Smooth Talk and Smart Operations
Southern Ohio Medical Center is a 232-bed, acute-care facility located in Portsmouth, Ohio. Seven radiologists provide a full complement of medical imaging services including CT, MRI, mammography, ultrasound, bone densitometry, nuclear medicine and PET as well as diagnostic radiography. The center is slated to complete 168,000 imaging procedures in the fiscal year ending June 30.

Our enterprise started its PACS journey in 1996 with the goal of improving efficiency and service to referring physicians. After a two-year evaluation process, in November 1998 Southern Ohio Medical Center installed Agfa IMPAX PACS, which the evaluation team agreed represented the most complete solution on the market.

Strong selling points for radiologists included the IMPAX toolset, which they insist is the largest on the market. Moreover, applications and tools could be configured for each individual user. This feature may be near standard today, but in 1998 it was quite unique and it has continued to expand. From the IT and image management perspective, the ability to accept non-DICOM modality images as JPEG or TIFF files was a significant advantage. Similarly, the manufacturer-independent platform assured the team that the PACS could accept images from all of our medical imaging systems without technical glitches that might require an interface. Finally, Agfa offered IMPAX as a turnkey solution, by contracting for HL7 interface programming for our legacy Cerner RIS and our Stockell Information Systems HIS.

Shortly after deploying IMPAX, it became apparent that we had invested in a solution that would facilitate our goal of enterprise-wide efficiency. The primary benefit of the initial installation was a dramatic drop in turnaround time. Prior to deploying the IMPAX solution, turnaround time hovered in the 20-hour range. Post-IMPAX, it plummeted to less than 12 hours. Plus, radiologists gained the ability to read studies in near-real time while the patient was in the ER or ICU, improving service to both referring physicians and patients. There were no more lost images, and electronic distribution of images was a great improvement over film-based processes.

The drive to improve: part two

The initial IMPAX deployment enabled us to realize significant benefits across the enterprise; however, over the next few years, we realized we could gain additional efficiencies throughout the medical center by incorporating speech recognition in the radiology department. By 2002, radiology report turnaround time had dropped to a mere nine hours, but it remained stagnant at that point.

The medical imaging department adopted a bold goal - to create instant reports for referring physicians. Speech recognition software could provide the vehicle for the medical center to achieve our goal.

Once again, we set off on a two-year evaluation process, eventually selecting Agfa's TalkStation and IMPAX RIS as the solutions to fuel improvement. Both solutions were deployed as a single project in November 2004.

The combination of the paperless IMPAX RIS, IMPAX PACS and TalkStation has yielded great gains in productivity. Report turnaround time has fallen from nine hours to an average of less than two hours from the time the patient enters the medical imaging department to the creation of a signed final report. Typically, our radiologists sign reports within one hour of receiving images. Although these figures are impressive, they are 24/7 averages. From 7 a.m. to 5 p.m. Monday to Friday, turnaround time is under 30 minutes. 

At Southern Ohio Medical Center, we've configured IMPAX RIS to run an active worklist. Our radiologists sign in one time and all IMPAX and TalkStation applications begin running. In practice, this means a radiologist can sign off on one report and the next case pops up. IMPAX RIS populates demographic information, the radiologist dictates his findings and signs the case. It is a two-click process to open, approve and report exams. Radiologists also have access to the full worklist, which means that they can pick up and read any open, available case.

TalkStation did present one surprise. We had not planned on implementing full self-editing with our radiologists, but under the leadership of a radiologist who had been reluctant to use the technology, radiologists decided to complete their own editing rather than sending reports to transcription for editing. All seven radiologists began self-editing on day one. Within a few weeks, radiologists had created templates, macros and standardized reports to boost efficiency and productivity.

Similar to IMPAX PACS, the move to TalkStation speech recognition software has had benefits across the enterprise. When we went live with TalkStation, we had three open transcriptionist positions at an annual cost of nearly $200,000 in wages and benefits. Self-editing by radiologists has allowed the center to save transcription labor costs. Those positions remain unfilled. What's more, the remaining 16 transcriptionists are freed up to concentrate on reports from other departments.

Turnaround time for non-radiology reports has dropped, and the medical center no longer farms out dictations to a third-party service.

Integration plus

Southern Ohio Medical Center is poised to deploy IMPAX 6.0 in 2006. The newest release will provide more complete integration between IMPAX RIS/PACS and TalkStation. The RIS component will be immediately available to radiologists as a complement to PACS rather than a separate application. This will bring additional workflow improvements allowing radiologists to access the RIS - and physician orders and requisitions - from the IMPAX interface.

Such continuous process and technology improvements represent the level of service that Agfa delivers. At Southern Ohio Medical Center, Agfa has transcended the role of PACS vendor to technology partner. In the medical imaging department and across the enterprise, we count on Agfa to deliver the imaging and IT solutions necessary to improve service and efficiency.

Luis Marquez is Administrative Director, Medical Imaging and Howard Stewart is RIS/PACS Administrator at Southern Ohio Medical Center.