Inside the State-of-the-Art Community Hospital
 Grenada Lake Medical Center in Grenada, Miss., is located midway between Jackson, Miss., and Memphis, Tenn., and serves both states’ populations. The 156-bed, acute-care hospital exemplifies community commitment and aims to provide patient care equal or superior to that available in larger sites and urban locales. The medical center provides a full range of services including radiology, oncology, orthopedics, and family medicine to the 23,000 residents of Grenada County and those residing in seven surrounding counties.

Grenada Lake Medical Center manages to achieve the extraordinary. The hospital combines its commitment to patient care with both state-of-the-art technology and fiscal responsibility. “Grenada Lake is a community-owned hospital. We operate in the black even though we are not subsidized by the county. Plus, the hospital manages to remain up to date with the latest healthcare technologies,” explains Murray Dozier, director of radiology.

The latest evidence of that commitment is a new PACS, a facility first. The digital image management solution, GE Healthcare’s Centricity PACS SE, enables caregivers to provide state-of-the-art patient care. But the benefits of PACS extend beyond clinical excellence to increased efficiency and improved workflow. At the same time, the PACS provides a firm foundation for upcoming advanced technology implementations including 64-slice CT.

The right place and right time

Grenada Lake deployed Centricity PACS SE in August 2006, but the roots of the project are several years old. In fact, the hospital’s chief financial officer had placed the PACS project on hold three years ago, says Dozier. The hospital had evaluated mini-PACS to determine if a scaled-down model might meet the needs of a their hospital. The answer was no.

Two related factors led to the decision to postpone PACS, says Dozier. “We realized that generation of PACS technology might not meet the medical center’s future needs,” notes Dozier. Grenada Lake prides itself on investments in advanced technology. “The local competition relies on basic imaging technology. The hospital invests in advanced technology, allowing it to maintain a competitive edge,” states Dozier. One planned future investment that requires a robust PACS as a prerequisite is 64-slice CT. “A mini-PACS probably could not accommodate a 64-slice CT scanner,” notes Dozier.

The hospital’s clear vision for future imaging deployments translated into a second reason for delaying the PACS investment; if a mini-PACS reached premature obsolescence, it could prevent the hospital from realizing the full benefits of its investment. Given the potential negative financial implications associated with a mini-PACS, the medical center decided to wait. “We chose not to forget about PACS, but to wait for a full-fledged solution that could meet both current and future needs,” states Dozier.

Efficiency realized

By 2006, PACS technology had reached the point where Grenada Lake was comfortable making the investment, since system features and functionalities were robust and issues such as integration within the department and across the enterprise had been addressed. Also, Grenada felt the system was scaled to the needs — and budget — of a small community hospital. The Grenada Lake PACS team completed many site visits and evaluated various vendors. “From the PACS administration perspective, the degree of user-friendliness was very important,” explains Cristy Seibel, PACS and RIS administrator.

Seibel felt Centricity PACS SE provided a high degree of user-friendliness, which could lead to simplified training programs and, in turn, facilitate widespread adoption among physicians. As an added plus, Centricity complemented the hospital’s RIS with a similar training program. Two final factors put the system over the top in the selection process. The first is longevity. “We knew GE would not be bought out in two years, they had staying power as a vendor,” explains Seibel. In addition, the company employs a healthy network of field engineers, including one located a mere 30 minutes from the medical center. That was a big selling point in the rural south. If a problem arises, the hospital won’t need to wait a day or longer for someone to fly here, says Seibel.

As further evidence that the time for PACS has arrived, the implementation at Grenada Lake produced fairly rapid results. The hospital installed PACS in August, and by October the radiologist reported a 50 percent improvement in reading efficiency for digital modalities.

The facility, which is so closely tied to the community it serves, recognizes that the value of PACS transcends the radiology department. Referring physicians rely on Centricity Web. “Centricity benefits the entire community,” Seibel explains. “Radiology workflow is faster, so we are able to serve more patients. It also speeds up referring physician workflow and accelerates patient care.”

Seibel provided one-on-one training for the hospital’s 30 referring physicians. “We want to develop great relationships with our referring providers,” says Seibel. She went to each office individually to demonstrate how to use Centricity Web and answer any questions clinicians had. The personal approach paid off.

Two months after deployment, only four physicians continue to request film. Film costs for digital modalities have been reduced by 75 percent, and the hospital is aiming for an additional 20 percent reduction by the end of the year. The hospital plans to reduce film use further by offering additional individualized attention and technical instruction to encourage the slow adopters to transition to CD or web access.

Clinicians that use the web have realized several key benefits. “With Centricity Web, our referring providers have images and reports at their fingertips in their offices and at home. This translates into faster diagnosis and accelerated patient care,” states Dozier. This benefit is especially important at night, says Seibel. An ER physician can call a referring physician at home; both can view images online and conference by phone to eliminate late-night drives to the hospital.

Tips for PACS success

Community hospitals are discovering and adapting best practices for PACS evaluation and deployment. Grenada Lake has realized significant and rapid success. The PACS team leaders share some insights and advice:
  • Secure the financial commitment from the CFO and CEO, says Dozier. For decision-makers to commit, they need to understand PACS, so the radiology department must educate them.
  • Consider inviting referring physicians into the process. Grenada Lake invited referring clinicians to PACS demonstrations. This not only provided preliminary education but also helped to secure buy-in and boost adoption.
  • Don’t oversell the financial benefits. “In a small institution, it’s very difficult to guarantee financial payback. We are saving $70,000 in film and chemistry costs, but it’s balanced by the new cost of the service contract. The intangible benefits of PACS outweigh the cost-benefit analysis,” says Dozier.
  • Complete multiple site visits to hospitals of comparable size, communities, and departments. Sit at the workstation, and get a feel for its use and functions, he adds.
  • Evaluate three to four vendors. “An OEM that has demonstrated sufficient research and development and has a good market share merits strong consideration. They will be in business for the long haul,” states Dozier.
  • Go virtual. “Don’t buy PACS without a web solution,” says Seibel. “Centricity Web ties PACS to the whole community.”
  • It’s clear. PACS need not be limited to large hospitals with relatively deep pockets. Small sites can reap the benefits of digital image management with the right PACS that provides a robust, full-featured system. Centricity SE enables small community hospitals like Grenada Lake Medical Center to provide image management processes comparable to its larger colleagues — it also allows them to keep current with cutting-edge technology. At the same time, the hospital is reaping the benefits of PACS — improved workflow and efficiency and enhanced patient care.

    The IT Angle
    PACS is an enterprise project, and a key part of the transition to digital image management lies within the IT department. How does the small hospital IT department prepare for PACS?

    The question that tops many sites’ lists is: Can the network handle PACS? Patrick Crum, IT director at Grenada Lake Medical Center in Grenada, Miss., outlines the process at the community hospital, which deployed GE Healthcare’s Centricity PACS SE in August 2006.

    “We made sure to ask about networks on our site visits,” recalls Crum. Prior to PACS, the hospital relied on a flat network, but Crum and his colleagues realized that the addition of PACS and the planned acquisition of 64-slice CT would increase traffic and could tax the network.

    “We decided to segregate the PACS network from the main hospital network,” says Crum. GE provided networking assistance to split the hospital’s gigabit network.
    The medical center also considered IT stability. “We realized the distance between the server room and the furthest image modality might be at the outer edge of the 100-meter limit on CAT 5 cabling, so we added a second layer three switch in the middle of the line,” explains Crum.

    Another logistical challenge occurred as the hospital transitioned from a single network printer to PACS; all modality vendors needed to change simultaneously their IP addresses from the printer to PACS. “It took a month to coordinate all of the vendors,” says Crum. The lesson? Prep for the switch early in the process.
    Some facets of the PACS deployment garnered additional IT benefits. Consider Centricity’s Intel Xeon platform. “The Xeon platform delivers outstanding performance. We like it so much that almost all of our newest servers and planned future servers in the data center are Xeon,” reports Crum.

    A final change was simple. Grenada Lake’s server room was at its temperature limit prior to PACS; the hospital made way for the additional server with a new five-ton air-conditioning unit. The unit did have a domino effect and required Crum to find space for two employees displaced by the air conditioner.

    All in all, says Crum, the challenges were small and manageable. “PACS is not a burden for the IT department at the small hospital,” opines Crum.

    The IT director provides a basic recipe for success.
    • A good IT team and a dedicated vendor partner provide the foundation for a successful project.
    • Make sure to make enough time in the schedule for PACS projects, says Crum.
    • Make the best use of resources; don’t involve everyone in every aspect of the project, or it could impact other IT duties. Crum played the lead IT role and was solely responsible for site visits and vendor conference calls.