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objectives. That deployment included implementation and migration to the enterprise RIS/Powerscribe sys- tem at all hospitals, as well as the implementation of PACS. In addition to those core systems, the technical project also included related upgrades of the enterprise data network (to handle projected image traffi c) and radiology devices (including the introduction of CR for non-digital devices). Beyond the technical, a key task to assuring success was the evaluation and modifi cation of radiology work fl ow, including more standardized patient care practices and metrics of delivery.

As the project progressed, other related items, such as ambulatory radiology units, third-party teleradiology services and peer review functionality, have also been incorporated into the fuller picture of what is entailed in delivering radiology services.

Looking back A benefi t of the integration between the upgraded RIS and PowerScribe is that the reports are available for review immediately after dictation. The radiologist can now sign off a completed report while viewing the origi- nal image, thus improving turnaround time on a patient’s results. Naturally, any evolution of work fl ow is bound to have its quirks, and the integration between PowerScribe and PACS has been no different. Currently, there is not a mechanism for launching a study in PACS based on the selection of a report in PowerScribe. This is an issue at those hospitals where reports are often generated by residents and passed on to an attending physician’s queue. Future enhancements to the resident work-fl ow features are expected to provide more fl exibility to drive a report review from within PowerScribe. The cost of the RIS, VRS and PACS software licenses, the necessary hardware associated with the enterprise storage solution and application servers, incremental network bandwidth and the need for additional infor- mation technology staff to operate and maintain each of these components offset the savings of an enterprise radiology system. However, far outweighing the fi nancial investment is the increased quality of patient care the technology offers. By moving to PACS, multiple physicians and allied health professionals throughout the health system can now access a patient’s study at any given time, eradi- cating the issue of many individuals vying to share one document, as well as the problem of missing fi lms. Radiologists also now have the ability to develop spe- cialized work lists which route studies to the appropri- ate covering physician group. Factors like these have contributed to a more timely interpretation of studies. Since February 2007, NSUH’s radiology department has seen nearly a 90 percent reduction in unread cases

(defi ned as exams older than 48 hours which lack a fi nal interpretation) and about 40 percent reduction in fi nal report turnaround. At LIJMC, the radiology department has experienced an 80 percent reduction in fi nal report turnaround time. According to Chusid, at the onset of implementation there were a few bumps in the road regarding the sys- tem’s stability and the limited capability of customizing or adapting the product to accommodate the needs of the user. While no single piece of technology is ever perfect, he says, having all health system hospitals linked in a “virtual reading room” allows staff “to provide scarce subspecialty expertise to community sites, which would otherwise make do without the full gamut of subspe- cialty radiology interpretations. This includes access to musculoskeletal, neuro, and thoracic fellowship-trained radiologists.”

An enterprise RIS/PACS/VRS also permits “greater

fl exibility in coverage and limits underutilization of physician resources, since cases performed anywhere in the health system can be accessed from any worksta- tion,” Chusid says. “Radiologists at NSUH can help read cases at the Center for Advanced Medicine if they are short-staffed. In the evening, a single staff radiologist can cover both LIJMC and NSUH ED cases from his or her usual workspace.”

Since the deployment of the enterprise system, the radiology department has been able to cover emergency cases during evening hours, which typically would have been handled by an outsourcing company. Outsourcing services for this type of work would have cost approxi- mately $750,000 annually for preliminary interpreta- tions alone and nearly $1.1 million annually for the fi nal interpretation.

Future expansion and enhancements The future of North Shore-LIJ Radiology is expand- ing as the needs of the health system and patient com- munity increase. Later this year, a third ambulatory imaging center is scheduled to open. There are also plans to implement digital imaging within several ur- gent care centers being opened. This requires that the enterprise PACS not only be integrated with Eclipsys Sunrise Clinical Manager for its inpatient EHR and the Allscripts Emergency Department Information System (EDIS), but also with the Allscripts Ambula- tory EHR for its ambulatory settings and the LIPIX Regional Health Information Organization (RHIO). This RHIO will connect healthcare entities across Long Island to improve the quality and effi ciency of health- care for the region’s patients and care providers by facilitating the exchange of clinical information without compromising privacy.


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