Enterprise PACS for the Masses: The New Rules of Success

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Edward Milman, MD, director, MRI Services, St. Joseph’s Regional Medical Center, reviews and reports on images from a diagnostic PACS workstation.

Over the last two decades, PACS has grown from a bleeding edge technology that delivered a massive productivity bang as sites transitioned from film to digital image management to a mature, commoditized system. The radiology-centric focus has been replaced by an enterprise view that considers image-intense specialties like orthopedic surgery and emergency medicine as well as IT ramifications and system integration. In short, PACS is an enterprise business essential.

A 2010 PACS deployment is not the same as the initial transition from film to digital, says Greg Spencer, MD, chief medical officer of Crystal Run Healthcare in Middletown, N.Y. “We see a slow, steady incremental gain in workflow,” he explains. Plus, new systems have more fleeting lifespans with most lasting three to four years rather than the 10 to 12 years expected with early digital image management systems. With fewer, more elusive gains; terabytes of legacy data and hoards of diverse enterprise users, the recipe for a successful enterprise deployment can be a tenuous proposition.

Despite the challenges, many sites have carved a path to enterprise success. The common denominators are a user-centric focus, integration and value.  This month, a trio of successful sites shares their rules for success with Health Imaging & IT.

Rule #1: Adopt an enterprise focus

PACS is not just for radiology anymore. True success in the digital image management world hinges on rich use across the enterprise. When St. Joseph’s Regional Medical Center in Paterson and Wayne, N.J., replaced multiple, disconnected PACS with an enterprise system (Infinitt), the planning team engaged users across the enterprise.

The emergency department came to the table with a fresh perspective and made requests that the radiology department hadn’t considered, shares Ed Milman, MD, director, MRI services. For example, the chair of the emergency department asked for an integrated feedback mechanism, so that physicians could receive a streamlined confirmation or disagreement of preliminary results.

Similarly, ABQ Health Partners of Albuquerque, N.M., focused on needs across the enterprise as it planned its PACS deployment (NovaRad). “We realized heavy users like orthopedic surgery, podiatry and the hand clinic would need diagnostic quality image access as soon as it existed,” explains Susan Thomas, PACS project manager. The multi-physician specialty group carefully differentiated diagnostic users from patient relations users, providing the latter with low-bandwidth access needed for sharing images with patients and equipping heavy image users with rapid access and diagnostic workstations.

Thomas recommends pulling all users into the tent early to fully grasp their needs and ensure that they receive adequate training. The practice also supplemented vendor training with internal workflow training; radiology team members played various parts so all users understood what go-live day would look like. Super-users stationed across the practice’s 17 locations during go-live ensured a smooth experience.

Similarly, Miguel Hernandez, director of information technology at Crystal Run Healthcare, touts a comprehensive approach to workflow assessment and staff training. “Document workflow from beginning to end and train all users from radiologists to technologists. Every user needs to understand how the system will change his workflow and how individual workflow ties to others in the system.”

Rule #2: Insist on integration

“Crystal Run Healthcare is a very high-volume facility with 2,800 to 3,000 patient visits daily. We want our providers seeing patients not flipping through charts,” Spencer says. The model requires a seamless, rapid interface between PACS (Carestream) and the EHR. The integrated practice also prioritized integration with RIS and voice recognition as well as never-before integrated diagnostic imaging modalities including mammography and DEXA. “It’s all about physician efficiency,” shares Spencer.

As the enterprise PACS team surveyed the landscape, they rigorously tested various systems. “We wanted workflow to reduce clicking, and we didn’t take anyone’s word regarding performance,” Spencer says. The team also made sure that the new system presented information to physicians in a unified way, so physicians didn’t squander any time looking