PACS: Step One of the Growth Plan

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 A number of important factors influenced the addition of PACS in the radiology department at Schneck Medical Center in Seymour, Ind., nine months ago. In addition to storage headaches related to film and the desire to improve workflow and report turnaround time, the implementation of PACS was the first step in upgrading Schneck’s imaging department.

This progressive, 166-bed community hospital is eyeing an expansion of its radiology services, including the use of a new-generation 64-slice CT scanner and performing noninvasive cardiovascular imaging studies. PACS was a key first step to enable this growth as well as helping to increase the efficiency and productivity of the department and handle the oncoming volume of data that will eventually be produced by the department.

Schneck provides clinical services to more than 120,000 residents of southern Indiana and performs more than 48,000 radiology procedures annually. Imaging services include diagnostic x-ray, ultrasound, CT, MRI, nuclear medicine, mammography, bone densitometry, and special procedures. The radiology staff includes 30 technologists and two radiologists who work with 100 referring physicians, and the hospital’s radiology department sees 125 to 150 patients daily, says Rita Baker, director of diagnostic imaging services.

Selecting a reliable and scalable PACS that would accommodate the department’s workflow and meet the hospital’s budget was not a simple task. Baker was part of the PACS development team that included a PACS administrator, the facility’s two radiologists, the IT department, and administration personnel. To cost-justify implementing PACS, Baker says the team highlighted how the hefty costs associated with film, processing, and hard-copy storage would be eliminated immediately. They also looked into the future of the department, its expansion, and how the installation of a 64-slice CT scanner as well as digital mammography would require PACS.


Search and rescue

After a six-month stretch that included numerous site visits and onsite vendor presentations, Schneck selected an image management system and began planning for its implementation. They went live with two CR readers in November 2005 and, a couple of months later, GE Healthcare’s Centricity PACS SE. “We wanted to go with a company that would be here for the long term,” says PACS Administrator Suki Wright. “We have witnessed [over the years] how the number of PACS vendors has dwindled. We did not want to get involved with a vendor that would not be around for the long haul.”

Currently, all modalities, except for mammography, which is still analog, send images to PACS. The image management system is integrated with MEDITECH’s electronic medical record system, radiology information system, and hospital information system.

Throughout the implementation process, GE helped the PACS team evaluate the department’s analog workflow and examine how daily operations would change in a digital environment. The company also was involved in determining the necessary changes that had to be made to the facility’s internal and external infrastructure for enterprisewide access to electronic images and reports. “When we finally did go live, it went very smoothly,” says Wright. “We had a couple hiccups here and there, but they were nothing that we could not be fixed that day.”

According to radiologist Neil Staib, MD, medical director of the diagnostic imaging department, the starting point for any viable PACS is to be seamlessly integrated with the hospital’s other information systems, in this case the EMR, HIS, and RIS. “Information can go back and forth from the radiologists to the referring physicians,” he says. “The radiologist also has access to all the patient information and medical record at his or her fingertips.” Schneck patients now have a virtual record containing medical history and critical information, including digital imaging studies, which can be accessed by authorized radiologists, specialists, and referring doctors.

Upon going live with PACS, the radiologists quickly realized that they were able to read and dictate imaging studies in a more efficient manner. In general, radiologists are in short demand and work in an environment where medical imaging services are in high demand. “With PACS, you can really leverage the ability of the radiologist to more efficiently view, read, dictate, and report studies,” says Staib. “PACS allows for a more efficient way to do radiology.”

One tool that augments the radiologist’s interpretation process is the GE Centricity AW Suite. It provides radiologists advanced capabilities to manage large, complex data sets directly on their high-end workstations. “When you have a multi[detector] CT scanner and a large amount of slices to view, you can read them on the volume viewer,” he explains. The radiologist has greater command of the anatomy that is being imaged when the reconstructed, 3D CT data set can be viewed in any plane.

As well as having a very positive impact on radiology, the installation of PACS has moved outside the department to onsite physicians, specialists, and referring physicians. While the radiologists need to interpret studies on high-end, diagnostic-quality workstations, Schneck wanted to provide physicians the capability to access images in their offices or at home via the hospital intranet. In areas where a number of physicians tend to consult on patient cases — such as the ER, ICU, and OR — the facility deployed viewing stations in areas that both increase access to the images and guarantee patient privacy. The PACS is integrated with the hospital’s HIS and RIS, and physicians can access images through the EMR.


Moving to the web

The web-based component of the PACS grants referring physicians instantaneous access to patient images and written reports via a secure virtual private network connection. Referring physicians have fast access to electronic images and reports, and multiple physicians have the capability of simultaneously viewing the same information. This feature permits speedy collaboration among multiple physicians in different geographical locations.

Staib says the power of the web has greatly improved communication with the referring physicians. Since digital images are available in a more timely fashion than ever before, the referring physicians can quickly review images online for any cases requiring immediate diagnosis and treatment.

PACS will allow Schneck’s goals to perform more complex radiology procedures, such as noninvasive cardiovascular imaging, become a reality. “As you gain efficiencies [with PACS], it enables you to advance the complexities, the number, and the types of procedures that you can offer from your radiology department, such as coronary CTA, noninvasive peripheral vascular imaging, or CT colonography,” opines Staib. “If you can efficiently and quickly handle what you are doing now in your radiology department, then you have the ability to increase the number, type, and complexities of the imaging services that you provide.”


Conclusion

While PACS will allow Schneck to expand its imaging services, the hospital has already experienced a 25 percent increase in patient turnaround time in radiology, as well as witnessed a decline in repeat radiographs and reduced patient wait times. Additional benefits include a reduction in patient information errors. “The integrity of the information is assured, since the PACS is integrated with the HIS and RIS,” says Kelly Koptizke, manager of diagnostic imaging. “We only have to type in the patient information once. We are not typing in the wrong patient ID number or wrong date of birth. We have gained an amount of security and continuity with the PACS.”

The ability to afford and implement PACS also allows Schneck to compete with larger healthcare facilities. “Some patients do not want to travel to Louisville or Indianapolis for treatment,” says Koptizke. “We can provide the best services we can to our community.” PACS is helping Schneck to be a more competitive player in the marketplace.