Despite a lack of government funding allocated for their PACS implementation, the radiologists at St. George Hospital in Sydney still managed to turn their department into a filmless operation.
The state of New South Wales had no area-wide plan for PACS implementation. Equipment funding was provided in an ad-hoc fashion and usually only to new hospitals or hospitals undergoing redevelopment, explained Dr. Derek Glenn during a presentation at the 2003 Royal Australian and New Zealand College of Radiologists (RANZCR) meeting in Brisbane, Australia.
As a result, St. George Hospital had no provision for new radiology equipment. "I’ve had no (new) money for capital since 1997," said Glenn, who is the director of radiology. Still, Glenn and his team managed to nab the funding by invoking those magic words: cost cutting.
A cost analysis predicted that (AUD) $1.5 million Australian (U.S. $1 million) would be spent over the life of the five-year PACS implementation project, according to Glenn. Savings would occur through cost reductions associated with stationery, clerical staffing, and processor maintenance. Finally, gains would be achieved in staff productivity thanks to easier image retrieval.
Working with their existing budget, they were able invest (AUD) $106,000 (U.S. $72,000) on a workstation for their DICOM-compliant digital subtraction angiography suite (the department’s CT scanner and all ultrasound systems also were DICOM compliant). The $106,000 actually came from a one-off communication grant.
There was no separate RIS requirement with the workstations, which were integrated with the PACS, Glenn said. "There is one keyboard, one mouse, and a dual-head monitor all residing on the (server). So when I’m in CT, I can actually write and launch e-mail, select an image, and send that by e-mail. I don’t have to leave CT reporting and go back to my office to check my e-mail anymore. The dictation is built-in and the RIS is running on the same box; it’s on the (server), it’s all completely integrated," he said.
A state-funded telehealth project provided (AUD) $130,000 (U.S. $88,000) to enable radiology registrars to perform remote call after hours. This required a Web server, home-based PCs, and broadband communications for image transfer. Finally, annual funding of (AUD) $320,000 (U.S. $217,000) was allocated for laser film and processor chemicals. This funding was then routed to running the PACS.
The approach to PACS implementation was gradual rather than all at once, Glenn said. Initially, modalities utilizing laser film were moved to the PACS, and eight months later the entire department became filmless. The existing hospital network was adequate for the system’s needs.
There were, however, a few glitches. First, the removal of plain film caused significant problems for referring doctors, although they had been informed that a filmless department was on the agenda. In order to accommodate these physicians, additional PC workstations were purchased for surgeons and the critical care unit, all funded by the hospital administration at a cost of (AUD) $90,000 (U.S. $61,000).
Second, a significant number of images were deleted during the initial phase of implementation, although they were eventually retrieved from the hospital’s secure Web server. Glenn recommended that security should be especially tight during the implementation and testing phases.
Overall, Glenn deemed PACS a success. "What we provide now is same-day reporting, and voice clips are immediately available on the Web," he said. Images and reports are available on the network. Planned improvements include linking to other hospitals’ PACS, broadband access for referring doctors outside the hospital, and electronic examination requests.
"We want to implement a paging system to alert referring doctors that reports and images are available on the network automatically. We want to deliver everything online and on time," Glenn concluded.
Needless to say, the hospital executives were pleased that a filmless department was achieved without significant additional funding. "The entire process was very informal and required no external consultants," Glenn said.
By Leanne McKnoultyAuntMinnie.com contributing writer
October 9, 2003
Related Reading
Keeping your eye on the PACS ball, September 30, 2003
Smoothing the transition to filmless, June 16, 2003
Assessment planning improves PACS performance, August 11, 2003
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