PACS Customized & Configured for the Imaging Center and Small Hospital

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hiit040504.jpgThe North American PACS market is growing at a good clip of about 11 percent a year through 2008 from a 2001 base of about $500 million, market analysis firm Frost & Sullivan projects. Much of that growth is occurring in small and medium-size hospitals and robust imaging centers that are ready to take advantage of a more mature market with more options. Smaller facilities have much to gain from installing PACS but their limited resources require thorough evaluation and careful investment. Making a wrong decision is clearly not an option. Here's how a variety of facilities have added PACS with great success.

Going completely paperless in a rural environment

Lea Regional Medical Center is a 250-bed full-service hos≠pital in rural Hobbs, N.M. A move to PACS began because the facility could not afford to lose its one and only radiologist. They'd gone through nine locum tenens radiologists over a year-and-a-half period and did not want to go through the process of searching for a new radiologist. The ability to read images remotely was essential to retaining their radiologist.

After deciding to implement a PACS, the facility began seeking the right vendor. They wanted to go completely paperless, says Larry Hannah, director of IT. "None of the off-the-shelf, large companies seemed to want to talk to us." Plus, their users were still generating paper. "In our journey, we found that small companies talked at our level," Hannah says. "They were willing to at least entertain the idea that there were features they could work on."

NovaPACS' Notes feature was the function that clinched Lea Regional's decision, says Christina Seed, director of medical imaging. It offers the radiologist the ability to pull up images on screen and write a note on screen. That answered that part of the paperless drive, she says. The technologist can type from five to 5,000 lines in a popup box and then send it to the radiologist so he doesn't have to search for the patient's history or wait for a piece of paper to make its way to him. That popup box can be made available to referring physicians as well.

Novarad also developed their own software—Nova≠scan—that allows the user to scan in any paper that previously would have been filed, essentially allowing for digital archiving of all associated forms and documents. With the elimination of film, practitioners were still pulling a film jacket for orders and forms. "That didn't make a lot of sense," says Seed. "With the ability to scan, we're only pulling film jackets so we can do comparison reads. If [the] Medical Records [department] needs a document retrieved, we can print up a scanned copy."

"The Novascan function that couples with their own software and the Notes function are the two things that really helped us get off the ground as far as being paperless," says Hannah. "Larger companies said they could do that but Novarad already had it in place and is refining it daily."

Lea Regional is one of 51 facilities owned by Triad Hospitals Inc. The organization is slowly moving their radiology departments into PACS, says Hannah. At the corporate level, no one had yet used a smaller vendor. "They were interested in seeing how well that worked," he says. "They let us do our own research and come up with our own answer and they supported our choice. They are looking at us to see how well this will work out and compare our costs with other facilities."

After their first few months of working with the system, Seed and Hannah remain impressed. "Since this is our first experience with the digital world and PACS, we have weekly, if not daily, communication with Novarad," says Hannah. They're continually listening and soliciting comments for new features, he adds. He's already seen some of his suggestions appear in the product. "The flexibility is there and the willingness to evolve the product in a timely manner. As we're learning what we need and what we want they're learning how to provide that for us and meet our needs."

Centralization in private practice

It's not only rural facilities limited to one radiologist that can benefit from centralization. St. Paul Radiology is a large, private group of more than 80 radiologists in Minnesota. The group has six of its own imaging centers and provides radiology services to more than 10 hospitals. Back in 1996, they decided to centralize the night call. With a PACS, rather than having five or six radiologists on call, they could have one or two radiologists in a central