pennsylvania. InterMountain has been working with Sage Healthcare to set up the Sage Intergy electronic health record. Working in four phases, the group has set up the billing module, imaging center software and is now working on the clinical chart.

The efforts undertaken so far mean that patients are registered using a tablet PC. That registration information is available at any location so patients don’t have to resupply their information. Each patient’s needs are tasked to the appropriate person, whether that is the front desk or a nurse. If a patient needs an imaging study, the results go directly into the record and are then tasked to the physician and automatically released to appropriate clinicians. Everything is automated and Morgantini says users are very pleased with the prevention of phone calls and re-entering of patient data. Physicians can see all patient study results—from sleep studies to lab results—in the record and can see images via the PACS web viewer, if they wish. Plus, the record visually looks like a paper chart so it has been relatively easy for the physicians to make the switch.

Big Bang theory?

Morgantini advocates a gradual phase-in. InterMountain started setting up two solo practices in July and increased that to five practices by August. A group of seven was added in October. “Doctors are reluctant with computers,” she says. “Take it in pieces.”

Springhill went with a Big Bang theory of implementation. They had budgeted 10 weeks from the start of the install to go live but everything was online—every modality—within six weeks, Cleveland says. Five months later, they went filmless.

Cox agrees with the Big Bang theory. “I prefer to do all the change right upfront,” she says.


Tips from the Trenches
PACS is phenomenal, but it is organizational-changing, says Kenneth Deans, vice president and CIO at Bassett Healthcare in Cooperstown, N.Y. To gain full advantage of PACS, you’ve got to take a close look at the distribution process. If you will be sending images back and forth between locations, you need an adequate wide area network and bandwidth. “You’ve got to ensure solid, logical connectivity.” Web-based was one of Bassett’s product-choosing criteria.

Think about your current workflow and what your future workflow might be, Deans says. “Expect the unexpected. Whatever your volume is today, what would you do if it rose 20 percent? Would you be scrambling trying to support it?”

If you’re selecting an EHR, Jacob Tapia, clinical analyst at Cleveland Clinic, recommends reviewing its extensibility mechanisms. If they don’t exist, “you’re just going to run into walls of functionality not present in the system you bought,” he says. “Physicians will have a need for a mechanism and you can’t provide it.”

If you’re in the process of choosing a PACS, Chuck Podesta, VP, CIO of Caritas Christi Healthcare System, recommends that you make sure the vendor has a strong relationship with HIS vendors so they can link to and launch the web viewer.