See what develops without film

Replacing film with a Picture Archiving and Communication System (PACS) requires

PROBLEM

The Scottsdale Healthcare Corporation in Scottsdale, AZ is comprised of two full service hospital campuses located 10 miles apart-the 285-bed, Level I trauma Osborn campus and the 242-bed Shea campus. The hospitals serve 128,000 combined patient visits a year and the radiology departments perform 235,000 procedures annually.

Although we had digital imaging available for computed tomography, magnetic resonance imaging, nuclear medicine and angiography, we did not have a permanent electronic record and we were completely dependent on film.

Being film-based caused numerous problems, the most significant of which (aside from cost) was managing and coordinating use of film across two campuses. Using one patient identifier, the radiology departments shared a film file. When a radiologist or physician from one campus needed to review a file from the other, it was shuttled back and forth-potentially delaying procedures and interpretations.

We routinely double-loaded cassettes for every ICU and CCU patient chest X-ray and provided duplicates on the unit to ensure that cardiologists, attending physicians and radiologists had timely access to the films. This was hardly a step in the direction of efficiency.

Film was expensive to maintain and created lengthy turnaround times to process. As volume grew, physicians needed faster access to completed exams. Consultations between physicians and radiologists depended upon locating the film file, and dictations were often delayed when films were needed in surgery or the emergency departments. We had 24 FTEs dedicated to film management, and we spent $700,000 annually on film purchases and more than $200,000 on film processing and storage.

SOLUTION

In 1998, we formed a PACS steering committee and began researching our options. Our PACS steering committee consisted of representatives from information technologies, administration, radiology, radiologists, medical staff, nursing and an outside consultant. At first, the committee's role was to select a consultant to help us identify goals and navigate the financial strategy, vendor selection and contract negotiations. Later its focus was to:

* Establish a unified approach for organizational implementation of PACS that improves patient care;

* Prepare a PACS financial plan that would be cost justified;

* Design a flexible and modular PACS implementation timeline;

* Develop a transition plan for migrating the current systems environment and department workflow to PACS;

* Oversee project implementation, communications, technology decisions, education and medical staff transition.

We created an implementation plan with scaled budget recommendations to finance a three-year transition to PACS and presented it to the board of directors. An enterprise-wide plan and the overwhelming benefits of PACS convinced the board to fund the entire project in year one. This decision permitted our organization to experience the benefits of PACS within one year of project initiation.

IMPLEMENTATION

After analyzing proposals from six vendors, we selected the GE Medical Systems PACS and began implementation. Early on, we identified three key components for a successful implementation: network infrastructure, clinical systems and interfaces, and existing imaging equipment integration.

First we enhanced our local area network by replacing core network componentry, including switches and routers, with multiple links and increased bandwidth to the desktop. We contracted with a local telecommunications provider to enhance the wide area network with increased bandwidth and redundancy between the two hospital campuses.

Our IT team designed a robust interface between the hospitals' McKesson HIS-RIS systems and the GE PACS database permitting registration, radiology order information and transcribed reports to be associated with images stored in PACS.

When radiologists identified the need to view old history as a persistent link to our film system, the hospital's IT team and GE engineers designed a solution. Approximately 1.4 million HIS/RIS radiology records (patient demographics and exam descriptions) were backloaded into the PACS database to link in relative historical data. During our transition to filmless, this permitted the radiologists to request film files only on exams that had relevant prior history. Our installation relies on PACS workstations in radiology reading rooms and key clinical locations in the hospitals, as well as a Web-based product that has provided every PACS user a file room at every PC throughout our organization and in hospitalowned buildings. Soon, we will continue our deployment by offering PACS Web to our physicians in remote offices.

In assessing existing equipment, we found 50 imaging modalities that required integration with PACS, some requiring purchase of software upgrades. New equipment purchases already included the necessary options for PACS connectivity. The most significant equipment purchase and installation was the conversion of a wet film processing system to a computerized radiography (CR) system, because it required physical construction changes as well as changes in the department's workflow. Nine wet processing darkrooms were remodeled and replaced with nine CR units, providing redundancy and CR service to two growing departments.

Approval of funding for the entire project permitted a much faster implementation plan. Our team developed a one-year plan that required escalated equipment deliveries, accelerated construction schedules and multiple scheduled network downtimes to meet the deadlines.

Buy-in and support were fundamental components of our success. We arranged multiple presentations and equipment demonstrations for physicians and nurses, and we continued to promote PACS in hospital and physician newsletters. As soon as the database was built, we installed a workstation in the radiology reading rooms so radiologists could familiarize themselves and consulting physicians with the new technology.

RESULTS

We have experienced overwhelming change within the radiology department and throughout the organization. Report turnaround times are drastically reduced. Physicians see PACS as a time-saver and a critical component to providing timely patient care. Patient schedules have been expanded, a direct result of PACS technology and inherent efficiency. We continue to assess and eliminate positions changed by a conversion to electronic image management. We have reduced film usage costs by $500,000 and we have eliminated $50,000 annually in processor chemicals and maintenance. With our deployment of PACS Web in surgery, film usage will decline more over the next month.

We view installation of PACS as a competitive tool that will enable us to expand our radiology services without adding staff, integrate with future, remote campuses, provide multiple and concurrent review of images by physicians, attract top radiologists and physicians, and reduce turnaround time for diagnoses and reporting.

For more information from GE Medical Systems, Circle 189