No more missing films. No more empty file jackets. And no more wasted office space crammed full of x-ray films, folders, chemicals and processors. And that’s just the icing on the cake: the overall improvements in practice efficiencies and patient care, along with a quick return on investment are among the concrete benefits of adopting an orthopedic picture archiving and communications system (PACS) to store and retrieve digital x-ray images via a computed radiography (CR) system.
That’s the experience of both Douglas Halstad, MD, an orthopedic hand surgeon with New England Orthopedic Specialists in Peabody, Mass., and Jim Colone, MD, director of medical imaging services at Syracuse Orthopedics in Syracuse, N.Y., whose practices installed comprehensive PACS to facilitate image flow for their specialists both inside and outside their offices.
“Our return on investment has been remarkable,” says Halstad. “It doesn’t require any fuzzy logic to see that we have immediately realized savings. We’re not spending money on film and chemicals or using valuable space to store patient files and films. And with our [NovaRad] NovaPACS, we’re able to scale it up without incremental price increases.”
A comprehensive PACS solution, Colone says, is well worth the investment, especially for a group with multiple locations as specialists can view images immediately from wherever they are. “We move images much more quickly with the PACS in our two-story facility with multiple providers,” he says. “Frequently, the images beat the patients back to the exam room and they are very surprised.”
New England Orthopedic Specialists uses NovaRad’s NovaPACS with the Orthopedic Template Library. Syracuse Orthopedics employs a GE Healthcare Centricity PACS.
As a fairly early adopter of the orthopedic PACS technology in Boston’s North Shore, New England Orthopedic Specialists benefits from its image on the cutting edge of technology with the adoption of the PACS. “Patients are impressed with the digital images and the speed at which they are available, and that has helped our image in the community as being progressive and forward-thinking,” he says.
Accessibility for physicians—orthopedists and radiologists—is another benefit of an enterprise-wide PACS adoption. Syracuse Orthopedics has six offices, and the specialists at various offices can view both new and archived images in the system immediately from any location, including their home offices. While referring physicians are generally not interested in viewing images, it’s an option as well within system capabilities as physicians in the community upgrade their own systems so they can receive and view images via high-speed internet connections and workstations with enhanced graphics capabilities.
Syracuse Orthopedics conducts imaging studies for outside physicians, a business which accounts for 10 percent of the total images processed. Those outside physicians view the images on CDs provided by Syracuse Orthopedics; down the road, as capabilities increase, they could connect into the PACS via a secure internet connection. “Eventually, they’ll be able to access their images from the web, as will the entire healthcare community, but that, as they say, that will take a village as the entire community will have to buy into a local web network,” Colone says.
For patients who need to take along copies of their images, CR images stored in the PACS make it much easier to provide those images on demand. “Previously, we had to tell patients who needed copies of their images that they had to call in advance and then we had to spend staff time getting copies of the films,” says Colone. “Now, a patient can just come by the office and we can burn a CD right away and have a copy he or she can take to physicians who are accepting of CD images.”
Halstad has noticed improvements in workflow that have resulted in reduced patient wait times and made it much easier to move patients and images through the facility. Couple the PACS with electronic medical records, as New England Orthopedic Specialists and Syracuse Orthopedics have, and the improvement in workflows is evident.
Furthermore, the storage and retrieval of digital images banishes the chronic problem missing x-rays and lost folders, a continual irritant for orthopedic practices. “We can employ our people more efficiently because we don’t need them to move, sort and handle film all day,” says Halstad.
Colone agrees, saying, “Films and folders were constantly getting misplaced, and we’d have to have all the doctors clean out their cars and trunks to find lost films. And it was a logistical nightmare transporting images from one office to another. Inevitably a patient would come into an office, and the film wouldn’t be there, so they would have to go home and come back. Now, we have instant access at all locations which is better for patients and physicians all the way around.”
The cost savings for practices in areas where office space is expensive is considerable, notes Halstad. New England Orthopedics can now employ rooms that were used to store film, chemicals, processors and patient image records for patient care or other necessary functions without incrementally increasing spending on storage elsewhere, because digital storage is cheap, he says.
Higher quality images
While the quality of film x-rays is generally good, orthopedists and radiologists benefit from the increased clarity of digital images. “We have a higher quality of image than with film,” says Halstad. “Because we can digitally enhance the images, such as changing the contrast, we can see soft-tissue problems, for example, much more clearly resulting in a much higher quality study.”
Specialists also have previous patient images and studies at their fingertips, so they can compare images on demand. Colone praises the high quality of the GE digital PACS images, noting that they are clearer than the film images the practice used previously.
The higher quality images result in improved surgical outcomes for orthopedists, as surgeons can use the images to plan their surgical approach. Surgeons utilize built-in orthopedic tools that include a complete template library with screws, nails, plates and prostheses, to electronically overlay on an image, ensuring a better fit during surgery. NovaPACS, as well as software from other vendors, also allows surgeons to simulate fracture reduction, osteotomy and trauma.
Installation & Upgrades
Installation of any new system can create major headaches for physicians and staff, let alone a complete transformation in the way an orthopedics practice uses images. Halstad, however, was impressed with the smoothness of his PACS installation and the fact that NovaRad staff stayed on site until all issues were resolved and the system was up and running smoothly.
In addition, the practice can add workstations in its current location and also scale out to any new locations it might add without incurring lots of additional costs; also, software upgrades are included in the ongoing costs of the system, which means the practice will always have up-to-date software without paying extra or having to undergo major hassles or switch vendors.