The Second Time is a Charm: PACS in the Small Hospital

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 Henry County Medical Center in Mount Pleasant, Iowa, is a digital imaging pioneer in the small hospital arena. The 25-bed critical access hospital completes 21,000 imaging studies annually in a state-of-the-art environment. Earlier this year, Henry County Medical Center became one the first small hospitals to install digital mammography.

The digital mammography implementation builds on the hospital’s tradition of innovation and imaging excellence. For example, the imaging department has provided multidetector CT and CR for about five years. But the true cornerstone of the digital imaging era is PACS, and Henry County Medical Center was one of the first small sites to attempt to tap into the benefits of digital image management. The hospital initially deployed PACS more than six years ago. “We weren’t planning to go filmless at the time. We were building a new department and found that we could achieve economies of scale by wrapping the PACS into the project,” recalls Radiology Director Deb Leichty.

The hospital opted for a package deal and installed multidetector CT, general x-ray, a multipurpose room, and PACS from a single vendor in September 2000.

Within a few years, however, the equipment vendor changed hands twice. Unfortunately, Henry County did not benefit from the transaction. “Service became an issue. The new vendor was not willing to upgrade when we outgrew the archive. We realized we needed to look at other vendors,” explains Leichty.

A new choice

The decision to deploy GE Healthcare’s Centricity SE PACS was fairly simple for Henry County. Between 2000 and 2004, the hospital’s radiology group expanded to two other institutions, and both sites relied on Centricity as the digital image management solution. (See related story on page 10.) “We wanted to provide continuity for the radiologists,” Leichty says. The hospital decided to partner with GE and began laying the groundwork for a replacement PACS.

One of the first items on the replacement PACS agenda was to prep the data center for the new servers. “With the first system, all of the PACS servers were located in the radiology department. We decided to put the Centricity server in the data center with the other hospital servers for a number of reasons. The data center provides a secure, climate-controlled room with the necessary electrical drops and gigabit hardware for the high-speed connection,” says Information Technology Manager Brian Moreau.

The other major IT challenge and upgrade for Henry County was a RIS-PACS interface. During the initial PACS installation, the hospital did not tie into the RIS for orders and results; technologists simply inputted data manually. Radiologists were convinced that an interface could streamline workflow, and the hospital asked GE to help create an interface from its RIS to the new PACS. “The RIS-PACS interface makes a great world,” says Moreau. Techs no longer need to input data manually for most modalities, which provides a significant workflow and patient safety benefit over the initial PACS. The interface cuts the possibility of human error and minimizes time-consuming data entry.

On the downside, unanticipated upgrade costs prevented Henry County from upgrading a few modalities to enable the automated merges from RIS to PACS, which necessitates manual merges for CT, fluoroscopy, and some nuclear medicine studies. “The DICOM upgrade for the multidetector CT scanner cost $18,000, which was a huge expense on the backside of the implementation. We decided to live without the upgrade and do manual merges, which means we’re working with two different processes for orders and results,” explains Leichty.

The other work in progress at Henry County is the connection among PACS at the various hospitals that contract with the radiology group. All three hospitals and the radiologists’ homes are connected via a T1 line, which is the foundation for totally automated distribution and seamless image review.

The current solution is advanced, says Moreau, but the hospital is aiming for refinement that will enable a more seamless process. For example, if a radiologist is reading at another Centricity site, Henry County can push images over the T1 line and call the radiologist to review the images. The physician exits the PACS at the first site and connects to the Henry County PACS to read the images. The goal, says Moreau, is to enable radiologists to pull images from their current location. “This last bit of refinement will