The Insider's Primer: Taming the Workflow Beast

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Five Facilities Tell How

Workflow is the No. 1 challenge facing radiology departments and imaging centers focused on efficiency. Those that tame the workflow beast can list numerous positive outcomes: better service to referring physicians, shorter report turn-around time, increased satisfaction among staff and patients, and a healthy bottom line. On the other hand, sites that struggle with workflow may find themselves in a downward spiral losing patients, partners and profits. This month, Health Imaging & IT visits a few sites to learn more about specific workflow challenges and solutions.

Challenge #1
Transitioning to paperless radiology in a multi-site setting

Oregon Health Sciences University (OHSU) of Portland, Ore., a teaching hospital and tertiary referral center that completes 250,000 imaging studies annually, solved many of its workflow problems eight years ago when it deployed Agfa HealthCare Impax PACS. Early this year, the hospital supplemented the project, integrating the PACS with Agfa Impax RIS. Administrative Director of Radiology Erwin Schwartz believes the technology could help the multi-site enterprise transition to paperless radiology.

“We are geographically challenged; we provide imaging services in 12 locations in eight different buildings. Communications and protocolling are problematic,” says Schwartz. The OHSU radiology department protocols all exams. The previous information system limited the department to paper protocols, creating a protocol workflow akin to film. That is, each digital study was tied to a paper protocol.

Impax RIS enables online protocolling; the radiologist can create the protocol as soon as the exam is scheduled in the RIS. Plus, Impax PACS integration allows the radiologist to view prior images and use the information to fine-tune protocols as needed. “It boosts efficiency and patient care,” explains Schwartz.

Challenge #2
Timing tech adoption to maximize gains

Salinas Valley Memorial Hospital in Salinas, Calif., postponed its digital image management deployment for five years, waiting until 2007 to implement McKesson Corporation Horizon Medical Imaging PACS. The hospital optimized the situation, using the lengthy planning period to talk to end-users, begin soft-copy review in digital modalities and thoroughly analyze digital workflow.

Several issues stood out as the radiology department surveyed the landscape, says Tom Burnside, divisional director of diagnostic imaging.  First-generation PACS lacked a solution for paperwork. That is, paper continued to follow digital images, resulting in sub-optimal workflow. Second, early PACS did not offer a one-stop shop. 3D, PET fusion and cardiac nuclear medicine studies were not integrated into early PACS workstations. “The specialized workstation disrupts efficiency,” Burnside says. Finally, certain workflows, such as the ED/radiology workflow, presented unique workflow challenges.

Salinas Valley Memorial Hospital went live with PACS in 2007, slashing report turn-around time from 24 hours to between two and six hours. Paperwork is minimized. Radiologists use McKesson ER Discrepancy Tracking to agree or disagree with initial ER reads in a single click. Plus, information is automatically captured in a database for review and quality assurance. An interface with the Meditech RIS automatically sends PACS data to the RIS for streamlined billing. The interface also enables sharing of clinical data such as lab results between the RIS and PACS, minimizing the need for physicians to log onto multiple systems to access information. Finally, specialized applications including 3D and PET fusion are available on the PACS workstation, eliminating the need for workflow-busting specialized workstations.

Challenge #3
Integrating multiple PACS in the rural setting

Radiology Consultants of Iowa in Cedar Rapids, is a 25-radiologist practice providing professional services at 12 hospitals. Business is booming with radiologists reading 450,000 studies annually. CIO Joe Moore explains the group’s workflow challenges. “We try to maintain the focus on imaging services. Some of our hospitals are located two hours away. Radiologists were spending too much time on the road traveling to different sites. Plus, each hospital is outfitted with different image management technology. Radiologists were forced to learn to interface with a variety of applications.”

The answer seemed simple. A single umbrella PACS could consolidate studies into one worklist to reduce