PACS as an enterprise resource: digital imaging comes of age, as improved Web, storage, network and EMR technologies support its extended reach throughout the healthcare enterprise - PACS/Radiology

Health Management Technology, Nov, 2003 by Richard R. Rogoski

Snapping an X-ray film onto a wall-mounted light box might be the way they still do it on television, but many radiologists and referring physicians now view diagnostic images on computer monitors.

The decision on the part of hospitals to invest in both picture archiving and communication systems (PACS) and radiology information systems (RIS)--especially those using integrated Web technologies--has meant that X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scans can now be accessed by more caregivers and from more locations.

For Matt Ebaugh, senior vice president and chief information officer of Commonwealth Health Corp. in Bowling Green, Ky., being able to offer greater access to images was vital to running an efficient healthcare organization. It operates two small hospitals, each about 30 miles away in predominately rural areas, in addition to the flagship 400-bed Medical Center in Bowling Green.

Its radiology group, which provides all radiological services at Commonwealth Health, was involved in the decision-making process for choosing a PACS and has greatly benefited from the PACS implementation. However, the organization's February rollout of the Synapse PACS from Fujifilm Medical Systems USA Inc., Stamford, Conn., provided a much-needed link for physicians, too. "We're a Six Sigma hospital, and we're very active in improving our service to our referring physicians," Ebaugh says. "Initially, it was designed with the referring physicians and critical care specialties, such as ED and ICU doctors, in mind. Now, every caregiver in our health system is using it."

Physician Needs

According to Ebaugh, physicians want two outcomes from diagnostic imaging: fast report turnaround and fast image distribution. "To achieve this, especially within a multisite, rural setting, we needed the capability to move images electronically to the radiologists who are primarily centralized at our main hospital. PACS was the only alternative," he says. "As a result, our patients now have the flexibility to go to any campus and still receive a high standard of care and expedited service." Kiley Rodgers, PACS/IT administrator at Rush-Presbyterian-St. Luke's Medical Center in Chicago, says purchasing the SIENET MagicStore PACS from Siemens Medical Solutions Health Services Corp., Malvern, Pa., three years ago was meant to facilitate the distribution of images and save money. "The goal was to increase access to information and to reduce costs through a reduction of FTEs (fulltime employees)," he says.

The 650-bed hospital, which is affiliated with Rush University Medical School, already had a computed radiography unit in place, but was still using film. That has since changed. "It took us about a month to go from 100 percent hard copy to 100 percent filmless," Rodgers says.

Ebaugh says his healthcare organization also is on the road to becoming totally filmless, although he admits it is now about 85 percent there. "Unfortunately, the ability for us to communicate seamlessly with other providers in this manner simply isn't there yet," he says.

Facing a similar situation is Gary Jump, chief information officer at the Baton Rouge, La.-based Our Lady of the Lake Regional Medical Center, where all of the critical care units (CCUs) are filmless, but the ED is only 50 percent filmless. However, since all radiologists in the 850-bed hospital now read digital images, Our Lady of the Lake should be 100 percent filmless before the end of the year, according to Jump.

Since Our Lady of the Lake had purchased the majority of its hospital information systems from Kansas City, Mo.-based Cerner Corp., the healthcare organization again turned to Cerner when looking for a RIS and PACS. Investing first in the Cerner RadNet RIS, the hospital then purchased Cerner ProVision PACS and is currently piloting Cerner ProVision Web solution.

Although the hospital has yet to realize savings from not having to buy film and related supplies, Jump says the real return on investment is coming from increased efficiency. "Turnaround times are faster, and lost films are a thing of the past."

Extending the Enterprise

The inclusion of a PACS has extended the enterprise for each healthcare organization, creating a seamless link between radiology systems and other hospital information systems. Since all three institutions use some form of an electronic medical record (EMR), this link provides physicians with greater access to patient records and a more complete, up-to-date view of those patients.

Getting those who would be most involved with SIENET on a day-to-day basis at Rush-Presbyterian-St. Luke's did not present much of a challenge, according to Rodgers, since all of the file room techs were cross-trained. "PACS is based on workflow, and if there's anyone who knows workflow, it's the file room techs," he says.

Nevertheless, there are some who may consider a PACS more valuable to the radiology department than to the rest of the hospital. "One of the biggest nontechnical challenges was working with all staff to get them to relate to the technology as an enterprise technology, not something that belonged in, and was controlled by, the radiology department," says Rodgers.