| |||||||||||||||
|
Home
|
For other articles and previous issues click here. May 10, 2004 Small Facility,
Big Change "It looked like something out of the 1960s or 1970s with the old equipment,” says Kevin White. The trouble is, that’s what White found in January 2002 when he arrived in Wheeler County Hospital’s radiology department. Simply put, the imaging department of the 25-bed rural hospital in Glenwood, Ga., needed an update. “Nothing was DICOM-compatible,” says Wheeler, who is the radiology director, and now also PACS administrator, for the 12-person department. “We were running out of storage space for the films as our productivity and patient volume increased. We had to look at our options. Could we expand the hospital to make more storage space? Or did we need to change the system?” After careful consideration, White, along with the administrators and owners—Steve Noble and Randy Stigleman—at Wheeler County, decided that the PACS route was more suitable. “We would have had to add on to the hospital just for additional film storage space,” he says, “which would have hurt us because it wouldn’t have produced revenue.” Although the pairing seemed logical to them, the notion of linking PACS to small hospitals frequently does not come to mind. Looking Ahead Though the road to PACS implementation may seem long and difficult, especially for such a small facility and radiology staff, Wheeler County made the switch in only six to eight months. The implementation process included DICOM upgrades to existing modalities, radiology LAN (local area network) and WAN (wide area network) installation, PACS installation, RIS development, new equipment orientation, and changing radiology reading groups. White notes that their new system, Avreo, Inc.’s InterWorks, is easy to operate and maintain. “The vendor came in for the first couple days and trained the techs on how to schedule patients and work with the system,” he says. “They made sure we were comfortable with it and showed me how to correct problems that could arise.” The technologists handled the transition well and caught on quickly, according to White. He also notes that Wheeler County did not need to bring on additional computer personnel to work with the system. Of course, there were kinks that had to be dealt with during the implementation process, such as questions about where problems came from and how to trace them through the system. “It was something different, so it just took some getting used to,” he says. Everyone from the physicians and technologists to the transcriptionists had to learn the details of operating the Avreo system. John C. Sloan, Avreo’s CEO, also believes Wheeler County’s implementation went smoothly. “The server was built ahead of time using [Wheeler County’s] current data sources to populate our database. With assistance from our engineers, a gigbit network for radiology was installed,” he says. “With the advance preparation of preloading the server, the implementation time for the Avreo application server and hardware only took one day. Because Avreo’s browser-based technology gives broader access to the radiology information, application is now required for referring physicians, nurses, and front-desk personnel.” Therefore, says Sloan, product applications are the most time-consuming portion of the implementation, taking approximately one week to complete. Equipment Upgrades “First, we looked at the CT, which was 8 to 10 years old,” White says. “We purchased a Shimadzu scanner that performs CTA-CTs of the head, chest, and abdomen and does bone densitometry and virtual endoscopy.” The Shimadzu Helical CT Scanner had to be reliable and DICOM-compatible to the PACS. White adds that with this CT, the staff doesn’t “have to worry about the system shutting down and having to wait for someone to come fix it.” Next, Wheeler County looked at its ultrasound equipment. With more people needing ultrasounds, the hospital found that it needed a system with the capability of doing 10 to 12 exams per day. “Each vendor was looked at very carefully and on-site demos were performed using the same patient so image quality and penetration could not be blamed on the patients’ body habits, so the playing field was level,” White says. Wheeler County purchased a GE LOGIQ 7 Ultrasound, which has 3-D imaging capabilities. According to Bob Thompson, global marketing manager for GE Ultrasound, the LOGIQ 7 helps with workflow because the user can freeze a produced image and apply live scan controls to it, therefore allowing increased productivity. The LOGIQ 7 also has flexibility on the data transmission because it allows the user to select multiple still or moving frames and send them through the system instead of sending them individually. CR Solution According to Jatunn Gibson, applications consultant at the Eastman Kodak Company, this Kodak CR unit is user-friendly and easy to implement. “I am responsible for providing each staff member with the system knowledge they need to perform daily tasks, including training them on the use and functions of the system to deliver the images from our Kodak CR to the other unit of the PACS,” Gibson says. “The way they had their implementation process planned, it went very smoothly.” She adds that it cuts out much of the middle work because the film doesn’t have to be developed. Now, it takes 35 to 45 seconds to get the image to the radiologists. Wheeler County also invested in a Siemens 1.0 Tesla Harmony Short Bore MRI, equipped with a comprehensive application package. The MRI speaks easily to the PACS—sending and storing all the images it produces. “We no longer have to print MR film because of the PACS; however, if or when there is a need for film to be printed, this can be done from any PACS networking station,” White says. “MR film is very costly, and by eliminating this type of printing, it is just an additional saving for the hospital.” Laurie Fisher, BS, RT(R)(MR), Siemens Medical Solutions’ high field product manager, adds that the Integrated Panoramic Array technology on the MR scanner allows multiple coils to be plugged in simultaneously, permitting extended anatomical coverage and less time the patient has to spend on the exam table. “The resultant images will be ready quicker and can immediately be sent to the PACS for faster diagnoses,” she says. “The syngo user interface has the same look and feel as [a Microsoft] Windows-based computer, which minimizes training time due to the familiarity.” Since this new system sends the full DICOM data sets, the radiologists can manipulate the pictures after they have been received, which greatly reduces retakes. According to White, this is significant because it saves time, and the technologists “don’t have to expose the patients to radiation again to get those different images.” Integrated RIS The combination allows for scheduling, department management, digital dictation, and electronic signature signing. Once the radiologist finalizes the study with the electronic signature, “the server faxes the films and results to the ordering physician,” White says. The ordering physician’s fax number and e-mail address can be programmed into the server so the front-office personnel do not have to manually fax or e-mail all the information. The system also operates with a quality assurance tool for RIS validation. “This checks the RIS data and matches the correct DICOM study with eight fields of verification,” says Sloan. “This process verifies that good data is being archived.” With so many capabilities, Sloan likens the system to a toolbox. “Avreo has all the tools necessary to complete the radiology workflow with its different software modules,” he says. “These software modules can be used at the discretion of the user to meet [his or her] individual needs.” Improved Access The Avreo solution makes it easier for referring physicians to look up reports and files while in other areas of the hospital as well. Instead of going directly to the radiology department to view films and reports, “there are different stations around the hospital linked to the server,” White says. “Physicians no longer have to leave the nursing station, emergency room, or dictation department. This is more efficient and allows us to be better caregivers.” Another perk for the physicians is that more than one of them can look at a particular image at any given time. Before the PACS, physicians waited in line for their chance to view the tests and results. With administrative access to the server, everyone who needs to see the images can see them when they need to see them. The PACS makes the technologists more efficient, giving them the ability to do other procedures and increase their productivity. “We want to make it a family atmosphere when people come to work,” he says. “We want it to be a low-stress environment. This system takes a lot of stress off the techs and cuts their job in half so they can be more productive in other areas. “There is less paper shuffling,” White continues. “The big problem when I first arrived was that films were being lost or not being returned. Now, we don’t have to worry about that. When patients request their films or reports, we simply print the copies from our stationary base server. All the while, we have accommodated the patient and retained a record of all exams and procedures that patient has undergone on the server.” Turnaround and Coverage Most importantly, the ability to provide more radiology coverage for patients sold Wheeler County’s physicians, administrators, and owners on the PACS idea. “It was so difficult for us to get around-the-clock coverage in such a small hospital in a rural location,” says Josey. “With larger hospitals, their departments have radiologists available 24/7 because they can have them on hand at all times. Smaller hospitals like ours don’t have that luxury because we don’t have as many people on staff to have them around all the time.” Wheeler County reconnected with Chatham Radiologists, PA, a radiology group located in Savannah, Ga.—100 miles east of Glenwood—to perform the diagnostic interpretations for the exams done at Wheeler County 24 hours a day. Once Wheeler County technologists complete the procedures, the images go into the PACS and Chatham’s specialized radiologists access them from their own office. They read and dictate the exams, create reports, make diagnoses, and then put all that information back into the system so Wheeler County can see the results. David Estle, MD, Chatham president, says, “We have a work list that is continually updated so we know what needs to be read and what tests are scheduled. “We provided services to Wheeler six or seven years ago,” Estle continues, “but it was just too far to travel to do all the reading, so we parted ways. Now that the system is in place, we can provide 24/7 service without leaving our office.” Wheeler County currently has radiologists on hand twice per week to conduct the fluoroscopy testing. But before the PACS implementation, those radiologists did all the reading and testing in those two days. This system also deals with every modality Wheeler County offers. For other hospitals, it might be a problem because, like other PACS, this system does not handle mammography. For Wheeler County, however, it is not an issue because it never did mammography. White adds that Wheeler County considered this particular PACS because of its user-friendliness, reliability, and technical service support. Web access and phone support is available 24 hours a day, seven days a week and on-site support is rarely necessary to correct any problem with the system. Compared with other PACS where service support is hours—even states—away, Wheeler County’s online support can be performed in minutes. “This PACS is the real deal and it is truly what Avreo is all about,” says White. Following in Wheeler County’s footsteps is its sister hospital, Stewart-Webster Hospital, which is approximately three hours away from Wheeler, just south of Columbia, Ga. Stewart-Webster saw the success Wheeler County had with Avreo’s solution and is looking to add the same one, according to White. Chatham will cover them as well, the 400 miles separating the facilities not being a deterrent due to the new technology. “We’ve had other hospitals come in and look at our system live in operation,” White says. He adds that a few hospitals and imaging centers within a 75-mile radius of Wheeler County have a PACS, some with the Avreo InterWorks. Ultimately, White advises other small hospitals that may be considering a PACS to look past the initial cost of the system. Yes, there is the initial cost, but he says “you have to look past that initial cost and focus on the long-term benefits of the system.” — Cristen Leaper is an editorial assistant for Radiology Today. |
 |
|
3801 Schuylkill Rd • Spring City, PA 19475 Publishers of Radiology Today All rights reserved. |