BOSTON – Enterprise-wide PACS implementation requires participation by hospital information services departments. But how can prospective PACS purchasers secure the cooperation and financial support of hospital chief information officers (CIO) for digital image management?
"Show them exactly what PACS is so they can understand [the technology], how you’re going to work together, and how PACS will make them popular," said Dr. Keith Dreyer at "Radiology Into the 21st Century – The Digital Department," a conference organized by Massachusetts General Hospital (MGH).
Dreyer is the vice chairman of radiology, computing, and information sciences at MGH in Boston. His presentation was part of the Information Services’ perspective on electronic medical imaging held on Sept. 13.
To help a CIO gain an understanding of the technology, he or she should be taken on a site visit, and allowed to talk with other CIOs, Dreyer said. Presenting the professional benefits of PACS may also pay dividends. A successful implementation will make a CIO popular with the chief medical officer because clinicians can view images at any time.
The chief financial officer will appreciate the return on investment (ROI) that can be generated, Dreyer said. The hospital chief executive officer will like the visionary aspect of PACS, while the IS staff will welcome the opportunity to work on a "way cool" technology, he said.
PACS must also be defined to the CIO so that he or she can understand the benefits of the technology. At MGH, electronic medical imaging includes three components: PACS, voice recognition system, and distributed medical imaging (Web-based distribution of images and reports to clinicians).
Before implementing the new technologies, Dreyer describes to the IS department the current practice for film-based radiology, and how the systems can be improved. For example, in the traditional film-based radiology environment, it took an average of five days until the completed report was returned to the referring physician, Dreyer said. With electronic medical imaging, that process has been cut to approximately one day, and in urgent cases, to a matter of minutes, he said.
"Once IS starts to realize this, they can understand how the automation of this is going to really improve clinical utility for the patient, and if you can do that by showing an ROI, that’s clearly a good IS thing to do," he said.
Distributed medical imaging enables the transmission of PACS data to be transmitted to computers throughout the enterprise, dramatically improving the speed and ability of referring physicians to view images.
"You can also hook up imaging centers, so as you’re growing your institution, you can put those into a Web server from anywhere, or directly into a PACS if they’re close," he said. "You can also hook up remote radiologists."
CIOs must also understand how the departments will work together in implementing PACS, he said.
"Many CIOs feel there is a large disconnect between the IS staff and the functions of a clinical department, such as radiology," he said. "It’s really hard for them to understand what the clinical need is within a department, because they’re too busy keeping everything connected together and implementing."
To solve this problem, responsibilities should be assigned to each department. The radiology department should handle tasks such as image quality control, radiology utilization management policies, clinical needs analysis, film reduction management, and teleradiology support issues, he said.
IS should be responsible for network services, computer room support, storage and backup management, clinical display support, the help desk, and security administration. They should also take over remote Internet access, Web server support, and electronic medical record integration, he said.
There are some duties that should be handled by both the IS and radiology departments, however. PACS justification and vendor selection should be handled jointly, as should PACS implementation management, support for radiology workstations, and voice recognition systems, Dreyer said. RIS and billing systems support, electronic order entry systems, and PACS/EMI daily management are also appropriate candidates for joint management.
Finally, Dreyer said a PACS manager should oversee the entire electronic medical imaging project. "If you don’t have a [point person] responsible for this whole thing going in, it’s just not going to work," he said.
By Erik L. RidleyAuntMinnie.com staff writer
September 14, 2000
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