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For other articles and previous issues click here. July 11, 2005 PACS
Implementation From a Technologist’s Perspective Floyd Memorial Hospital recently implemented PACS. Here’s one technologist’s perspective on the experience. What can make a technologist laugh and cry in the same moment? PACS, the acronym for a picture archiving and communications system. Used for storing, viewing, manipulating, and distributing images, PACS creates an environment where a patient’s images are stored more efficiently and viewed with state-of-the-art software. PACS and RIS allow radiology orders, examinations, histories, and reports to be viewed on one or several monitors at once. A click of a mouse is all that is needed to find the complete patient record anywhere a computer is available. Laughter or tears are just a click away. Floyd Memorial Hospital and Health Services of New Albany, Ind., is just over eight months into the use of PACS—part of the digital transition of the radiology department at Floyd Memorial. Computed Radiography (CR) First A 210-bed hospital, Floyd Memorial is considered a midsize hospital with a Level 2 trauma emergency center. The only hospital in Floyd County, Floyd Memorial is nearing the completion of a $65 million addition. Planned state-of-the-art additions include a heart center, a new emergency department (ED), and conversion of all hospital rooms to private rooms (www.floydmemorial.org). As an associate of Floyd Memorial Hospital, I see the quality of care improving. From a technologist’s viewpoint, PACS is definitely an element of quality patient care. In the hospital, training is always available on site to anyone who needs to learn—just ask for help and you get it. Physicians have monitors available anywhere they are needed—radiology, ED, operating rooms, nursing stations, and Floyd Memorial satellite offices. PACS access is also available on the Internet with password protection or through the physician portal on the hospital Web site. Director of radiology Tony Cooke, RT(R), has seen radiography change many times since his graduation from Louisville General Hospital in 1976. Cooke has worked at Floyd Memorial as a technologist, shift supervisor, and now as director for the past three years. Cooke’s preliminary research on PACS began with reading and seminars in 2002. In 2003, he went to RSNA and began perusing the many available systems. With that information and an idea of his department’s needs, a PACS committee was formed. The committee developed a request for proposal. Its specifics were based on the needs of Floyd Memorial and a wish list for the facility. The committee developed a grading scale to assess the advantages and disadvantages of each system. Cost was not the No. 1 question. The eight-month process began with seven vendors and their products. The grading scale narrowed the search in a manner that allowed the committee to focus on choosing a system based on functionality and the wish list. Cooke says his reasoning for acquiring PACS was simply “technological advancements and better delivery of patient care.” Additionally, maintaining film was too labor-intensive and costly—and that’s before film storage and distribution. Narrowing the Field Once selected, McKesson built and tested the hardware, software, and interfaces in Vancouver, Canada. The PACS arrived and was installed a week before going live. The workstations were installed in radiology over a weekend. Seemingly, in just one weekend, technologists, radiologists, other staff, and patients embarked on what felt like the biggest adventure in radiography since the discovery of x-rays in 1894. Each associate has an opinion about PACS. A few are less than elated, but such issues often stem from a lack of computer knowledge. Comments from associates about the PACS system included: “Wonderful, wonderful!” “No more loading cassettes.” “It’s great!” “It will be good.” “I don’t understand.” “Less filing.” “More written work.” My opinion is, “Wow! What took so long?” A technologist’s time is better spent taking care of patients instead of hauling film jackets to radiologists or emergency physicians. With PACS, less time is spent finding reports to read over the telephone because the physician can get the information anytime with any computer. One associate commented, “It will be great when the bugs are worked out—operator bugs.” Typically, it seems, the problems or bugs are with those who do not understand computers and have a fear of not “getting” PACS. Busy Man “My job is making sure PACS runs smoothly and resolving the techs’ QA [quality assurance] issues,” Chang says. Behind the scenes, he makes sure the servers are configured and run properly. After six months, it all seems to be running fine. Additionally, as new modalities are introduced, such as a new digital portable x-ray system, Chang configures them into the system. Backing up Chang with the unofficial title of “super user” is service support coordinator Leigh Ann Rudy, who led the technologists’ training on the fundamentals of PACS use before implementation. The radiology staff also praised the PACS training McKesson provided. The few grumbles seem to primarily emanate from giving the radiologists what they want. Difficulties come from actually getting better images that are perceived as lesser quality. CR and PACS let the radiologists see more than film due to the better resolution on a 3-megapixel monitor. Technologists have adapted techniques to CR and view the final images on a 1-megapixel monitor. The radiologist then gets an image with three times better resolution. Thus, more information sometimes equals less quality. Everyone is learning and adapting to the enhanced capabilities and advantages of PACS over film. In my experience at Floyd Memorial Hospital, not hanging and filing film and reports are enormous benefits and time savers. Radiologists do not wait for films; with PACS, the images are at their fingertips. Film rotators are almost a thing of the past and losing a film or an entire jacket is impossible since physicians do not need to remove films from radiology to view elsewhere. Reports are sent to PACS and attached to the patient records and available straight away. Life as a technologist is simplified for me. I can make my patient my focus instead of being pulled in multiple directions at once. Saving Money Cooke shared a small revelation: “The only disappointment is filming more than I anticipated.” Cooke says because neurosurgery is not performed at Floyd Memorial, actual films are necessary for those surgery cases at other hospitals. Many other specialists require films due to the nature of the surgery or lack of access to PACS. Not all doctors are equal in computer use and some are dragging their feet in using the new system. Cooke says, “They think they need a high-quality PC.” In actuality, all they need, according to Cooke, is a computer with a monitor purchased in the last two to three years with resolution capability of 1,200 x 1,000 pixels. Chang suggests that the doctors are uncomfortable with change and “have not reached their comfort level, yet.” Cooke and Chang agree that storage is the biggest issue facing radiology departments. Cooke described the film storage area at the facility as a 30- x 50-foot room housing four years of film, with another year stored elsewhere in the hospital. Indiana law requires facilities to store radiological exams for five years. Because of the switch to PACS, staffing was reduced from three to two full-time film librarians and the hospital no longer needs a full-time associate for report filing. Disk Archive What do the technologists think and how well are they adapting? Donna Esterle, RT(R), works in the diagnostic area and has mixed feelings. “We have less one-on-one with the radiologists,” she says. “It is more difficult to provide a quality product without close interaction with our physicians. Our jobs work hand in hand.” Esterle believes progress is being made steadily and with determination and education, patients will be better served. She says, “We are faster without cutting back on patient care or interaction.” Pam LaDuke, RT(R), second-shift supervisor, mentions another concern. The task that is repetitive and needs addressing is the multiple entries for histories and requisitions, LaDuke says. History sheets are done in writing, then scanned and entered in the editor portion of the program. This is one place where workflow is slowed, especially when there are only two work stations for seven examination rooms. Aura Richards, RT(R), day-shift supervisor, agrees that a lack of workstations and additional entries causes a backlog during the day. Overall, she likes the PACS, saying, “It’s wonderful, until it goes down mid-afternoon.” A recent glitch sent the entire system crashing and everyone into a panic. The ever-present Chang resolved the problem in 15 minutes. Film Mammography CT supervisor Terri Thomas, RT(R), CT(R), reports better image acquisition and that doctors can manipulate the images without special filming from a technologist. All in all, Thomas seems happy with PACS and believes it has made life simpler for technologists. MRI technologist Susan Lilly says it makes MR easier for radiologists. There are fewer calls from radiologists to MR and less filming. Lilly says, “I really like it.” Ultrasound supervisor Susan Miller Maschenik, RT(R)(M)(S)(ARDMS), is happy with PACS—especially with live imaging from one station to another. She says, “We can call the radiologist and tell him to turn on his camera and he can view real-time images from ultrasound without leaving his desk.” Jana Judge, RT(R), works third shift weekends in diagnostic radiology and CT. Judge travels more than 150 miles from Illinois to work at Floyd Memorial and seems to be able to handle anything PACS can dish out. “It’s productive and efficient,” Judge says. In the beginning, she says things were not quite as efficient, but now her workflow is more productive than before PACS. — Janet Needham, RT(R), is a radiographer and freelance writer in New Albany, Ind. |
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