|
From the November 2003 Issue PACS as an Enterprise Resource |
PACS as an Digital imaging comes of age, as improved Web, storage, network and EMR technologies support its extended reach throughout the healthcare enterprise. By Richard R. Rogoski
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
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 (full-time 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.
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. Training also went smoothly during the ProVision rollout at Our Lady of the Lake, according to Jump, because a physician liaison led the transition effort and physicians were encouraged to attend training sessions. But, he adds, “you have to tailor the system for each group’s individual use.” The ability to extend an enterprise by adding a PACS, and to make that transition as painless as possible, often depends on the system’s ease of use and its integration with other hospital information systems. For Jump, integration was no problem, because Our Lady of the Lake uses Cerner’s Millennium EMR, which means that all radiological images become part of the patient’s medical record, and all of the information in the EMR is also part of the radiological workflow. “Once you’re on the Cerner architecture, you’re pretty much integrated,” he says. For Ebaugh, it took a number of site visits and consideration of multiple factors, such as system architecture, product support and the company’s future development plans for its products, before Commonwealth Health narrowed its search to three PACS vendors that included Fujifilm Medical. “We are predominantly a Dell and EMC shop when it comes to our server and SAN (storage area network) fabric. Fujifilm works very well with these vendors, which lessened my worries when it came time to bring the system live,” he says. Moreover, Synapse is a Web-based product—an invaluable feature for Ebaugh. “With many other solutions, vendors use a hybrid imaging server with a separate Web server for referring physicians and clinician access. But if connectivity to that Web server goes down, the majority of individuals won’t be able to access any images,” he says. Rodgers also considered potential problems that could arise when accessing images using integrated, Web-based technology. Rush-Presbyterian-St. Luke’s stores all images produced by the radiology department in-house by using the StorageTek L700, which offers 14.5 TB of storage, but the medical center also has created a strategy to safeguard these images. “Most PACS use a centralized architecture, where images are sent to a central server, but we use the system on a distributed architecture,” he says. With a rules-based distributed architecture, images are sent to a specific workstation based on workflow and then sent to an archive. However, the system, in essence, uses two separate databases: the archive and a “local” database. Each review station maintains its own database, which is a mirror of the archive, and these images are retained in the local database for five to seven days. Because images stored in the local database are mirror images of those stored in the archive, any change made in the local database automatically results in the same change being made in the archive. Luckily for Rush-Presbyterian-St. Luke’s, this kind of mirror-imaging has proven to be a success. “Since we’ve had the system up, we have had two events when it did go down. But because the images are stored in the local database, the physicians never knew the system was down,” Rodgers says. Integrated Technologies The PACS chosen by each of these healthcare organizations fits into their overall strategies of creating an integrated patient care record that can be accessed easily and quickly. Rodgers says Rush-Presbyterian-St. Luke’s uses a RIS from IDX Systems Corp. and an EMR from 3M Health Information Systems. There were few integration problems, he recalls, until they tried to get the RIS “to drive the PACS,” but because Siemens has joined the Integrating Healthcare Enterprise (IHE) initiative, it uses both DICOM and HL7 to create appropriate interfaces between SIENET and other hospital information systems. When it comes to viewing images in the radiology department, CCU or the ED, Rodgers says the hospital uses 24 UNIX-based MagicView 1000 and 16 Windows 2000 NT-based MagicView 300 thick-client workstations that have large, high-resolution monitors. On other floors, and when access is necessary from outside the hospital, thin-client MagicWeb work- stations, running Microsoft Internet Explorer, suffice. Currently there are about 2,600 registered MagicWeb users both in-house and outside the hospital. Like Rodgers, Jump says the majority of specialized workstations requiring high-resolution image viewing are in Our Lady of the Lake’s most critical areas. Since Cerner also uses IHE standards, “We now have Web access from almost anywhere in the organization,” he says. As a secure and scalable solution, ProVision Web seamlessly integrates with Cerner Millennium and uses advanced image compression to reduce bandwidth requirements. However, Our Lady of the Lake also developed its own secure physician Web site a couple of years ago and is now making it possible for physicians to access diagnostic images from home. Commonwealth Health uses an EMC Corp. 10 TB SAN located at one of two fiber-connected data centers, and it has installed five 2 KB monitors for radiologists to utilize and four 1 KB monitors in the most critical areas of the flagship medical center for image viewing. The organization had very few integration problems, Ebaugh says, because Fujifilm took care of all necessary interfaces and trained both radiologists and staff. Moreover, since Synapse is a PACS that uses Web technology as its foundation, it was easily integrated with the healthcare organization’s unique EMR, called iCareCentral. “All of the images are part of an EMR, but we don’t utilize a single EMR product,” he says. “We’re kind of tricking our applications right now to behave within our corporate portal until the CCOW initiatives become a better option for us within our environment.” Ebaugh explains that Commonwealth Health uses a remote access appliance provided by Netilla Networks Inc. that provides Web-based remote access to Web or legacy applications. “It has a Web front-end that allows you to integrate any application into a Web browser. When our physicians utilize the Netilla appliance, the user interface doesn’t change, even over a wireless network that is currently being installed,” he says. “Also, we were able to roll it out to 400 physicians and 1,500 end-users in a month and a half.” One of the benefits of investing in a Web-based PACS is that the organization was able to leverage existing IT investments, according to Ebaugh. It’s not being used just as a radiology system, he stresses, but as an enterprise system, too. Synapse uses a single Oracle database, flexible image compression technology and a standard Windows Internet Explorer format, making it possible for radiologists to do some of their readings from home via their VPN connection. Likewise, ordering physicians can use the Web portal, logon and collect the critical clinical information and images they need, whether they are in their office or at home. Ebaugh says that although it was the radiologists who initially pushed for a PACS to better assist them in improving efficiencies, other physicians readily accepted the new technology—especially after they saw the quality of images on the monitors from their homes and offices. “It’s an eye-grabber,” he says. Richard R. Rogoski is a free-lance writer and contributing editor to HMT. Contact him at rogoski@aol.com. For more information about
Synapse from Fujifilm Medical © 2003 Nelson Publishing, Inc |
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.
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.”
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.