Radiology's Best-kept Secret: RIS-driven PACS Workflow

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Children’s Hospital of Alabama in Birmingham deployed PACS four years ago in crisis mode. Prior to PACS implementation, within a few months, the radiology department had lost three of its eight radiologists. “We had to become more efficient,” recalls Radiologist in Chief Stuart Royal, MD. In a way, however, the crisis proved to be serendipitous. The radiology department had considered investing in PACS technology earlier, but had delayed deployment because early systems did not facilitate RIS/PACS integration—a criterion considered essential to success by the hospital radiology department. “The department realized PACS integration could increase productivity among radiologists and improve workflow across the facility,” says Lynne Hamer, divisional director, pediatric imaging.

As the downsized department surveyed the PACS landscape in 2002, it realized that at least one current system delivered true integration. The hospital decided to deploy the Siemens PACS, RIS and Web based image and report distribution in an integrated “RIS drives PACS” workflow model.

The hospital PACS went live in April 2003. Since the deployment, the imaging department has converted nearly all imaging equipment to digital, installing CR and DR in the diagnostic, outpatient radiology and emergency departments. Operating rooms are outfitted with digital C-arms. Other digital modalities include a 16 and 64-slice CT, ultrasound, echocardiography and two 1.5T MRI systems.

Outside the walls of radiology, Children’s Hospital deployed PACS in the emergency department, operating rooms, hospital clinics and all nursing floors. “Acceptance of PACS has been phenomenal. Our physicians and staff have embraced the technology… It is the single most positive change I have seen in imaging over the past 20 years,” reports Hamer.

“It was a lifesaver,” adds Royal. “We could do the work of eight radiologists with five.” Royal credits the department’s success to RIS/PACS integration and RIS-driven workflow. Today, the hospital stands at the cutting-edge of pediatric patient care. Its eight-person radiology department completes 101,000-plus procedures annually. It is 99 percent digital, except for scoliosis film.

Since deploying RIS/PACS, Children’s Hospital has realized a number of benefits including improved and accelerated patient care, cost savings and reduced report turnaround time. In fact, Royal estimates that the move to the integrated Siemens RIS/PACS model has yielded a 40 percent increase in radiologist efficiency.

Dissecting RIS-driven workflow

The Children’s Hospital radiology department implemented integrated workflow when it deployed PACS. Under the Children’s model, the hospital information system (HIS) updates patient information in the RIS,  called syngo Workflow. Data flow is seamless for radiologists. “Everything is in one place. They don’t need to move from one system to another to complete their work,” explains PACS Administrator Lynn Odom.

The integrated model provides the robust flexibility needed in the pediatric environment. Take for example MRI studies. In the adult world, radiologists don’t view images until after the exam is complete. But in the pediatric environment, radiologists typically want to view images as they are acquired. That’s because pediatric patients often require sedation prior to an MRI study. “We need to minimize the time patients are sedated and maximize the information acquired during the study,” says Royal. The integrated RIS/PACS allows radiologists to view studies in progress, so if a patient requires an additional sequence it can be completed during the initial study.

The RIS/PACS integration boosts patient care in other ways as well. For example, Children’s Hospital strives to provide one-stop shopping. As the only children’s hospital in the state, it isn’t uncommon for its patients to travel half a day or longer for medical testing. In addition, anxious parents want same-day results.

“We try to give [outpatient] families preliminary results before they leave the hospital,” says Royal. This model requires a robust electronic system that includes a sound archive, rapid access to prior studies and a solid means of distributing images to clinicians. Integrated RIS/PACS provides a complete solution. Radiologists can readily view studies on the PACS workstations, and its archive provides rapid access to priors. Specialists, such as neurosurgeons and orthopedic surgeons, can view studies via the Web-based Viewer and