Deploying PACS beyond the physical and virtual walls of the radiology department or imaging center, regardless of size, provides the opportunity to extend beyond the reach of diagnostic imaging to a broader range of caregivers and enabling improved efficiencies, cost savings and better patient care.
Training is Key
Education is an integral component of implementing an enterprise PACS, according to Barbara Nagle Bodyk, PACS administrator and manager at the 300-bed Greater Baltimore Medical Center, which processes approximately 150,000 studies on their PACS annually.
Greater Baltimore began installing components of the AMICAS’ Vision Series enterprise PACS in the spring of 2005, and went live in August 2005. “Over the course of those four months, we continued installing, testing and training with our staff,” Bodyk recalls.
Various subsets of medical professionals received training at different times and for different purposes. “We conducted training sessions by appointment, in addition to open-house settings. The radiologists gained initial access and training on the PACS in July and August, followed by the technologists, who had to learn how to use modality worklists in every department, as well as learn how to access images via PACS and through the Meditech EMR. Finally, the referring physicians had to learn how to access the images via our Meditech EMR.”
Even with smaller facilities, these types of training sessions can be beneficial. When Bustleton Radiology Associates, an ACR-accredited, radiologist-owned and operated facility that images 100-plus patients a day, implemented Viztek’s Opal-RAD PACS in 2005, the entire deployment took approximately one week.
The process went smoothly, says Anthony J. Limberakis, MD, president and CEO of Bustleton, with a Viztek representative guiding each of the three radiologists through a tutorial for two days. This sped the deployment process and eliminated the natural learning curve when working with a new system. “While there was some lead time to integrate our voice recognition system into the PACS and RIS, we were reading soft copy within a week. Because of the training, it was a smooth transition.”
“Communication and education are just huge components of the acceptance of PACS in an enterprise situation,” Bodyk says.
Great Baltimore’s enterprise PACS connects three joint ventures, including Medical Imaging of Baltimore, where the hospital’s MR and PET/CT images are acquired, and Advanced Radiology—both of which are physically attached to the hospital.
Due to the large size of MR and PET/CT studies, the hospital has to account for the expanding storage volume. “Within a hospital’s budget, you have to account for any equipment that is attached digitally to the PACS environment. This year, we added a CR system, so we had to make sure that we had enough SAN [storage area network] storage to make sure we were covered for our increased study volume. Because we pay for our web-based PACS according to our study volume, it determines what we pay annually for support.”
So that the various proprietary systems to interact with PACS, Greater Baltimore modified different DICOM fields to make studies come across correctly. “We have 40 systems from various vendors that connect to our PACS within the radiology department, and we have learned that each vendor has different nuances to DICOM that we have successfully worked through,” Bodyk says.
Bustleton experienced similar DICOM communication issues between its GE Healthcare’s digital mammography unit and its Viztek PACS soon after installation. GE and Viztek worked together, Limberakis says, to resolve the issue between disparate DICOM settings within a few weeks.
Smaller facilities gain autonomy
PACS healthcare enterprises of any size, large, medium and small facilities, see the benefits. PACS helps to make 25-bed Floyd Valley Hospital in LeMars, Iowa, more competitive and independent, says Radiology Director Denee Hardyk. Each year the facilities processes about 11,500 imaging procedures. Aspyra’s enterprise PACS is their PACS of choice.
PACS brought autonomy to Floyd Valley Hospital, Hardyk says, because the facility “owns the images. For example, we do not have interact with the vendor IT department, in order to grant access for additional users—everything can be handled in-house.”
But autonomy is far from isolation. PACS allows Floyd Valley to easily transfer and receive images from its governing health system, Avera in Sioux Falls, South Dakota, even though they have a different PACS.
Similarly, at Bustleton Radiology Associates, MR images are read off-site. Web-based enterprise PACS brings the advantage that these remote radiologists or any referring physicians can easily access the images through a secure username and password, opposed to using couriers, Limberakis says.
He says they chose an enterprise PACS to remain competitive by obtaining the most current technologies. “We are now able to offer our referring physicians the ability to image patients at their own facility without having to physically transfer the film to their offices.”
Becoming a completely digital facility has offered cost-savings in the long-term thanks to the elimination of film, processors and chemicals, Limberakis notes.
Community hospitals blossom
Richardson Regional Hospital is a 205-bed acute-care hospital in Richardson, Texas, that provides about 75,000 imaging procedures a year—a statistic that is expected to rise as the hospital this month opens its new 100,000-square-foot Bush/Renner facility, also located in Richardson.
“With Bush/Renner, we will add another component to our configuration that will allow us to add those procedures to our current eRAD PACS,” says PACS Administrator Lan Brockington. “The benefit to this is all our radiologists can dictate exams at one location instead of having to be physically located at the Bush/Renner site: essentially bringing the images to them.”
The other benefit is the uniformity in understanding and practice among all users. “There is only eRAD system that users, doctors or referring physicians need to view images performed at both locations, eliminating the challenge of remembering multiple user IDs and passwords that would come from separate PACS. Plus, with eRAD being web-based, the application can be opened from any location with internet access when the network security is authenticated,” she says.
The remote access is particularly helpful for the opening of new facilities. “As we open up new hospitals, it is easy to add them to our current configuration since there is no previous history of procedures performed,” Brockington notes.
Data migration, however, is a potential barrier to expanding with a single PACS. “When new hospitals or imaging facilities are acquired, how can the new data migrate into the current PACS configuration,” she questions. “Such as the patient who has been to both facilities but has been assigned different medical record numbers. How can the system recognize that the patient procedures belong to the same patient or a patient with a similar name?”
Another benefit of enterprise PACS access is the speed with which a referring physician can obtain the information he or she needs to treat a patient more quickly. “About two years ago, our radiologists began entering preliminary reports into PACS. Those reports are available within minutes for the emergency department physician, who can pull up the study through the Meditech EMR. As a result, the patient can be treated within minutes,” Greater Baltimore Medical Center’s Bodyk says.
Greater Baltimore also has installed PACS workstations in each of the critical care units. “By the time a portable chest x-ray is completed, the image can be processed on the Fujifilm station in the unit, it can be processed and available for the physician within two or three minutes of acquiring the image.”