LAS VEGAS - You've strung cable through the facility, hooked up beige boxes with pre-loaded software across the department, and added a new rack of computers to the server farm. Your PACS is ready to go, but what happens when you turn it on?
If you don't have a strategy for integrating PACS into the workflow of the radiology department, you could be in for a few surprises, according Vicki Petersen. And those surprises may end up costing more money than you budgeted for your PACS installation.
Petersen, an information technology consultant with Waukesha, WI-based GE Medical Systems, shared her experience with PACS integration at the American Healthcare Radiology Administrators annual conference this week.
"One of the important things to remember about PACS is that you’re trying to change or eliminate processes. One of the more common integration pitfalls for some folks is that they add layers of PACS process to existing systems. All this ends up doing is making the department work harder," she said.
Plan the PACS
Petersen recommended a four-step operational integration strategy. Step one is to detail a plan of the operational perspective of the proposed PACS. This plan should include a scope of the PACS that contains all the hardware under consideration for the system, as well as manufacturer and model number. The plan includes power needs, footprint, and equipment dimensions.
Metrics need to be taken of the radiology department’s performance before a PACS implementation, noted Petersen. These numbers will provide an administrator with a baseline against which to set their department’s PACS expectation metrics.
A current workflow of processes also needs to be charted prior to a PACS implementation. The chart must provide a clear view of how things are really working in the facility, not an idealized version of how the processes should be working, she said.
Marketing the PACS in the planning stage is important for getting users -- both internal and external personnel -- to accept the new system. The administrator should communicate clearly what the PACS will be and what it will do for both the radiology organization and its external customers.
Design the PACS
The next step involves designing the PACS implementation. This starts with the creation of a future workflow plan -- how the information and images will be moved around the facility.
"The future workflow plan can be a pretty intimidating chart to create," she said. "I’ve found it’s more manageable if you start by modality or by work area. Once the individual processes have been documented, you can start charting how they’ll interact via the PACS."
Once future workflow has been determined, an administrator will need to conduct a site survey of the department. This should include the location of power sources and voltage, network cabling, phone lines, and height and width restrictions. In addition, personnel work areas need to be surveyed for possible modifications.
Once the site survey is completed, the configuration and layout of the new PACS equipment is the next item on the administrator’s agenda. Items that need to be taken under consideration include location of PACS servers, impact on the technologist’s work areas, support areas for the PACS workstations, and the design of the radiologist’s reading rooms.
Petersen advocated communicating timelines and a training schedule on the PACS at this stage of the game. It’s also a good time to share what expected service level improvements and workflow changes are envisioned with the PACS.
"I can’t stress how important it is that people in your department are aware of what’s going on and what the expectations are -- both in the departmental and professionally -- from the upcoming PACS deployment," she said.
Implement the PACS
At this point, the equipment is being delivered, installed, and going through acceptance testing. And this is precisely the time when human factors will play the biggest role in determining the speed with which the PACS achieves success.
Petersen suggested implementing process changes as each piece of the PACS is brought online. For example, a department should consider digitizing the last pertinent film image of each exam during the transition period to PACS. In this way, there is a digital archive of current patients and users gain experience with new workflows.
During the PACS implementation time, the administrator will also need to review and redesign the clerical workflow of the department. This may include RIS processes and procedures, as well as the addition of modality worklist capabilities to the department. Film printing strategies will need to be enacted and enforced as more modalities become filmless in the department.
This is also the time when an administrator may want to start pilot or outreach efforts with other departments in an institution, such as orthopedics, the emergency department, radiation oncology, internal medicine, and surgery.
"Orthopods love PACS," said Petersen. "They often book their surgery setup on the basis of ER diagnosis, and if that diagnosis is incorrect, they’ve wasted many hours of preparation. So, they are eager to have teleradiology and images at their locations. They may be the group that embraces the technology the most quickly."
Administrators should consider holding an open house for other departments to come in and view the PACS and learn its capabilities. Another option is to hold "learning lunches" to educate physicians about what PACS can offer their medical practices. A newsletter touting PACS options that is distributed throughout an institution and to external clients is also an effective means of promoting the radiology department’s new services, she said.
Maintain the PACS
So the PACS is up and running, workflow changes have been implemented and accepted, the internal and external clients are taking advantage of the new technology delivery options, and the administrator’s job is done. Or is it?
"Now is not the time to pat yourself on the back and bask in the glory of your implementation," Petersen said. "Now is the time to gather to the data to determine the success of your PACS."
The expectation metrics gathered in the initial PACS plan can now be verified and validated. In addition, documentation of personnel training and access policies should be compiled for possible state and U.S. compliance regulations.
Policies and procedures on digital information distribution will need to be written and implemented. Focus studies can be conducted to assess inter- and intra-departmental image access and report timeliness with the PACS in place.
An administrator will want to examine operational expenses and savings in the PACS environment. This could include staffing costs, a cost per procedure with the new system, and revenue reimbursement time as a result of new workflows.
Staffing responsibilities will probably have to be reallocated, and continuing education on best PACS practices will need to be implemented as well. Metrics, performance objectives, success stories, and updates on new areas online in the PACS should be shared continually with radiology department staff, according to Petersen.
"I keep coming back to communication in each area of the operational plan," Petersen said. "That’s because, in my experience, the most successful PACS implementations are those that were communicated with staff and clients at each step of the way."
By Jonathan S. BatchelorAuntMinnie.com staff writer
August 3, 2001
Related Reading
Swift move to filmless radiology can pay dividends, July 9, 2001
Proper training can reduce errors in PACS implementation, July 4, 2001
PACS/RIS integration saves time and money, June 1, 2001
RIS/PACS integration defeats data duplication, May 11, 2001
Advance planning is crucial for PACS success, May 5, 2001
Copyright © 2001 AuntMinnie.com
