RIS/PACS Migration & Integration Offer Challenges for Imaging Centers
  Regional Medical Imaging in Flint, Mich., migrated from mini-PACS to Amicas PACS three years ago. The PACS provides the new Patient Record and the new Halo Viewer, both of which complement the RealTime Worklist.
Deploying PACS capabilities beyond a single radiology facility provides the opportunity of extending the reach of diagnostic imaging to a greatly expanded customer base. The benefits to imaging center practitioners are straightforward—increased market share and greater efficiencies from existing personnel.

However, unlike large academic medical facilities, private practice diagnostic imaging centers face different challenges to extending a PACS throughout their enterprise—primarily extremely tight budgets and a limited pool of technical support employees. A pair of multi-site practices recently met these challenges and succeeded in extending the reach of their PACS, through a migration or integration.

Easing the migration headaches

At one point during his enrollment in business school, Randy Hicks, MD, MBA was assigned a paper detailing how he might go about reorganizing his Flint, Mich.-based radiology group to make it a more efficient, prosperous practice. Very quickly, Hicks concluded that Regional Medical Imaging (RMI) needed to embrace a distributed model for reading so that the practice could provide subspecialty interpretation to multiple clients without having radiologists present at every RMI site.

Having to perform this academic exercise inspired Hicks to explore the possibility of acquiring such technology for RMI. Unfortunately, at the time (about 10 years ago), PACS was not a particularly practical investment at the practice level. These were systems intended for large hospital applications, judging by the price point of the systems at the time. However, he accomplished what he could with the deployment by of a collection of mini-PACS in the practice.

This solution, while acceptable at first, did not meet the needs of RMI as the practice grew to five imaging centers with 110 employees. About three years ago, Hicks made the decision to migrate RMI from its mini-PACS installations to a complete, enterprise-level PACS from Amicas.

“Amicas PACS gives me the ability to read all of my exams from one workstation,” says Hicks. “It has developed a single workstation that has all the mammography workflow, 3D tools and patient information that I need, which reduces the number of places I have to go to read a case to one.”

Once a system was selected, Hicks began preparing the practice for migration. His first step was to involve stakeholders from every area that would be touched by the new PACS product: IT, radiologists, technologists, scheduling, reception, billing and administration. As part of its migration strategy, RMI took these representatives to a one-week training session on the Amicas system prior to its implementation.

“This is a key element to the successful adoption of a new technology,” he says. “Involving stakeholders early, and often, create champions of the project in each group.”

Carrie A. Berlin, RIS and PACS director for RMI, noted that the migration of data from the old system to PACS was a challenge for the group.

“The integrity of the data that were being migrated definitely slowed the process,” she notes. “We were relying on the technologists to manually enter the data in our old PACS and, as you can imagine, there were a lot of errors.”

The practice utilized the services of DeJarnette Research Systems to assist in the data migration, Berlin says.

“We migrated approximately 66,000 studies and we began migrating only four months in advance,” she says. “We were approximately 60 percent done at go live. We would have been further along, but had a lot of data that needed to be cleaned up manually. We were fortunate that DeJarnette provided us with a QC tool that allowed us to quickly fix and migrate any study needed by a radiologist that had not yet migrated.”

Berlin advises that a practice contemplating a PACS migration candidly assess its data migration task as part of project. Looking back on her experience, she notes that she would have started the process at least a couple months earlier.

RMI, like many practices, is accelerating the return on investment of its PACS by uncovering and developing opportunities to transform the systems from cost centers to profit centers.

“The way medicine is being practiced is being changed by the digitization of radiology; as radiologists, this digitization has allowed us to get closer to our referring-physician customers,” Hicks says. “For example, we’re now in the offices of our referring physicians and linking them to us with our PACS. It allows them to tie their radiography equipment right to our PACS and send their images into our centers. It also allows, for example, a surgeon in the operating room to look at my images instantaneously and discuss them with me in real time.”

Hicks advises that a practice considering its PACS needs be brutally honest about its capabilities and projected business volume. Just as underestimating these elements can hamstring a practice’s IT investment, overestimating them can result in an expensive and unnecessary system that is not fully utilized. Overall, Hicks has been extremely satisfied with the path his practice has taken.

Integration disparate PACS

A little more than five years ago, Henry Hollenberg, MD, and a partner at Total Radiology Solutions (TRS) in West Monroe, La., recognized the solution to reading studies for multiple hospitals with disparate PACS was to present the data to radiologists on a single system. He worked with Brit Systems and the company’s Roentgen Files PACS to route studies from a collection of small- to medium-size hospitals into a server driving the practice’s diagnostic interpretation workstations.

At each facility, all modalities, as well as their hospital information system or RIS, communicate directly with the PACS server, Hollenberg says. The server provides features to ensure data uniqueness and labels it so that the PACS is aware of which facility it came from and can return the radiology report to the originating entity.

In some of the hospitals, the system acts as the primary PACS server and communicates directly with the HIS/RIS. For others, Hollenberg says the institutions use a nighthawk reading model where orders, images and their relevant priors are pushed to the server as a secondary system.

TRS also took over the DICOM modality worklist with its PACS, superseding installed systems at all other facilities.

“This allows us to manage workflow and maintain a high level of productivity by using one user interface,” he says.

All radiologists in the practice read from the same worklist, regardless of their physical location.

“In addition, our technologists QC their studies and patch multiple modality studies into one seamless presentation, including history sheets,” he notes.

This workflow model enables the practice to ensure quality study data, without the burden of tasking additional full-time equivalent employees to clean up errors made downstream, Hollenberg says.

At TRS, the PACS also is integrated with the firm’s billing company, allowing the automation of the entire workflow from imaging requisition to charge, he notes.

Hollenberg advises practices considering a multi-site presence to fully map out their front-end workflow with their back-end technology needs as part of making a system selection.

“Persistence and finding the right vendor to make it work is the best bet,” he says.