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June 7, 2004

PACS Platform
Going Digital: The Operational Impact of PACS
By Michael R. Orand, RT
Vol. 5 No. 12 p. 28

PACS offers electronic access to information to many users in a healthcare system, including radiologists, physicians, nurses, and staff. This access transforms communication among caregivers and can enhance the dialogue between the doctor and patient. But nearly as valuable are the operational advantages of going filmless. Digital environments significantly improve workflow, efficiency, quality, and equipment utilization.

The first noticeable change occurs in workflow. In a filmless department, scheduling orders are no longer paper requests that have been handled by as many as four people; order entry happens electronically. Once the order is confirmed, the patient’s demographic information is available with the touch of a keyboard. Work list management, a feature that assists users in entering data uniformly, reduces the chance of typos and immediately prepares the system for the scheduled procedure. This work list reduces the need for support staff to manage paper files and can increase the scheduler’s speed and productivity by up to 50%.

With PACS, notification of patient arrival no longer requires a telephone call or support staff to enter the control room to relay the information. Instead, a monitor in the control room indicates a patient’s arrival. Most systems have color code capabilities that track patients’ status changes with different colors. Additionally, once old films are digitized and readily available electronically, the necessity for film library personnel to access old films and jackets disappears.

In a radiographic environment, a routine chest procedure requires correctly positioning the patient, making the exposure, and transporting the film to the processing area, where it is either processed by another employee or a technologist. This development cycle time is approximately 90 seconds per film, with only one film processed at a time. Once the images are processed, the technologist must review them for proper technique and forward them to the radiologist for interpretation. Assuming the senior technologist handles the review, the tech who shot the film returns to the room and releases the patient. This process, frequently encompassing only two views per procedure, can take 10 to 15 minutes per patient.

Digital Throughput
Using direct radiography (DR), 75% of this process is eliminated. In a filmless department, the technologist positions the patient, takes the exposure, and views the results within seconds on a review monitor. The patient is then released. Once the DR system is correctly calibrated, the need for repeat views due to technical error is reduced to virtually zero. The advantage of this technology is consistently clear, quality images and a reduction in dose due to repeats. While positioning the patient, making the exposure, and releasing the patient still requires the same number of steps, the processing and review of the procedure produce significant gains in efficiency. Indirect conversion, or computed radiography (CR), offers a similar benefit, adding only the step of converting the image on the cassette to a digital radiograph.

One recent study found that it takes 6.5 minutes to perform a conventional examination with film as compared with 2.2 minutes to do the same examination with DR—a clear indicator of the time savings and potential for increased throughput using DR. This time savings creates a new baseline for determining room utilization rates. With DR, a baseline of 6.5 procedures per hour is a much more accurate number compared with the baseline of 4.5 procedures per hour when using film (based on a room utilization of 75% to 80%). Although the initial investment for DR exceeds the cost for conventional rooms, it does not take long to realize a return on investment (ROI) through a more productive, efficient operation.

Other Modalities
Digital imaging is not new to advanced modalities such as CT or MRI. Most imaging departments utilize advanced imaging modalities with monitors and electronic transfer capability. Consequently, we must assume that those efficiencies have already been realized and, with the exception of portable advance imaging, any additional streamlining of patient throughput will occur through the use of faster scanners. But when film-based systems are used, printing film is not the best use of a highly trained technologist’s time.

When making the transition to filmless imaging, consider a mini-PACS approach as a first step:

• Start with CT and MRI and configure a small server for soft-copy reading.
• Bring on ultrasound and nuclear medicine and expand to a Web server so outside physicians may have access to the files.
• Go outside the department to one other department, perhaps the emergency department, for a trial run, capturing feedback from the end user to avoid unnecessary assumptions about their needs.

These steps will allow you to capture efficiencies not only in the imaging department, but also in other departments. With proper staff training, the gains can be considerable.

Radiologist Productivity
Radiologists often garner the greatest efficiency gains in the digital environment. The ability to have current studies integrated and compared with prior studies and to have reports accessible at the click of a mouse allows the radiologist to produce reports more quickly. Speedier patient care decisions have dramatically impacted patient turnaround time. Radiologists now have interactive and frequent real-time correspondence with the referring physicians. The reduction in time-consuming handling of film allows radiologists to better use their time reading films and attending to examinations. Being able to “window down” an examination and in a few seconds access a physician’s study translates into increased productivity. Referring physicians also save time waiting for film or locating patient information. Some sources estimate that referring physicians or their staffs spend an average of two weeks per year looking for patients’ films. This is time that could be utilized seeing patients.

PACS’s impact on operational efficiency should be looked upon as an enterprisewide improvement in patient care and efficiency. PACS, when implemented properly, will deliver both.

Staff Training
Train your staff properly to ensure a successful transition to changes in workflow that PACS creates. Whether the personnel are assigned to the film library or are involved in the acquisition and processing of film, the conversion requires reengineering and retraining key staff. With adequate training, optimum improvement in operations and a successful implementation will be achieved.

While the transition to PACS can be complex, the operational advantages far outweigh the investment in time, training, and costs. The technology readily improves the diagnostic quality of the image and clearly increases workflow efficiency. The positive impact of PACS on operational efficiencies is shared systemwide. The critical question is not whether to implement PACS but rather when to make the transition.

— Michael R. Orand, RT, is a senior consultant with Equipment Collaborative, Inc. He has more than 35 years of experience in radiology equipment, room design, and PACS implementation.

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