RIS/PACS Propels the Community Hospital

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Sponsored by an educational grant from GE Healthcare

United Memorial Medical Center | Batavia, N.Y.

 
  Carol Vanderberg, specialist assistant in radiology, at United Memorial Medical Center reviews CR-based digital mammograms on the GE Healthcare Centricity RIS-IC that links the healthcare organization’s five campuses.
In some respects, United Memorial Medical Center (UMMC) of Batavia, N.Y., is a typical community hospital. It is composed of five campuses including a 111-bed hospital and four imaging centers. The group completes 50,000 imaging studies annually. Imaging modalities include multidetector CT, CR-based digital mammography, ultrasound, MRI, CR and digital fluoroscopy.


As the only hospital in the county, UMMC is somewhat challenged. For starters, it employs a single radiologist (supported by a specialist assistant in radiology), which can make it difficult to manage imaging volume, provide acceptable report turnaround time and review the breadth of modality procedures, especially subspecialty and ER reads. Four external radiologists based in Buffalo, N.Y., help manage the center’s daily workload, so robust digital image management processes are critical. Secondly, the metropolitan areas of Rochester and Buffalo are within an hour’s drive; it’s important to maintain high-quality local care to keep patients local.

The organization’s decisions to deploy GE Centricity RIS-IC in 2001 and to pioneer PACS with integrated RIS and voice recognition in 2006 play a vital role in UMMC’s ability to provide optimal, local patient care. What’s more, workflow and report turnaround time are significantly improved with integrated RIS/PACS and RIS-driven workflow.


RIS rules

Centricity RIS-IC is the workhorse behind the smoothly functioning radiology department at UMMC. The rationale behind the staggered, RIS-first deployment is quite simple. The RIS provides a means to capture accurate information and populate the PACS, says Lisa Foss, medical imaging supervisor. An interface with the HIS also facilitates patient processing and scheduling. “RIS-driven workflow helps bring the patient through the department a lot smoother. Data like patient registration flows from the HIS to the RIS, leading to fewer data entry errors and less manual work for technologists,” says RIS/PACS Administrator Mary Niland.

Physicians, both referring doctors and radiologists, benefit, too. The RIS centralizes all radiology reports and imaging files, providing streamlined access to reports and images for referring physicians. It also provides a line of communication between radiologists and technologists, which boosts workflow. For example, the radiologist can view images immediately after acquisition. If a study requires additional views or a retake, the radiologist can relay that information to the technologist—without leaving his chair or breaking workflow.

Both parties in the image reporting equation—referring clinician and radiologist—also gain from embedded voice recognition. Prior to Centricity, UMMC used a third-party system that required an additional server, interface and HL7 message. The Centricity system streamlines management, says Niland, and allows the radiologist to manage reports from a single home page, which, in turn, helps cut turnaround time.

Dan Ireland, vice president of clinical support services, credits the center’s workflow success story to a complete pre-RIS workflow analysis. “Our goal was to use technology to streamline activities,” Ireland says. By strategically locating status boards within the department and placing barcode scanners in radiology rooms, UMMC has slashed its paper consumption, replacing paper with electronic data flow. The workflow analysis helped the hospital track pressure points to help it determine where to place PACS workstations. Wall-mounted units and mobile carts complement fixed workstations to provide physicians access to images and lab results anywhere in the hospital, including at the patient bedside.

Centricity RIS-IC enables electronic billing, another critical workflow booster. Prior to Centricity, UMMS used a courier service to ship hundreds of billing reports to its billing company every day. Now, reports are generated automatically within Centricity and sent electronically to the billing company, saving the time and dollars associated with the paper approach. In addition, bills can be generated more rapidly, which translates into accelerated collections.

Centricity RIS-IC provides other significant advantages, too. The RIS incorporates data-mining capabilities, helping the medical center optimize resources. For example, when evening technologists complained about their workload and clamored for another FTE, Foss ran a technologist productivity report for seven days. She found that volume was significantly higher during the 3 to 7 p.m. period. Instead of hiring an additional tech or authorizing overtime, Foss juggled the schedule to provide triple coverage during the department’s busiest hours, saving the hospital critical dollars and keeping hard-to-replace employees satisfied.

The workflow and data-mining benefits of Centricity RIS-IC and PACS are ongoing, says Director of Radiology Darren Kazmierczak. “We’re constantly reevaluating our workflow to see what we can change efficiently, and it’s all based on having RIS/PACS.”


Customer satisfaction

Customer service can be a tall order, particularly in tight departments with a single radiologist. Centricity helps UMMC maximize its single radiologist and provide outstanding service to internal and external customers.

Take for example the emergency department. ER physicians have specific, critical needs—specifically rapid, accurate review. The hospital runs weekly ER reports to monitor turnaround time. “When we first implemented Centricity RIS-IC, we measured turnaround time in hours. Now we measure it in minutes. We turnaround 68 percent of ER reports within 15 minutes,” Niland says. That rapid turnaround helps physicians provide timely, informed patient care.

Another bugaboo in the conventional ER is discrepancy tracking. Prior to RIS/PACS, UMMC relied on a manual process with the radiology department staff walking to the ER every morning to chase films and bring them back to the department for the radiologist to review. Any discrepancies between the initial ER read and the radiologist’s review required paper forms and phone calls. Now, images are shared electronically between the departments. If a radiologist finds a discrepancy, Centricity generates a note to inform the ER.

“Our ER physicians are much more satisfied,” sums Ireland. “They can review images right in the ER, and they can share them with patients.” Centricity streamlines consults, making it easy for physicians to transmit images to Buffalo hospitals for sub-specialty review as needed.

The digital system also helps the hospital maintain a competitive edge with referring physicians, specifically by helping the hospital minimize report turnaround. Some primary-care physicians admitted to referring patients out of town in the center’s pre-RIS/PACS days because it was difficult for the single radiologist to make a timely diagnosis, says Ireland. Since Centricity, however, some have returned to UMMC because the radiologist can return results with an hour of the study. In fact, in the last year UMMC improved on its 5 percent annual growth rate, achieving a phenomenal 19 percent growth. Ireland credits the growth to Centricity. “With RIS/PACS, we’re able to provide the level of service expected by our primary-care physicians and patients.”

One patient group particularly satisfied with digital image management model is STAT patients. “Patients who come to the hospital for STAT work can wait in the waiting room because reports are completed so quickly. The radiologist can call the referring physician with results to find out if the patient should go to the office, ER or home. Patients aren’t driving home to find out they should return to the hospital,” explains Foss.


A perfect fit

Centricity RIS-IC is a perfect fit for UMMC. The community medical center has achieved key goals since deploying the integrated system. Customer service is improved via rapid report turnaround; business is booming and physicians, technologists, and patients are satisfied. The system provides access to data, helping the center continue to improve services. Paper is gone, and film consumption is negligible. n


Advice from the Field
Implementing RIS/PACS is a major undertaking particularly for smaller, community hospitals. United Memorial Medical Center (UMMC) in Batavia, N.Y., has optimized RIS/PACS to improve service at all levels, slash paper and film use and grow its business. Its RIS/PACS team offers some advice for colleagues looking to purchase a system.
  • Cost is a key focus, says Medical Imaging Supervisor Lisa Foss, but it should be tempered. “Everyone has to use the system. If it’s difficult to use and navigate, price becomes much less relevant.”
  • Train, train, train. UMMC RIS/PACS Administrator Mary Niland established training centers to educate staff and clinicians from various departments. She also visited referring physicians’ offices to set up the system on their computers and complete one-on-one education. The efforts helped persuade reluctant physicians to give up film.
  • Tap into internal and external resources. Colleagues can provide a wealth of information on peripherals like CD burners and modality integration. On the internal side, carefully track workflow of all film users to understand areas that can be improved by digital workflow.
  • Look at compatibility between the HIS, RIS and PACS. The RIS and HIS must communicate effectively on a daily basis. A single vendor RIS/PACS reduces integration challenges and streamlines the end-user experience. Think single password, single log-in.
  • Plan for site visits to see systems in action. Try to visit a facility of similar size and needs as your own. It can be very helpful to arrange to visit sites that use the same RIS and HIS as yours as well, says Darren Kazmierczak, director of radiology.