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For other articles and previous issues click here. April 18, 2005 Digital
Georgia on Their Minds — WellStar Integrates 11 Imaging Sites The largest not-for-profit hospital system in Georgia is just wrapping up its four-year conversion to digital imaging. WellStar Health System, the largest not-for-profit hospital system in Georgia, serves one of the fastest-growing counties in the state—Cobb County, situated northwest of Atlanta—and three adjacent counties. Established in 1997, WellStar has been expanding ever since. Five separate hospitals joined to form the integrated health system to better serve an increasing number of patients. The system includes the hospitals and six imaging centers. “The imaging centers are hospital-based, yet they’re sort of separate,” says Robert Mandler, WellStar’s executive director of medical imaging/radiology. “Still, I don’t want to call them ‘free-standing’ because that term makes it sound like they’re a private corporation. But they’re not. They’re all hospital-based. WellStar’s business is really hospitals, not imaging centers.” At one time, the system had only one imaging center. But in the late 1990s, it reached a juncture where it realized it needed to provide better service to referring physicians and all the types of patients who use the hospitals’ services: inpatient, outpatient, and emergency. To meet the need, WellStar built five more imaging centers. Moreover, all the new imaging centers would be digital. Adding to the complexity of the venture, WellStar needed to have all the work—the building construction and medical imaging technology installation—accomplished as quickly as possible. Moving Outside the Hospitals First, in the large suburban Atlanta area where the system operates, the population was rapidly growing. In addition to the five community hospitals, the WellStar system includes multiple associated physician groups and urgent care centers. The largest hospital in the system, Kennestone, has 455 beds. WellStar deemed it extremely important to make its services more convenient to physicians and patients and to offer them state-of-the-art technology. “We wanted to create a patient-friendly environment that addressed all of the issues relating to things such as parking and registration and to make all of the latest technology available to the patient,” says Mandler. More importantly, WellStar wanted to accommodate emergency department (ED) patients and inpatients more effectively by addressing the issue of competition for radiology services within a hospital. Mandler explains that by having everything located in a hospital setting, you essentially create the competitive environment where ED patients need to be triaged first, followed by the outpatients who generally have appointments. In such an environment, inpatients tend to fill in the gaps. So, by servicing as many outpatients as possible outside the hospital, treatment for ED patients and inpatients typically becomes more effective. “We wanted to shift outpatients from the hospitals, particularly Kennestone, which has what is probably the largest emergency [department] in Georgia and one of the largest in the country,” Mandler says. Thus, the strategy became building new outpatient facilities near the existing hospitals in the WellStar system. The existing imaging center near Kennestone Hospital would be converted from a film-based to a digital center. Further, the new centers would all be designed to be digital. WellStar was performing more than 110,000 exams annually. A digital environment would increase staff productivity, decrease report turnaround time to referring physicians, and help better manage the ever-increasing number of imaging studies. Finally, and importantly, a digital environment would enable WellStar to install the latest, most cutting-edge generation of imaging modalities available. No Film Storage Construction on the new outpatient center began in 2001 at an East Cobb County site. Soon after, WellStar brought in Agfa HealthCare, an international manufacturer of digital and analog products and systems, to install the technology. WellStar chose Agfa to provide its PACS as an application service provider (ASP). Other equipment manufacturers would provide the specific imaging modality equipment at the various new centers. “We had looked at two other companies, but we thought that Agfa could just bring more to the table, as far as our needs,” Mandler says. “WellStar is a very diverse organization, so we had a lot of different equipment—both legacy and DICOM—and we thought that Agfa had the edge when it came to taking all of our equipment into a digital environment.” Installation began in October 2001 with Agfa’s IMPAX Basix system to accommodate the transfer of digital information. By December 2001, the East Cobb Imaging Center in Marietta and the Towne Lake site both opened to the public, offering services including open MRI, CT, fluoroscopy and general x-ray, bone densitometry, ultrasound, and mammography. Both facilities were equipped with Agfa’s IMPAX Basix Server with RAID (redundant array of independent disks) on-site storage, an IMPAX Basix dual black-and-white diagnostic station, multiple CS 5000 clinical review stations, and a DRYSTAR 3000 laser printer. In addition, the two centers had the Agfa Diagnostic Center (ADC), a complete computed radiography package. Eventually, the ADC would be installed at each of WellStar’s new imaging centers. To make a patient’s previous studies automatically available with any new studies, Agfa linked WellStar’s existing digital images and RIS to the new DICOM language of Basix with a broker data center. Agfa installed its Web server, IMPAX WEB 1000, to transport all images and reports to referring physicians. This arrangement would also be replicated at all the new imaging centers. Almost immediately after the first two new imaging centers opened, WellStar began realizing substantial benefits as far as customer service, staff productivity, cost savings, and better service to referring physicians and patients. Specifically, the system saw the following: • a steady increase in the number of studies handled by the new centers, as outpatient imaging services moved away from the hospital settings; • faster report turnaround time; • improved patient satisfaction as a result of the more convenient imaging locations and reduced waiting times outside the hospital setting; • increased efficiency in radiologists’ workflow due to the digital environment; • the ability to pull up images and reports at the same time, which wasn’t possible with film-based systems; and • elimination of the need to transport films from one location to another. Change in Plans So, WellStar modified its original plans so all the imaging centers and hospitals would be linked in a large hub-and-spoke configuration that characterizes an enterprisewide system. In the new plan, the hub would be a central Oracle server and database archive that would link each facility. Fortunately, because of the nature of Agfa’s products and services, all the equipment installed in 2001 was still useful. “We started with IMPAX Basix, which is Agfa’s independent server and archive manager, and we were able to turn these Basix servers into gateways when we brought everything into the central core of the enterprise-wide IMPAX solution,” recounts Mandler. Several factors combined to make the enterprisewide solution more attractive—including the size of WellStar’s radiology workforce, the central archive, and especially the image distribution capabilities. The hub-and-spoke configuration enabled all digital images and data to be moved to wherever necessary. This was very important, explains Mandler. “We have a diverse operation with a lot of subspecialization in radiology,” he says, “so we need to get our images to the highest level of specialty, where the radiologist is located, and that is not necessarily in every facility. So, by going to a central IMPAX solution, we now had the ability to manage our images across the system and get them to a point where they can be read in a location where a radiologist who could provide the highest level of interpretation would be available. We can select where to send neuroradiology, chest radiology, body radiology, and other specializations.” As was originally envisioned, digital technology made it possible for WellStar to install state-of-the-art technology at the appropriate new site. WellStar’s newest imaging center, the Cobb Imaging Center, located in Austell, offers the new GE LightSpeed 16-slice CT imaging system. It also offers general radiography/digital fluoroscopy, electrocardiogram, MRI, nuclear medicine, and ultrasound. The WellStar Douglas Imaging Center in Douglasville
offers a dual-head nuclear medicine camera, multislice CT, high-field
MRI, DEXA (dual energy x-ray absorptiometry) bone densitometry,
digital radiography and fluoroscopy, mammography, and ultrasound. The WellStar Kennestone Imaging Center at Towne Lake in Woodstock provides DEXA bone density screenings for osteoporosis prevention, as well as CT, general radiography/digital fluoroscopy, mammography, nuclear medicine, open MRI, and ultrasound. Minimizing Film Mandler reports that all imaging centers are completely operational. WellStar expects that by the end of this month, complete digital-to-analog conversion will be accomplished within the hospitals. “So, the whole system should be totally integrated and we will be digital throughout the entire enterprise,” he says. “We’re installing our last computed radiography unit to make us totally filmless. Still, it’s more accurate to say that we have a totally integrated environment digitally than to say we are totally filmless. Frankly, if a practitioner says they want film, we have to give it to them. But we also use CDs and we have the Agfa Web product, which is probably our No. 1 source for image access from a clinician’s perspective.” WellStar encountered the kind of difficulties that would be expected in a start-up of such complexity. But, according to Mandler, these were ironed out with the ongoing and comprehensive assistance of Agfa personnel. “With something like this, there will always be significant decision points along the way,” says Mandler. “Ours is a large operation to take digital. Moving in the fashion that we did presented a lot more issues than if we were able to just turn a switch and go from a digital to film environment almost overnight. The longer the transfer from film-based to digital takes, the more problematic it will be because you have to deal with a sort of duplicate environment, where some images come out as film and some as digital.” In 2005, WellStar has more than 10,000 employees, including the 600 who worked in medical imaging. Throughout the entire system, more than 600,000 imaging studies are performed per year. As far as acceptance and realized advantages of the new technology, Mandler reports that, in general, the radiologists express a high degree of satisfaction. “They’re pleased with the efficiency the system creates,” he says, “as well as the ability to do image distribution, which enables them to manage their workload across the system. The technologists are also very enthusiastic about the project because they see how they can offer a higher level of service. As far as operational efficiencies, we already see a reduction in the amount of film supplies and report turnaround time has been greatly reduced.” Next Target: Paper Mandler and WellStar believe the direction the organization has taken in establishing the new facilities reflects the move to the future of medical imaging information technology. In places, the route may be difficult to negotiate. Still, it’s the road best taken. PACS is certainly not cheap, as Mandler is quick to point out, but there is no question that it improves patient care and safety. “Today, in everything you read, the message is that information technology is where healthcare needs to get, if it is not already there,” he says. — Dan Harvey is a freelance writer based in Wilmington, Del. He is frequent contributor to Radiology Today. |
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