Creating the Enterprise PACS Success Story
Sally Grady has served as director of imaging services at Florida Hospital-Celebration Health for seven years. Florida Hospital-Celebration is part of Florida Hospital, a seven-hospital system which includes seven hospitals and 14 walk-in medical centers. It is owned by the Adventist Health System. Florida Hospital is the largest Medicare provider and ranked No. 1 in inpatient admissions with more than 1 million admissions in 2004. Imaging volume stands at 800,000 exams annually.

Florida Hospital-Celebration Health opened its doors in 1998 as a state-of-the-art facility designed to trial new equipment. Agfa Healthcare's IMPAX™ and CR solutions were selected as the core imaging solutions for the new digital campus. The remaining campuses deployed IMPAX over the next year.

Florida Hospital-Celebration Health is in a major expansion mode. The system currently contains 1,776 beds with 600 beds slated to be added in the next few years. The main campus will add 300 beds, and the remaining 300 will be split among other campuses. The main hospital is building a new 14-story bed tower, which will house a state-of-the-art cardiac center, and several outlying campuses will add new bed towers.

Florida Hospital currently offers a full scope of imaging services across the enterprise, including computed radiography, digital mammography and PET-CT. The system plans to deploy two more PET-CT scanners, several additional 16-slice CT scanners and two 64-slice scanners over the next two years, with the first 64-slice CT scanner in central Florida set to arrive at Celebration Health late this month.

Over the last seven years, Grady has partnered with Agfa to deliver comprehensive enterprise solutions designed to meet the needs of all healthcare customers - including radiologists, clinicians and patients. Florida Hospital-Celebration Health relies on a variety of Agfa solutions for radiology, outpatient imaging, orthopedics and women's care. One outpatient imaging center uses Agfa CR and IMPAX, and a freestanding Women's Center uses IMPAX to view ultrasound images. The Women's Center also relies on the new Agfa IMPAX Embrace mammography workstation for digital mammography viewing. Other applications include the deployment of Agfa CR and IMPAX in a very busy orthopedic surgery practice. And finally, the hospital system relies on the IMPAX WEB1000 as its web-based image distribution solution.

The result of the comprehensive, high-quality approach to digital imaging is seamless access to data and images with a single repository for the seven hospitals and one outpatient center, the Women's Center and an orthopedic office.

Sally Grady discusses the ins and outs of enterprise image management

What results has Florida Hospital realized since implementing Agfa's IMPAX PACS solutions?
One of the initial benefits with IMPAX was the ability to provide 24/7 coverage at all campuses. Radiologists staff the main campus 24/7, but outlying campuses are covered from 8 a.m. to 5 p.m. With IMPAX, any images taken on night or weekends at outlying campuses are seamlessly transmitted to the main campus for interpretation. Results are available within six to eight hours for general work and usually within 15 minutes for Emergency Department exams at all campuses.

Florida Hospital deployed Agfa's WEB1000 solution in early 2000. How has WEB1000 fueled additional improvements?
The WEB1000 has benefited our referring physician population. For example, neurosurgeons typically rotate among our campuses and other sites. WEB1000 allows them to view images on the web from other campuses, providing instant anytime/anywhere access to the information to make clinical decisions such as transferring a patient to another site.

Orthopedic surgeons report other benefits. With WEB1000, an orthopedic physician can log onto the system using his electronic token to view the images from home, enabling him to review the case and eliminating the late-night drive to the hospital for the sole purpose of viewing images.

WEB1000 also facilitates consultation between clinicians and radiologists. Last year, a referring physician came to me in a panic, demanding a radiologist consult at 5:45 pm. We logged onto an IMPAX workstation to view the images and consulted with the late-duty radiologist at our main campus. The two discussed the case by phone, annotating the images and achieving a comprehensive remote consultation. With WEB1000, this can happen anywhere - the physician's office, nursing station or a home office.

How does WEB1000 facilitate patient care?
WEB1000 can be a real selling point in terms of patient care. Some of our outlying campuses may have only one or two radiologists scheduled for the day shift. WEB1000 provides seamless image access for all 50 of our staff radiologists. Patients understand that the most appropriate physician will always interpret their exam. For example, all neurology work is interpreted by the neuroradiologist, even if he is scheduled at a different location. If a specialist consult is required, images can be transmitted to a nearby workstation instantly for a rapid, expert diagnosis.

What are the financial benefits associated with WEB1000?
It's not fiscally realistic to place true 1K x 1K PACS workstations in nursing units or OR suites across all of our campuses. But we deploy the web on PCs to enable access to IMPAX [images] in these settings, providing additional, seamless digital image access throughout the enterprise. We do use PACS clients in select locations, but overall, WEB1000 is much more cost-effective and benefits more physician-users.

Also, image quality on the web is very good. This lets us move away from printing film. We have Agfa CD burners attached to several workstations and print CDs for patients and physicians whenever we can. The stumbling block is often on the receiving end; not all referring physicians are set up to enter the digital age and need assistance in integrating digital images into their practice.

How is Celebration Health helping referring practices transition into the digital age? And what is your solution for providing images to patients?
Orthopedic practices are a good example of offices unprepared for the digital world. Many remain designed for the analog age, with viewboxes lining the wall of each fracture room. They aren't prepped for patients arriving with images on CD. Most orthopods like to show the patient his or her images, so they need to consider having a PC in each room or using a laptop to view the patient's images using the web or a CD.

Several of our Adventist Health System-owned campuses have pulled ahead of the main hospitals and have convinced referring practices to transition to digital viewing. Such changes are often determined by the location and local competition. If local competitors offer CDs, digital viewing becomes a much easier transition for the physician. At the main Florida Hospital, we've started to burn a CD every time we print film for a referring physician. We send both film and a CD to the physician with an educational letter soliciting their feedback and informing them that digital images are the future.

Celebration Health tries to burn a CD for every patient in the Emergency Department, primarily because the hospital images a large number of tourists. We don't want to print film, and patients don't want to carry film home in their suitcase. CDs are practical, convenient and high quality. An added benefit is that CDs contain more information than a sheet of film. It's a matter of educating physicians and helping them change their practice to take advantage of digital technology.

How are imaging needs evolving over time? How has your PACS enterprise suite met the needs of Florida Hospital-Celebration Health?
We're working very closely with Agfa to determine how to move forward with new imaging technology. We've installed digital mammography, combining a Hologic acquisition unit with Agfa's IMPAX Embrace [digital mammography] workstation. Digital mammography technology is still in its infancy, and it's a challenge to maintain productivity. Embrace is a full-fledged multi-modality workstation that aids the process. Not only can radiologists view and interpret any type of exam on Embrace, but it also features tools for mammography interpretation such as advanced hanging protocols to increase productivity.

As we prepare to install 64-slice CT scanners, we're getting ready for the data onslaught. We need to determine how many slices are needed and how to store and access them for everything from a standard brain CT to a triple rule-out for aortic dissection, pulmonary embolism and acute coronary syndrome. We know that IMPAX can handle the data, and we're working with Agfa to proactively determine how to do it effectively.

What do hospitals require from an enterprise computing solutions provider?
For starters, hospitals need a good PACS installation. The vendor should come in and analyze the hospital's business and spec the system to meet their current needs. A good partner helps hospitals learn how to use new equipment to maximize productivity and efficiency. The hospital should feel confident that high-quality service will continue after installation and over the life of the investment. Agfa helps Florida Hospital by assisting us with productivity issues when installing systems, analyzing individual workflow and assisting with solutions that provide maximum productivity.

It's also important that solutions continue to meet the hospital's needs as it grows. The companies that a hospital partners with should anticipate and analyze future needs. It's a tremendous help to understand Agfa's three- to five-year vision and consider how that vision intersects with our needs. As Florida Hospital plans for new construction, it helps the imaging department to know what solutions will be available to help us become more efficient.

Agfa's solutions have met our needs extremely well. Since deploying IMPAX, we've continued to consider other products at trade shows like the Radiological Society of North America (RSNA) and the Society for Computer Applications in Radiology (SCAR). We remain convinced that Agfa markets the most comprehensive enterprise solutions available today.

What advice can you offer for sites evaluating enterprise image management solutions?
The good news is the process has become much smoother than it was eight years ago. I recommend that hospitals develop a working knowledge of PACS and how it changes operations. Sites also should understand what they need. Questions to consider include:
  • Are referring physicians satisfied? Why? How can the hospital better meet their needs? Agfa IMPAX solves the problem at Celebration Health by enabling 24/7 radiology consultations and by offering fast and convenient image availability to assist in the treatment of the patient. That is, images are available on the unit, and physicians can view the images and reports to make timely and often more accurate decisions regarding patient care.

  • What are patient care needs? What improvements will PACS initiate? Here, PACS provides complete patient access to all radiology specialists across seven campuses. What's more, the process is transparent for the patient.

  • An enterprise solution can help film/file room management issues. For example, in the analog world, physicians come to the file room and check out films. It's not uncommon for those films to disappear. PACS eliminates lost films. File room personnel responsibilities have changed since implementing IMPAX. Instead of looking for films and jackets, they assist referring physicians in accessing images on IMPAX workstations or on the web.