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the case into a system that was monitored by a team of transcriptionists, who typed the dictated reports. Finally, on a recurring basis, a courier picked up the studies to deliver them to a third-party warehouse for storage. Therefore, when a comparison study was needed to make a clinical interpretation, many times it required submitting a request to the warehouse and waiting hours or overnight for it to be available. While a few hospitals had standalone PACS systems, it was only a partial solution. Long Island Jewish Medi- cal Center (LIJ) and Southside Hospital (SSH) utilized the Siemens PACS solutions, whereas North Shore University Hospital (NSUH) utilized two mini-PACS solutions in their daily work fl ow: Merge e-Film for CT/ MRI/X-ray and ALI McKesson for general ultrasound. Although these departments functioned somewhat electronically, they did not have all of the tools neces- sary to be effective. According to Dr. Jesse Chusid, director of imaging informatics at North Shore University Hospital’s radiol- ogy department, “e-Film had no automated work fl ow, so although we could view images at a workstation, we still used a paper-based system to determine which cases needed to be read. We were physically shuffl ing requisitions and other paperwork.”

The business case and deployment strategy When it was decided to move forward with integrated enterprise solutions for radiology, it was agreed that those efforts would include RIS, dictation, PACS and image storage components, and that there would be an integrated product environment rather than a single vendor solution. While it was not a problem to justify a migration of individual site RIS and dictation systems to enterprise-grade solutions, the larger costs and efforts associated with installing PACS at all sites went through rigorous business-case analyses. According to Chris Balbi, director of the PACS program in the offi ce of the chief information offi cer, “the primary objective of the system’s PACS strategy was to develop a budget model that included direct and indirect outlays, and identifi ed the cost savings/ ROI in order to provide a basis for project planning and development. A review of initial operational costs by site revealed signifi cant opportunities for savings based upon the establishment and utilization of an integrated enterprise-wide radiology environment.” As a result, strategic and tactical PACS roadmaps were developed to provide a phased PACS implementa- tion plan that included recommended support activities (data center work, enterprise system upgrades, imple- mentation of mandatory patches, hardware upgrades and disaster recovery/failover solutions), as well as

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recommended hospital facility improvements (network infrastructure improvements and deployment of com- puted radiography systems).

It was recommended that the health system move forward to fi rmly establish the infrastructure required for PACS development and implementation as defi ned in the imaging service line strategic roadmap. Balbi says that “the completion of the PACS implementation will provide the groundwork for enterprise-wide secure ac- cess to diagnostic images, rapid turnaround of imaging reports, virtual interpretation of images by radiology sub-specialists, overall improvement in customer sat- isfaction and greater opportunities for effi ciencies and cost savings.”

The approach

It was quickly determined that Siemens’ Novius RIS, and Nuance’s Powerscribe dictation system, which had already been installed as stand-alone systems in sev- eral hospitals, would be the enterprise RIS/dictation solutions. At the same time, there were active product evaluations undertaken for PACS and the associated image storage solutions, which led to the selection of GE’s Centricity PACS, and EMC’s enterprise storage products. Working with hospital and radiology service line leadership, a plan was developed to roll out this new integrated environment across the hospitals, with se- quencing based on system-wide clinical and business


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