PACS Brings Time and Money Savings to Blanchard Valley Health Association
By Chris Swanson, Vice President, Clinical Services, Blanchard Valley Health Association, Ohio
Blanchard Valley Health Association (BVHA) is a comprehensive, state-of-the-art health system offering Northwest Ohio a full continuum of care. For acute-care radiology services, BVHA offers two main campuses, with locations in Findlay and Bluffton, Ohio, along with a free-standing imaging center. Blanchard Valley Regional Health Center's Findlay campus is the location of the flagship facility, with 150-beds, level 1 trauma status. Annually, the facility completes 100,000 imaging studies. BVHA runs a mixed Meditech environment, using Meditech ITS for Radiology, and PCI for electronic medical records, effectively providing clinical information and radiological images to desktops throughout the enterprise.
BVHA selected Amicas Vision Series PACS to propel the organization's transition from film-based radiology to PACS. The changes have been breathtaking, providing tangible returns to the association, BVHA providers and the patients in our community.
Nearly two years ago, BVHA developed a strategic plan which focused attention on improving the technology infrastructure of the institution. Some of the challenges we were facing as an organization included significant physician dissatisfaction with report turnaround and accessibility to radiology; increasing film expense with the advances in CT and MR imaging; diminishing space for film storage; lost films; poor service excellence scores and operational inefficiency.
When we initially pursued PACS, we had a solid, enthusiastic team complete with clinical, administrative, biomedical and technical champions, including Jill Feehan, our current PACS administrator and former lead technologist, and Angela Dougherty, our Meditech clinical analyst. We also chose to engage a nationally-recognized consultant to assist us with the comprehensive selection process. Partially through selection, BVHA experienced an event that would cause most departments to come to a screeching halt on projects of any size, let alone PACS: contract disputes with our six-member radiology group erupted and eventually resulted in their departure from our organization. Instead of burying our heads in the sand, we re-doubled our efforts, with full knowledge that the forthcoming PACS would be a key differentiator for ongoing recruitment. Indeed, just knowledge that the PACS was coming helped us retain two members of the former radiology group, who decided to return to BVHA and form a new radiology group.
Following a nine-month selection, we chose Amicas due to their proven Meditech expertise, and depth of product suite.
The clinical, workflow and financial improvements that have taken place at BVHA have been possible due to the strength of our team, the flexibility of the PACS, along with the Insight Services group at Amicas. The web-based architecture of Vision Series PACS has allowed our users, who were not PACS experts pre-PACS, to become astute on PACS very quickly. The simplicity and pervasiveness of the tools literally mean that any application can be recalled anywhere in the enterprise based upon user ID. All of the system configurations are implemented using a graphical user interface, which has enabled us to really push the capabilities of the PACS to every corner of BVHA. We've implemented an advanced SAN solution so all prior exams are on-line regardless of when they were imaged, electronic medical records integration are available for referring physicians in Meditech PCI, deployment of viewers has occurred in all major clinical areas such as the ED and ICU, and we've extended RealTime Worklist access to all staff members central to radiology workflow. This is significantly different than other worklists we evaluated, that were strictly purposed just for radiologists. To further enhance workflow, our lead technologists developed handbooks for business continuance in each department for real-world downtime events (e.g, down network, application unavailability). This has dramatically increased the confidence of our end-users, and has provided BVHA a great training tool as new staff members are brought on board.
Positive feedback, saving money
In addition to the clinical, workflow and financial improvements brought about, PACS also has boosted morale. Pre-PACS, our technologists and film file room staff used to literally walk the "Green Mile," as they affectionately called it due to our green floor tile, to deliver jackets for interpretation by our radiologists. This walk was made dozens and dozens of times per day by our staff, interrupting their day excessively, and limiting the amount of time they could spend with patients. Now with PACS, the "Green Mile" is effectively eliminated for the distribution of jackets and film, since cases are available digitally on-demand anywhere in our enterprise.
In addition, we have recorded a phenomenal 50 percent increase in patient satisfaction scores. We credit the improvement to reduction in lost films; the increased time technologists are now spending with patients instead of entering data and looking for films; and the satisfaction of the referring physicians and the radiologists.
BVHA has been live since May 2004 and in that period of time we have noted a reduction in film expense of 61 percent - which exceeds our expectations by 21 percent. This reduction in film expense was realized despite the fact that we are not yet live with mammography and surgery due to some renovation projects in those areas. Some of the other measurable benefits we can attribute to the implementation of PACS include the following:
- Reduction in labor expense of approximately $50,000 on an annual basis
- Reduction of 450 square feet of file room space, allowing us to repurpose the space for revenue generating clinical services
- 14 percent increase in MR volume
- 6 percent increase in CT volume
- 30 percent reduction in report turnaround time
- Consolidation of radiologist reading rooms into one central location, improving access to radiology for the referring physicians
- Significantly improved physician satisfaction
Despite our size and pre-PACS expertise, we've accomplished more in a matter of months than many IDNs have accomplished after years of using PACS. PACS touches everyone and every department at BVHA, providing access to images, workflow and administrative tools everywhere. Our users are empowered, our administrators are informed, and are patients are better served. But we're not done yet - the PACS continues to grow with us as we expand our imaging services, and continually optimize our use of RealTime Worklist to improve workflow.
PACS Success for the Community at Shannon Medical Center
By Bill Wilson, Chief Information Officer, Shannon Medical Center, San Angelo, Texas
PACS provides quick, easy access to radiological images and brings significant financial benefits as well. Shannon Medical Center in San Angelo, Texas, found this to be true when it installed a new PACS in 2003 that improved satisfaction among patients and staff and saved the hospital more than $250,000 in the process.
Shannon Medical Center is a 400-bed, non-profit hospital that serves a 21-county region in rural central Texas. We provide comprehensive emergency, inpatient and outpatient services and annually see 12,000 inpatient admissions, 87,000 outpatient visits, 55,000 ER visits, and more than 70,000 radiology procedures. In 1998 we implemented a document imaging solution from McKesson in the medical records department as the first part of a strategic plan to deliver a completely digital patient record. Our clinicians quickly realized the benefits of the solution and showed great interest in the next step in the hospital's vision - going digital in the radiology department.
At the time, radiology used a courier service to distribute medical images to physicians. However, escalating costs, coupled with demand from referring physicians for better access, created the ideal environment to look at alternative methods of distribution. Early in 2003, the hospital administration approved the acquisition of an electronic medical image management system.
We formed a steering committee comprising key decision-makers - the chief information officer, director of radiology, chief radiologist, physician leaders and others. The group established criteria and objectives for the project and began interviewing vendor candidates. Because the earlier deployment of McKesson's document imaging product had been so successful, and because McKesson's Series Radiology and Horizon Medical Imaging systems met the needs of the department and provided good product support, the committee ultimately decided to choose McKesson.
Once the contract was signed in March 2003, the steering committee set a "go-live" date for six months later. Rather than using a gradual approach, the committee decided that the actual implementation would take place with a "Big Bang" within the course of just one week. To accomplish this goal, we needed to plan for a top-to-bottom change in the way radiological images were handled throughout the entire facility, not just in radiology. The challenge was to train staff, align systems and review processes within six months.
The radiology department realized that the greatest benefit in switching to PACS would be to eliminate films from 70,000 radiological procedures per year - and the expense of processing, distributing and storing them. Another goal was to enable physicians and radiologists to review radiology results more quickly to reduce wait times for patients undergoing tests, a stubborn spot of dissatisfaction in our otherwise high-scoring Press Ganey patient satisfaction reports. Additionally, by implementing a totally automated system, we hoped to realize more efficient use of staff hours, increasing job satisfaction levels among radiology department members.
Not long after the successful implementation and go-live, the department met these goals and was able to document successful results. During the year after install, turnaround time on radiology reports was cut in half. And the number of transcribed reports was reduced by 30 percent with the use of three-click reports, a unique feature that allows radiologists to choose from a list of report templates and send a final report with only three mouse clicks.
The department nearly eliminated film and courier costs, saving $260,000 annually. We no longer needed to devote 400 square feet of space in the radiology department for film storage, so we were able to reallocate that space for stereotactic biopsy procedures that had been done in a building across the street from the hospital. Meanwhile, because radiology was able to automate many manual processes, productivity improved by 8.5 percent.
Other areas of the hospital also benefited from the new system. Physicians were very pleased and adopted it rapidly. Shortly after implementation, 100 percent of the emergency department, ICU, and operating room staff began to use the system. Surgeons now use wireless workstations in the OR to display PACS images.
More importantly, patient satisfaction scores related to imaging improved significantly; they are now at or above the 95th percentile goal we have set for all Press Ganey reports. The satisfaction of radiology department staff also has improved, according to our annual associate satisfaction survey. Job stress improved by eight percentage points in a year - and that was a year during which PACS went live and many processes changed. Radiologic technologists were pleased that they could spend more time with patients because they weren't so focused on the film process.
The new system has improved processes within radiology as well as interactions with other members of the care team. Physicians are more satisfied. A physician survey before implementation included 12 negative comments about radiology; after implementation there were no negative comments. In fact, the PACS drew a positive comment from a physician who noted that it had made work easier. At a recent hospital board of directors meeting, the chief of medical staff described how much time he was able to save that day when two different patients needed images reviewed. Instead of rescheduling them to come back another day so he could have time to review the case in person with a radiologist, the physician was able to view the images and speak with the radiologist by phone before the patients left his office.
The PACS also has enabled radiology managers to review their procedures and improve them. For instance, Maribel Rios, the director of radiology, notes that nurses are more precise about the information they enter into the system because it inevitably ends up on the radiology report. Additionally, information is more consistent, and the elimination of manual "hanging" of films has dramatically reduced time from image acquisition to interpretation.
Since going live, on Horizon Medical Imaging, we have added McKesson's HorizonWP Physician Portal, a web-based tool that gives physicians remote access to images and information in their offices. For outside referrals, hospital staff can burn a CD with images instead of printing film to accompany the patient or medical record.
Today Shannon Medical Center sees a number of improvements as a result of our IT strategy. Medical professionals benefit from online access to radiological images as well as other patient information. We have reduced costs and improved satisfaction. While, physicians, as the driving force behind the change, benefit from the time-saving features of a well-implemented new technology, it is the patients and their quality of care that ultimately receive the most benefit.