Digital Image Management and the Rural Healthcare Network
 Avera McKennan Hospital and University Health Center in Sioux Falls, S.D., is the flagship hospital of Avera Health, a five-hospital system serving eastern South Dakota and neighboring states. Avera McKennan is a 490-bed magnet facility that provides a cancer center, air ambulance, cardiac care, emergency medicine, trauma care, and more.

Avera Queen of Peace Hospital in Mitchell, S.D., is a typical small community hospital with 120 acute-care beds. The facility’s origins stretch back to 1906 when St. Joseph Hospital opened in Mitchell. In the 1990s, the hospital joined Methodist Hospital and became Queen of Peace Hospital. The new facility is marked by a pioneering spirit and aims to provide the finest medical care via state-of-the-art technology and services. During the 1990s, the hospital completed a $15 million expansion highlighted by multiple new and improved department and services including emergency services, operating suites, diagnostic imaging, cardiopulmonary care, and laboratory. Today, the medical center serves 15 counties with a comprehensive range of healthcare services.

Both hospitals are affiliated with more than 100 regional healthcare providers.

Although Avera McKennan and Avera Queen of Peace are separated by distance and operate in distinct arenas, they share common needs and goals. In the past two years, both hospitals have turned to GE Healthcare’s Centricity PACS SE as their solution for state-of-the-art image management.

Small site, major needs

Avera Health began to explore PACS solutions in earnest three years ago. After researching vendors, the hospital system narrowed the field to two providers. One year later, Avera Queen of Peace Hospital decided that the time was ripe for PACS.

Workflow was the primary driver, says Mike Kowall, vice president of radiology and clinical services. “We analyzed image delivery throughout the hospital. Our radiologists predicted that workflow would improve greatly with PACS.”

The hospital selected Centricity SE for several reasons, says Kowall. Avera Queen of Peace Hospital became the third hospital in the Avera Health group to opt for the same system. “The decision to deploy Centricity led to consistency among the group as images are transferred back and forth among sites,” continues Kowall. In addition, the hospital’s radiologists preferred the PACS over the alternative systems under evaluation. The GE solution provided a streamlined interface with the hospital’s HIS/RIS, a factor that weighed heavily with the IS team.

Prior to PACS implementation in December 2005, the hospital laid the groundwork by visiting other Centricity sites and holding meetings with various stakeholders such as the ER and nursing staff. The goal, says Kowall, was to prep the entire team well for PACS deployment.

The diligence paid off. From a workflow perspective, images are read and reported on in far less time. Physicians also can access images from home, which can enhance and accelerate care in stat cases.

The benefits of PACS extend beyond radiology workflow. An interface with the HIS enables users to pull up images within the electronic medical record. Physicians appreciate the ability to view the entire record — lab results, images and reports — at the same time, says Kowall. GE experts worked with the hospital’s IS team to enable the integrated solution.

The PACS provides a solid foundation for other technologies. “Having Centricity in place aided the implementation of 16-slice CT scanning,” says Kowall. The PACS project also helped users understand the benefits and nuances of digital image management. In addition, the archive more than suffices for the increased image volume generated by the new CT scanner.

A final important benefit is improved patient care. “Avera Queen of Peace Hospital does a lot of air and ground patient transfers to Avera McKennan. With GE Centricity, the images can arrive at the Sioux Falls hospital before the patient, which accelerates and improves patient care. What’s more, we have not lost a single sheet of film since deploying Centricity,” states Kowall.

The larger perspective

Avera McKennan Hospital is not a small hospital. The 490-bed hospital completes 120,000 imaging studies annually and serves as the regional magnet site for several smaller hospitals.

The hospital deployed GE Centricity in May 2004. A variety of factors — workflow, efficiency, film costs — contributed to the decision, says radiology manager Susan Calmus. “Prior to PACS, we were printing multiple images, up to 20 sheets of film for a single scan. And procedure volume had grown to the point where users could not easily access what they needed, so efficiency suffered,” she explains.

Centricity has allowed the hospital to improve management from several angles. Radiologists and technologists have become more efficient in work processes; the hospital has regained filing space, and film and chemistry costs have been cut. The PACS integrates very well with the RIS, says Calmus. “Orders can be placed in the RIS and readily transferred to Centricity.” The web-based solution also facilitates access by referring clinicians housed at outside clinics. The physicians access patient images stored on PACS via a virtual private network (VPN).

Finally, PACS plays an important role in the regional provider’s teleradiology program. Avera McKennan provides teleradiology services for 20 hospitals. Images are sent to an outreach server at Avera McKennan. “If the patient is transferred to our hospital, current and prior images are easily merged onto Centricity from the outreach server,” explains Calmus. “The multi-site image management process is especially streamlined with other Avera hospitals that use Centricity. We’re able to merge images taken during the patient’s stay at Avera McKennan with images acquired at the ‘home’ hospital,” continues Calmus. Prior to PACS, the process was manual and cumbersome. Often, the only set of images for both hospitals might be located in an inconvenient location such as the OR suite, which could compromise patient care.


“This is a great step in the right direction,” opines Kowall of the small hospital Avera Queen of Peace. “The speed of image delivery has allowed the hospital to improve patient care and workflow.” Staffing issues are minimized with PACS as well. The hospital has reduced film clerk hours and reassigned the film management workload to meet other needs.

The situation at Avera McKennan is similar. The radiology department managed to trim its clerical staff from five to two because of reduced filing and film transfer demands. Workflow and patient care also have benefited, says Calmus. And PACS complements the larger vision for the Avera Health System. The system plans to move its 100 sites to a common HIS and patient index number for streamlined access to patient reports.