You don’t have to work in a large hospital to take full advantage of enterprise-wide PACS. Exeter Hospital, a 100-bed community hospital in Exeter, N.H., is thriving proof of how smaller, community hospitals can afford and benefit from PACS by streamlining workflow and increasing department and staff efficiency.
By installing Agfa HealthCare IMPAX version 5.2 and IMPAX for Cardiology combined with web-based PACS, physicians and technologists at Exeter attained a more streamlined facility, prevented the loss of x-ray films, saved storage space, eliminated chemical processing of film and the cost of film, and were able to access images from all modalities in one place, at any time.
Managing rising image volume
This community hospital caters to a large summer population in southern New Hampshire and northern Massachusetts, and parts of southern Maine. The year-round population is also growing and aging, contributing to a surge in imaging procedures each year. During the time that they were still debating whether to purchase PACS, they saw imaging volume grow from 41,600 imaging studies in 1998 to 47,400 a year later, and by 2000, the hospital completed 52,000 imaging studies — showing a 25 percent increase over two years. In 2006, after Agfa IMPAX had been installed for three years, they performed approximately 88,000 radiology exams.
“In the late ‘90s, we realized that the growth within our communities was continuously increasing,” says Lisa Martelli, PACS system administrator at Exeter. To manage the increase in population and exam volume, in 1999 the hospital began planning a multiphase expansion which included a new building at the front of the main hospital that would offer outpatient services including the women’s imaging center for ultrasound, x-ray and mammography, out-patient radiation oncology, medical oncology, endoscopy, and surgical services. That split the diagnostic imaging department between two different sections on opposite ends of the hospital. Physicians and radiologists were concerned about how they would handle going back and forth between the two separate departments for image distribution. “That led to the discussion of PACS,” Martelli says. “We knew with the expansion of the hospital and the increase in our volume, we would need to revise our workflow to continue offering excellent customer service by providing our patients and physicians with results in a timely fashion.”
Exeter also was running out of storage space due to increased exam volume and larger image studies for CT and MRI. “It used to be chaos.” Martelli recounts, “Pre-PACS, we had x-ray jackets stored in many different rooms. Films had the potential to be misfiled and not readily available upon request.”
Pre-planning PACS execution
To resolve these issues, a PACS development team began to discuss an enterprise-wide PACS solution, which meant that all digital images from radiology and cardiology would be available in any hospital location via PACS. In 2001, David Briden, Exeter Hospital’s vice president and CIO, met with the facility’s CEO, CFO, and board of trustees to propose the plan. Upon approval, Martelli began the year-long process of researching vendors and attending radiology shows to find a system that would meet their needs. They were initially interested in eight vendors and invited them to Exeter hospital for presentations. The PACS team then narrowed it down to three vendors and asked each vendor to conduct a hands-on workshop to demo their systems to physicians and staff. After the demonstrations, the field was narrowed to two vendors. The PACS team then hit the road on site visits to facilities of similar demographics that were using the system.
Agfa IMPAX won a unanimous decision of the PACS team, coming out on top for several reasons — one being Agfa’s willingness to interface with the facility’s Meditech hospital information system (HIS) and electronic medical record (EMR) which was already in place for referring physicians to access medical reports, laboratory values, and other information on their patients.
“We found that Agfa stepped up and took the initiative to want to [interface the Meditech system] and make it work for us,” Martelli says. A second reason was that Agfa was able to interface with the cardiology department, which was very important to the hospital because they wanted to combine radiology and cardiology without having to buy a separate image management system, according to Jennifer Mulholland,