Lahey Clinic expands paperless PACS possibilities

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As the Deficit Reduction Act of 2005 continues to deal a severe blow to reimbursements for diagnostic imaging services in the United States, imaging providers have been scrambling to make up the downturn in revenue. One strategy that has seen success is the implementation of IT systems to streamline workflow to increase practice volume.

One approach to practice enhancement that often goes overlooked is to optimize existing processes and procedures to increase productivity. A team of radiologists and PACS system administrators at the Lahey Clinic in Burlington, Mass., partnered to address this issue at their facility, and deployed a low-cost scheme that reduced the number of steps in the image interpretation process and increased radiologist productivity.

“We utilized a PACS-centric paperless workflow and minimized the number of steps required to interpret a study,” wrote the authors of a scientific poster describing their workflow optimization process at the Lahey Clinic. Their work was presented at the 2008 Society for Imaging Informatics in Medicine (SIIM) conference in Seattle last month.

Their PACS-centric paperless workflow utilized the facility’s Fujifilm Medical Systems Synapse 3.1.1 PACS, its GE Healthcare IDX 9.92 RIS, and its Nuance Dictaphone PowerScribe 4.6 voice recognition (VR) system.

“With a single keystroke, the prior study was closed, the new study opened, the reason for exam displayed, the technologist note displayed, the comparison study displayed, and the VR activated and displayed for the new study,” the authors noted.

The Leahy team achieved this capability with its existing systems by adjusting its workflow to fully take advantage of digital workflow possibilities. Technologists scanned their paper requisitions on which they had written any notes. To allow this, the department purchased six scanners at a price point of $1,000 each.

In addition, the group bought nine low-resolution color displays at $500 each, which were placed on their radiologist’s workstations as a third monitor. This allowed the facility’s radiologists to no longer handle paper, or barcode readers.

The paper-based emergency room (ER) discrepancy workflow also was altered so that ER physicians wrote their initial interpretations in a notes field in the PACS. If the radiologist’s interpretation differed significantly from the initial interpretation, the study was placed in a discrepancy folder which the ER used to track patients.

“We invested the time to develop related procedure code lists, allowing us to automatically display comparison studies and eliminating two [mouse] clicks,” the team wrote. “We found that optimizing the third monitor real estate allowed both the VR dictation as well as the reason for exam, tech note and comparison exam list to be displayed. We developed a macro to shift the active window focus from the VR window to the PACS window and to replicate PACS keystrokes such that these activities took only one keystroke.”

The group noted that CR exams read by non-CR scheduled radiologists picked up from 7.2 relative value units (RVUs) per day to 14.5 RVUs per day after implementation of their workflow enhancements. This represented 18 percent of the facility’s CR volume, which allowed it to decrease the staffing requirements for CR-scheduled radiologists and permit them to pick up other studies for interpretation.

Most significantly, the radiologist and PACS administrator team was able to achieve these productivity enhancements through adjusting their workflow processes by fine tuning the capabilities of existing IT systems at the clinic. And, they were able to deploy their strategy at a low price point.

“The small capital investment of $10,950 made this an attractive program to our hospital administration,” they noted.