PACS & the EHR: Users Love the Link

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 Integrating PACS with electronic health record (EHR) systems saves time and money, eliminates the dreaded multiple system sign in, and can even help retain and attract key radiologists. Several facilities share how they went from disparate systems to direct links.

Springhill Medical Center, a 252-bed hospital in Mobile, Ala., went live with PACS in March 2004, completely filmless in September of that year, and live with EHR a month later. Administration was pushing for technological advancement, says Systems Administrator Laura Cleveland.

With the hospital’s IS effort outsourced to Eclipsys, the organization had a good reason to consider Eclipsys products. The company promised Cleveland that they could integrate imaging to EHR. “That was a big selling point. We wanted convenience for our physicians, and it results in better care for patients. To make both happy, that was great,” says Cleveland.

Direct results

The PACS-EHR integration means that when the technologist completes an order for a chest x-ray, that information goes into the EHR and sends the message out to the interface engine. The engine sees the message that the test is done, and creates a message that goes back to the Eclipsys Sunrise Clinical Manager to tell it to create the URL to link over to the PACS web server. Basically, when a user clicks on an order, the system takes the user directly to the results. “As for our referring physicians, I couldn’t take it away from them,” Cleveland says.

Even though the radiologists look at images on PACS workstations, they “absolutely love the system,” Cleveland says. “It’s cut an hour-and-a-half to two hours off of reading time every day.” She designated two hours for training and most of the radiologists were up and running in less time. And, all the hassles and frustrations of retrieving and hanging films are gone.

The facility’s administration is pleased, Cleveland says, because referring physicians are so excited about the integration and find it very helpful. “Once physicians found out that images were online, they were clamoring to get access. That attracts more customers.” In retrospect, Cleveland says they could have built secure VPN connections for each physician earlier in the process.

Jacob Tapia, clinical analyst, says the integration wasn’t too challenging even though the team didn’t have experience writing plug-ins. “With our clinical system, we already had the capability to accept results information and order updates from HL7 messages. As far as actually getting the image viewer and other applications to launch from within Sunrise, you can provide a plug-in to display the link.” Tapia says they were able to use a plug-in to display web pages or information that can be downloaded over http and displayed in a browser. That plug-in logs the clinician into PACS and automatically opens a study as if they were opening the results from the order in the clinical system.

Tapia currently is working on a custom plug-in that will give the radiologists a more integrated experience with all study results loaded and displayed and all mechanisms for manipulation available. In hindsight, he says he would have invested more time in these efforts from the beginning of the project.

A win all around

Caritas Christi Healthcare System in Boston has a single McKesson PACS for all users across six hospitals and integrated it with its Meditech EHR last spring, according to Vice President and CIO Chuck Podesta. Once a master patient index and PACS were in place at all six facilities, “it made sense to give those same physicians access to images along with textual results.”

Caritas already was a McKesson customer. “As we implemented the system, we knew eventually that we’d want to link to the Meditech [EHR] system in some way,” he says. “Once we got pretty far down the implementing path, we went to them with a proposal to do that.”

The effort has been a “win all around” for physicians, says Podesta. Often, physicians would read the test results and have a question, so they’d call the radiologist to discuss the results. With access to both images and reports, they can better understand what the radiologist was trying to say, eliminating the need for phone calls. Physicians have told Podesta that their productivity has increased. “It fits right in with their workflow so they can keep moving through their day. It’s been well received.”

Physicians hate logging into separate systems, says Patricia Cox, director of enterprise imaging