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For other articles and previous issues click here. August 30, 2004 Getting
Your House in Order for PACS Are you ready for PACS? That question applies as much to your facility as to your people. Stephen M. Doerner, RT(R), installs PACS for a living; he’s a project manager for Eastman Kodak Healthcare Imaging. Doerner believes that preparing your facility before the trucks deliver equipment is one of the keys to a smooth, successful PACS installation. Speaking at the American Society of Radiologic Technologists annual meeting in June, Doerner offered a dozen valuable tips for preparing your facility for PACS. 1. Select a PACS team from all the stakeholders in the facility. Installing and implementing PACS affects more than just the radiology department—make sure those areas have representatives on the PACS team. Doerner says that in his experience, things run more smoothly when the PACS team includes representatives from each department involved. “PACS should not be viewed as a radiology project or an IT [information technology] project,” Doerner cautions. “It’s a hospital project. The PACS team should include radiologists, technologists, IT staff, and hospital administration.” 2. Define project expectations up front. At the beginning of a project, Doerner meets with the customer and asks the facility what they expect from PACS. “I want customers to tell me in their own words what they expect from their PACS,” he says. If your goal is to go “filmless,” does that mean filmless within the facility? Filmless except for mammography? Do you plan to go “paperless?” And what do you mean by paperless? The PACS vendor will certainly assist in the process, but being able to articulate expectations usually means people involved have thought about and discussed them—which is the point. Your objectives should include things specific to your facility, Doerner says, but there are some commonly articulated goals, such as reducing lost or unread reports, improving report turnaround, improving technologist and radiologist efficiency, and reducing expenses. 3. Have a functioning RIS in place. It’s easier to install and implement one system than work on two concurrently. Doerner says the PACS process goes much more smoothly when the RIS is already up and running rather than installing both simultaneously. Some facilities attempt to implement PACS before they have a RIS in place. While it can be done, Doerner doesn’t think it makes much sense. Without a working RIS, all patient information must be keyed into the PACS system, creating both data entry work for the radiology department and additional opportunity for mistakes. 4. Evaluate how your workflow process will change. This may be the single most important issue to resolve. You will do things differently under PACS. Doerner says the change represents an opportunity to build a better workflow system for your facility. He suggests starting by flowcharting your facility’s current process and measuring its production performance to provide a baseline. Then start thinking about how things will function in a PACS environment. Your vendor can offer suggestions, but every facility has its own unique issues. Your PACS team needs to be heavily involved in evaluating how patients and work will flow through the facility under PACS. Discuss the situation in detail and diagram it in a flow chart. For example, if your objective is to go paperless and you define that as eliminating the film jacket and report folder, how will you build that into your workflow? You need to have a mechanism to get all the pieces of paper currently in the report folder into PACS so it gets to the radiologist in the reading room. Unless you develop a mechanism for doing that, you won’t be able to read any case from any workstation. Your PACS team needs to consider how you’ll handle reporting in PACS. Will you keep traditional dictation, adopt some sort of structured dictation, or switch to voice recognition? If you switch to voice recognition, will you keep traditional transcription, use correctors or editors, or put the whole process in radiologists’ hands? “Cycle time is quicker because the film steps are eliminated,” Doerner notes, “but PACS won’t eliminate any transcription backlog.” 5. Understand the difference between installation from implementation. Doerner clearly differentiates between installation and implementation. Installation entails making sure the hardware and software are in place and work properly. Implementation is training everyone to understand how it works and taking the system live. 6. Create a contingency plan for downtime. There are two kinds of downtime: planned and unplanned. Doerner believes PACS teams need to think about how they’ll handle them. “If you have CR [computed radiography], what is your fallback if it goes down?” Doerner asks. “If you have a filmless [emergency department] with a single CR, when it breaks are you taking patients back to radiology?” Will you operate with redundant servers or tape backup only? 7. Communicate regularly with every part of the hospital involved. Doerner believes one of the keys to making PACS work is to communicate how going filmless will benefit different people and departments. Inform people when and how the transition will occur and how it will affect each department. The communication helps market PACS to the rest of the hospital. One communication key is how the hospital medical staff will access images under PACS. Wherever there are light boxes in your facility, you’ll need viewing stations or you’re going to be printing film for that department. 8. Plans for training. Who in your facility will use PACS? Doerner says the customer needs to identify all the groups in the hospital that will use PACS and think about how those groups will be trained, including identifying staffers in the hospitals who will make good trainers. Unless the facility purchases additional training, vendors usually train a facility’s “super users,” who then train the rest of the staff. “The trainers need to understand the subject and have the ability to communicate and teach,” Doerner says. He added that hospital administration needs to make arrangements so its in-house trainers are available to teach their colleagues, including arranging work coverage for training time if necessary. 9. Have a radiology department manager on the PACS team to act as a change agent. PACS will change workflow in a facility; having a manager in place on the team improves the opportunity to guide that change. “Making the change to PACS offers an opportunity to improve the delivery of the imaging service,” Doerner says. “A manager is more likely to see the opportunities and have the authority to make changes.” 10. Make sure the network infrastructure is in place. A first-time installation usually requires significant network upgrades. The vendor will spell out what the facility needs, but the hospital’s IT and/or physical plant staff must make it happen. Doerner says some network needs facilities sometimes forget to consider include setting aside a block of available Internet Protocol (IP) addresses for new equipment, a complete matrix of IP addresses for any existing equipment, remote service access to the network, a VLAN or subnetwork so image traffic doesn’t bog down the network, and high-speed cabling to desktops. 11. Make sure site preparations are performed on schedule. There’s usually more to site preparation than network infrastructure. For example, where will new equipment go in the work areas? Are there sufficient counters and furniture? Are there other renovations needed? Often these changes aren’t difficult, but they still need to be planned. Doerner noted that sometimes facilities need to purchase office furniture, which often has significant lead time when it’s ordered. 12. A secure storage/staging area. When the trucks deliver equipment and the installation team prepares to get down to business, they need a place to work and store things. A staging area disrupts the facility less, too, because the installers can configure and test everything before taking it into the imaging rooms, reading rooms, or emergency department. Doerner’s dozen tips don’t cover every contingency, but for facilities implementing their first PACS, there’s likely something on it that your team might miss. — Jim Knaub is editor of Radiology Today. |
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