Why Web-based PACS Works for the Community Hospital
Case Study: Bayhealth Medical Center  |  Dover & Milford, Del.

Sponsored by an educational grant from GE Healthcare & Dell

  PACS Administrator Laura Roy and CIO David Walczak access the Dell server rack console display in the data center at Bayhealth Medical Center in Dover, Del., that is adjacent to Kent General Hospital.
Bayhealth Medical Center is a two-hospital, 364-bed integrated delivery network located in Dover and Milford, Del., comprised of Kent General Hospital, Milford Memorial Hospital, Middletown Medical Center, as well as seven outpatient imaging centers, with more than 2,900 employees and 450 physicians. The two hospitals have an approximate annual imaging volume of 260,000 studies. By transitioning from a client/server-based PACS to Web-based PACS from GE Healthcare, the health system has seen increases in radiology productivity while decreasing its film and storage costs.

As part of the Delaware Health Information Network (DHIN), Bayhealth Medical Center is a founding member of a statewide health information and electronic data interchange network for public and private use for timely, reliable and relevant healthcare information. The legislation was signed in 1997; however, it took DHIN and the medical center several years to determine what role it would play within the network. “It wasn’t until recently that we decided that health IT could help improve care and perhaps reduce cost that we found our true mission,” says David Walczak, assistant vice president for technology and CIO who is responsible for telecommunications, clinical engineering and health information management at Bayhealth.

“We have been working very hard over the last three years and have deployed a system that is now automating the delivery of our results to our physicians’ offices,” he says.

The medical center saw the benefits of deploying health IT by deploying online medical records, electronic surgical systems, patient tracking systems in its emergency department, online clinical documentation for patient care services and electronic medication administration. About six years ago, the health system first deployed client/server PACS plus a Web distribution solution from Dynamic Imaging, now part of GE Healthcare, which was migrated over to a fully Web-based PACS—Centricity PACS-IW—in 2006.

“All of this was designed to provide additional information to caregivers to make more informed decisions which improve patient outcomes and patient safety,” says Walczak.

Prior to Web-based PACS, Bayhealth utilized a client/server-based system that worked very well within the imaging departments and worked OK outside of the imaging departments; however, Walczak says they quickly realized it would be difficult to extend that to every location that was needed within and outside of the hospitals to referring physicians. 

Since deploying Web-based PACS, the biggest challenge the medical center has faced was the change management in business operations. “With both technologists and radiologists going from a film-based to an electronic world, that was really our biggest challenge,” he says.

Another advantage is that the system uses the medical center’s own 1,800 PCs in its network to access PACS images and results. The ability to add additional imaging centers or equipment is really very transparent because of the way the architecture is laid out.  “We simply extend our network to wherever it’s needed, be it an off-site imaging center, be it to another new imaging piece of equipment coming into one of our hospitals,” Walczak says. “The ability to integrate our existing imaging modalities has been very straightforward—it is, for all intents and purposes, simply plug-in-play—it is that simple.”

A key feature is the integration of the Web-based PACS with the health system’s physician portal, giving physicians access to online dictation, lab results, x-ray results as well as images, points out PACS Administrator Laura Roy. “Our PACS also is integrated with the Commissure voice recognition system, which enables radiologists to populate the report from the PACS without having to type in or look up information on that patient from another PC,” Roy adds.

Since adding Web-based PACS, radiologist productivity has increased from 85 percent to approximately 95 percent. Report turn-around times that once took 24 to 48 hours for off-site reports, depending on when couriers came back to the hospital, now take roughly 24 hours, says Joyce Webb, RTR, QM, site manager for diagnostic imaging who oversees the daily activities at Milford Memorial. “Now it is a click of a button and a radiologist can read it,” Webb notes. “A patient can just walk into one of our off-site [imaging facilities], get an image taken and our radiologist can read it right away.”

PACS enables a radiologist to start reading a study 10 minutes after a patient is off the table, Webb says. Prior to PACS, it could take anywhere from 15 minutes to two hours to be ready for a radiologist read, she adds. “Previously, you had to go back and pull a jacket for prior images that they can compare. With PACS, all the priors are already in the system—they can go in and compare an MR to a CT and a CT to an ultrasound with just the click of a button.” Even when patients are airlifted to the level one trauma center in Newark, Del., trauma specialists can easily view the patient’s imaging studies via CDs provided with the patient, or log in over the Web to see their imaging studies.

Martin Begley, MD, a radiologist at Kent General and one of the medical education directors, confirms the workflow and report turnaround times seen with the deployment of the Web-based PACS. “PACS has been a tremendous boon to patient care, especially since it is linked to our voice recognition system. When a report is signed off, it immediately prints on the patient’s unit and is available on the Web for access. On average, final reports for most examinations are available to referring physicians wherever they are in the world within 35 to 40 minutes after the images are obtained. The images are also available with the report.”

Begley says he has seen measurable savings as well with PACS. “Previously we were spending over $600,000 for film, 20 percent more for processing and had a squad of clerks to manage, store and transport films throughout the hospital and to and from physicians offices. In addition, space for storage of these films had to allocated, heated, cooled, cleaned and lighted. Total cost was close to $1,000,000 per year. Almost all of that cost has been eliminated with the PACS while increasing efficiency that produces more savings, especially in prospective payment systems.”

Aside from the cost-savings experienced, another benefit has been the capability to integrate any study from another hospital or imaging center and put it into the system at Bayhealth for means of comparison, says Michael Samaha, MD, pulmonologist and intensivist at Bayhealth. He is able to remotely access patient studies to perform STAT reads if need be, whether he is at home or at another remote location.

“The beauty of it is that you can access those images from the hospital, from home, from the office or even a remote location where you are asked to evaluate,” Samaha says. “I can look [the study] up, give immediate feedback and get the patient going where he or she should go.”

Nelson Eric Wiegman, MD, an orthopedic surgeon at Bayhealth in Milford, Del., says that with the implementation of Web-based PACS, he has eliminated the need to archive images at his office. “I currently have three storage units of x-rays—I don’t need that. [With PACS images,] the hospital is doing it for me,” he says. While there a minor time [cost] to retrieve images electronically every time he wants to view them, he is no longer responsible for having to store films in an environmentally controlled unit. Additionally, he has eliminated the cost associated with having staff pull films the night before a patient’s appointment.

Looking back on the PACS deployment, radiologist Jonathan Patterson, MD, says that it is important to keep an open mind when transitioning from film to digital. “You have to be open to change and you have to change the way you look at things,” he says. “But I think it has been for the better—I couldn’t go back to a non-PACS environment and I never look at my studies not in stacks.” As more and more workstations come online with PACS and on other computer systems, it will ultimately increase patient care and safety, he notes. “There is a lot more to look at and it can be a little overwhelming at first,” he offers to other potential users. “But I don’t think you will be able to go back after you have gone in the direction of Web-based PACS.”

Images—anytime, anywhere

The benefits of deploying a Web-based PACS are manifold. Bayhealth Medical Center now has a transparent way to add additional imaging centers or equipment. “We simply extend our network to wherever it’s needed—be it an offsite imaging center or another new piece of imaging equipment coming into one of our hospitals,” Walczak says. “We literally just plug it in, configure the system and it is available for us. It is like adding a printer onto your network—it just works.”

With the speed of delivery the health system now has, radiologists have improved workflow and productivity and information is getting to caregivers much faster. This has translated into clinical benefits of having the immediate availability of studies for clinicians to make informed decisions on how to change the care plan or alter treatment for the patient. “That is a huge benefit of having this technology at a physician’s fingertips,” Walczak adds.

Words from the Wise
When it comes to choosing technology, one thing to keep in mind is that Web-based PACS is not just an IT system—it cannot be driven by IT. It is a joint effort by many clinical and IT departments powered by end-users from technologists through radiologists. A facility looking to deploy a PACS or Web-based PACS should consider the following to make sure the “i”s are dotted and the “t”s are crossed:
  • Look outside radiology. Establish a good working relationship with diagnostic imaging, clinical engineering and IT to make things happen.
  • Engage your vendors early. Make sure vendors work with IT staff on the different configuration changes to create a robust and highly available system.
  • Engage your end-users. Having the end-users of the system involved prior to selection and actively during pre-planning will help drive the process and selection of the system while keeping in line with the business plan.
  • Plan appropriately. The transition from a legacy system to a Web-based system is a complex process that requires a great amount of planning—it’s not going to happen overnight, but once your plan is established, you’ll achieve your milestones faster than you might think.
  • Listen to key decision-makers. The key decision-makers are going to be radiologists, department heads and managers, and technologists—the ones who are going to determine if a system is going to work to enhance the facility’s particular workflow.
  • Align with the overall business plan. Make sure the recommendations from the end-user community align with the administrative and financial considerations and overall strategic goals of the organization.