July 14, 2008

To Digitize or Not to Digitize: That Is the Question
By Adam Donaldson, BS, RT(R)
Radiology Today
Vol. 9 No. 14 P. 8

A phased go-live with technologists going live one month prior to the radiologists will help ensure that staff are more capable of answering the radiologists’ questions once the vendor’s application specialists leave.

During an initial PACS installation, imaging managers face difficult decisions regarding the policies and procedures that make up best practices for their facilities’ operations and workflow. One critical question that repeatedly arises is the decision whether to digitize prior radiographs.

Behind every PACS decision is a clinical, business, or technology need. The decision whether to digitize film into the PACS is based on clinical and technological needs. Clinically, radiologists find value in being able to review prior images to make comparisons; during an initial PACS installation, there are not prior images on the system for them to view. However, technologically the need is to utilize PACS storage capacity to its full clinical value.

There are benefits and drawbacks to each situation. Digitizing images prior to PACS go-live has several benefits, most notably that of allowing physicians to review a specific number of prior exams. In fact, many radiologists will state that having images available for comparison during this transition is nonnegotiable. The common answer to the clinical need is to digitize prior radiographs into the PACS. Doing so doesn’t provide radiologists with an optimal solution due to degraded image quality, nor does it make the best use of available storage capacity on the PACS archive.

Phased Go-Live               
A phased go-live approach may be the alternative that your imaging facility needs to optimize storage, satisfy the clinical needs, and eliminate preinstallation digitization. Another benefit is that a phased go-live can be customized for each facility. One common approach may be a technologist go-live followed one month later by a radiologist/emergency department go-live and then a referring physician go-live. Granted this process will prolong the implementation, but the benefits usually far outweigh the drawbacks.

With a phased go-live, managers can more easily schedule and conduct user training. Rather than scheduling role-based training for an entire facility all at once, breaking the scope down to a single area will allow for easier scheduling and more focused training for each user group. That strategy increases the training quality and the amount of knowledge trainees retain.

In addition, a phased go-live with technologists going live one month prior to the radiologists will help ensure that staff are more capable of answering the radiologists’ questions once the vendor’s application specialists leave. Giving your technologists the chance to be more familiar with the system prior to installing it in other areas will increase the overall satisfaction with the system as other users will feel confident in the support system on day one of their phased go-live.

A phased go-live also provides more benefits than digitizing prior exams because it optimizes storage space; images that won’t likely be needed aren’t archived and most clinical needs are satisfied because the most recent priors—and thus the most heavily used—will be available on the system. With a technologist go-live prior to the radiologist go-live, the radiologists will already have one month of images available online for comparison. This will suffice for most of the inpatients who have morning chest x-rays and other diagnostic procedures of the same body part, which are often performed for follow-ups. One month of priors may not seem enough, but when considering the effort and resources required to digitize a large number of images and the degradation of digitized image quality, a phased go-live often makes a very attractive alternative.

In addition, the clinical need is met as most inpatients will have prior exams in the system for the radiologists and referring physicians to compare. The technical need is met as the storage is being utilized for actual PACS images that are more likely to be used, not just lower-quality digitized images. The business need is met because time and money will not be spent digitizing images.

— Adam Donaldson, BS, RT(R), is the corporate PACS application analyst with Community Health Systems, which owns, operates, or leases 110 hospitals in 28 states.