Latest PACS implementations deliver results
CHICAGO, Nov. 27—Walter Hruby, MD, of the departments of radiology and IT at Danube Hospital in Vienna, discussed “Upgrade and Change Management Benefit of Integration” at the 93rd annual meeting of the Radiological Society of North America (RSNA). 

At Danube, an integrated RIS/PACS has resulted in a highly integrated reporting workplace, one keyboard and mouse per workstation, single login, speech recognition and finger print scanner. Also, users now have RIS-triggered image transmission, an average length of stay of 3.9 days, excluding geriatric and long-term care. Reports increased by 14.7 percent and, with speech recognition, average report turn-around time decreased by 62.6 percent, including nights and weekends.

Examination and reporting are the most expensive steps within the radiologist’s workflow, Hruby said. A faster process reduces costs per exam, which leads to a fixed cost degression for all resources.

He also said that radiologists have to be involved in the project planning of an integrated RIS/PACS. “Integration cannot replace radiologists. The radiologist is the most important interface between the patients and the technical tools.”

For a successful implementation of integrated RIS/PACS, Hruby said you should be sure to conduct a realistic assessment of all costs, including the development of a good RIS/PACS interface, impact on other IT applications, data storage, network implications and clinical training.

State-of-the-art information technology is a prerequisite for digital radiology, he said. Persistent and rapid changes make it necessary to keep the technical standard as high as possible on a daily basis. Strategic management and the definition of processes for system upgrades and workflow changes must be part of the overall strategy of a digital radiology environment in a hospital and in healthcare services. “Integration is the key to optimize workflow and to improve patient services.”

In conjunction with Hruby’s topic, Fred Behlen, PhD, of the department of radiology at the University of Chicago, discussed “Change Management: Data Migration How-To.”

There are many reasons not to keep an older PACS archive, he said, including the complexity, economics, reliability and detestability. But, using DICOM query/retrieve, it can take as much as one-third of the time it took to acquire the data from a legacy PACS. Most modern PACS rely heavily on RIS orders and results data. Orders and/or result usually must be sent to the PACS before migrated images.

To migrate the data, facilities can do it in-house or outsource the task. If you outsource, Behlen said you should be careful to specify a migration project. Provide a summary of your current state including type and version of system, target system and RIS/PACS relationship. Behlen recommended you “make it easier next time” by requiring outbound migration specification from your new PACS vendor and considering a long-term archive separate from the workflow PACS. He also recommended PACS “hygiene”—maintain your archive, understand and maintain your data, and beware of using proprietary image annotation. Some vendors’ image annotation is proprietary and cannot be exported to other systems.

In conclusion, Behlen suggested the following tips:
  • Include data migration from the beginning in your PACS replacement plans
  • Insist on an outbound migration plan as part of any new PACS procurement
  • Consider a long-term archive separate from the workflow PACS
  • Maintain your present archive until you’re really done with it
  • Start early on your HL7 Orders and Results interfaces to the new PACS