PACS and the Imaging Center: Boosting Flexibility and Patient Care

Imaging centers are benefiting from what PACS has to offer - better organization, redistribution of images and workload, a more streamlined working environment, an increase in productivity, faster report turnaround time, improvements in patient care and a significant reduction in hard-copy film costs. Health Imaging & IT spoke with four freestanding imaging centers utilizing PACS about the benefits PACS has brought to day-to-day operations.

Radiology Affiliates Imaging

Radiology Affiliates Imaging, a free-standing imaging center in Hamilton, N.J., is using NovaRad's NovaPACS to electronically acquire, store and transmit electronic patient images and data. The practice's 20 physicians provide coverage for two area hospitals, its Hamilton, Lawrenceville and East Windsor facilities as well as provide outside read services to networked healthcare facilities throughout the state. The PACS allows a radiologist to be physically present at one center but read images for any other facility in the enterprise.

"We would not have these other reading contracts - where we can increase the number of studies per day with the same physician staffing - without PACS," says CIO Pete Higgins.

The PACS has improved workflow and the services provided to the referring physicians, controlled operating costs, decreased the need for film and made the practice more competitive in the marketplace, says Higgins. A hospital may only have two doctors on site, but in reality the PACS allows the hospital to have access to 20 doctors in real time. Patient care is improved by enabling specialists to be consulted on cases in real time.

A voice recognition system (Dictaphone's Powerscribe) integrated with the PACS is another boost to workflow. "Our transcription system is web-based, so all of the transcription is done through the Radiologists Affiliates' network under one URL," says Higgins. "Usually within 10 minutes of a completed exam, the dictation also is completed." Transcription department FTEs have decreased from 4.5 to 1.25 with the integrated voice recognition software, as well as eliminated some costs associated with transcription services.

Return on investment can be seen in a number of areas, including a 50 percent reduction in film usage. "On the PACS side is the physician component," says Higgins. "The tools and the access to exams make it easier for the physicians to be more productive. Everything is at their fingertips. They are not struggling to find films. Previous exams are presented automatically through pre-defined hanging protocols. They are not juggling tapes. Films are not getting lost by the couriers."

"The physicians turn out volume," continues Higgins. "For the average physician, the number of cases they can read per day have increased significantly."

Borg Imaging Group

Borg Imaging Group in Rochester, N.Y., is an independent diagnostic imaging center consisting of eight sites that offer a wide range of medical imaging services, including CT, MRI, x-ray, digital fluoroscopy, digital mammography and ultrasound. The practice went live with Kodak Health Group's DirectView PACS System 5 at the end of 2004. Thirteen radiologists read for the practice - that has a volume of 100,000 imaging exams annually.

Borg Imaging is on their second-generation PACS. "The first generation was more of a learning experience than anything else," says Luke Bernier, director of business systems. "We learned a lot, especially in terms of the need for reliability."

Borg's experience with the first generation PACS also made the practice much more storage savvy the second time around; the facility implemented an enterprise-wide storage architecture from Kodak. "We wanted not only the PACS on the storage architecture, but we also wanted our RIS and some of our business systems," he says. "PACS drives storage, but if you engineer it correctly, you can take that engineered solution and leverage it toward other business systems."

A newer generation RIS will soon be integrated with PACS, which Bernier says will improve workflow for both the radiologists and technologists. "We guarantee the report within 24-hours, but normally deliver it in four hours," says Bernier.

PACS has improved business operations at Borg Imaging. "When you look at handling digital images as opposed to film, there are huge savings," says Bernier. "Radiologists and technologists are more productive and the network eliminates the needs for couriers. In the future, we will not need to send images to referring physicians that have connectivity to our network. Even for those without connectivity, we can send CDs at a huge cost and time savings overprinting 17 sheets of film."

How will PACS impact relationships with referring physicians? "Currently, we are working with referring physicians to tighten up their connection to our system. In fact, we are working with one of our large orthopaedic practices to integrate directly into their electronic medical record system. When the physician accesses a patient's medical record, they will also have the ability to launch our browser."

Arcadia Radiology Medical Group

Arcadia Radiology Medical Group is a free-standing imaging center in Arcadia, Calif., that offers a wide range of imaging services to the community of San Gabriel Valley. Arcadia Radiology, a nine-physician practice that has contracts with three larger hospitals in the area, performs approximately 250,000 radiology studies annually. To gain efficiency, the practice implemented DR Systems' PACS in 2001.

In addition to mitigating the cost of film, Arcadia's PACS solved a radiologist staffing shortage problem. "The imaging center got so busy that we were going to have to staff it with another physician," says Alicia Vasquez, practice administrator. "Or instead of hiring another physician, we could take the workload from that imaging center and redistribute it to other locations where the radiologist may not be that busy.

"Now with PACS, the nine radiologists can read images produced at the imaging center, as well as the outpatient and inpatient radiology exams produced at the three hospitals," continues Vasquez.

Vasquez says Arcadia also experienced a significant decline in film costs. "In 1993, our film costs were $140,000 without mammography," she explains. "Then our film costs dropped dramatically to about $60,000 or $70,000 and it went that way for many years. In 1998 and 1999, when we started doing MR angiography and multislice CT, our film costs started to go up again. In 1999, our film costs were just under $100,000. Last year [with PACS], they were $17,000."

As the PACS was "busy" helping to streamline daily workflow, Arcadia's imaging volume was increasing. "The way to think about PACS is that it is a better utilization of funds," says Vasquez. "It brings efficiencies for the radiologist and the technologist. It brings efficiencies for the referring physicians because they are able to access real-time information. It's those efficiencies in the long term that transfer into increased revenue."

American Radiology Associates

American Radiology Associates, a large sub-specialized radiology practice in Dallas, Texas, is comprised of 53 radiologists who remotely read medical imaging studies for free-standing imaging centers, community hospitals and physician offices - including orthopedic and neuroradiology practices - via Amicas' Vision Series PACS.

These imaging centers, which connect to ARA via a VPN, send their acquired radiology studies to a centralized server. "Once the studies are on the server, our radiologists can read the images over secure encrypted web access from anywhere there is internet access," says Anthony Toppins, MD, CIO of ARA. "We are able to offer sub-specialized radiology to imaging centers that can not provide that type of interpretation."

If the imaging centers do not have their own PACS, ARA can provide the image management solution for them. "In most cases, they do not need anything more than a VPN router at their facility," explains Toppins. "We can hook to the back of their equipment or hook onto their existing network infrastructure and take care of things from there. If we are to be staffing that site with a radiologist, then we can put a radiologist there and install an Amicas workstation onsite. The radiologist is there to staff the facility and is assisted by the other radiologists in maintaining our sub-specialized interpretation."

Toppins says the group offers its imaging center customers a number of benefits, including a significant reduction in the number of exams printed on film, off-site digital archiving with disaster recovery, and access to the resources of sub-specialized radiologists. The practice averages a 24-hour report turn around time, which Toppins says will be reduced to a few hours with the implementation of voice recognition software.

"In this era of digital imaging and advanced imaging studies, especially CT and MR angiography, the days of looking at hundreds of static hard copy images are gone," says Toppins. "We are to a point where PACS is a requirement and not a luxury."