Our Lady of Lourdes Memorial Hospital that Brian Wetzel works in now is fundamentally different from the Lourdes Hospital he arrived at when he started working at the Binghamton, NY, facility 9 years ago. The hospital has had building projects, but that’s not the growth Wetzel, administrative director diagnostic imaging/cardiology, is talking about. The new spaces Wetzel describes were additions by subtraction. “Our old diagnostic imaging storage area at Lourdes is now where the PET-CT is, is now where the doctor’s reading rooms are [located],” he said. “We had 2 to 3 years of storage film here—on three floors.” Since going completely digital, Lourdes has changed in ways that go far beyond mere bits and bytes.
Before coming to Lourdes, which has about 250 licensed beds, Wetzel had set up picture archiving and communication systems (PACS) at two other facilities where he formerly worked. Administrators at Lourdes wanted to make the digital switch when they hired Wetzel. Lourdes housed nearly 3 years of film on-site. Due to New York law, an additional 4 years of images were stored in a warehouse five miles away. “When we had to pull something more than 2.5 years old, we would pay a company to pull it, ship it, and put it back,” Wetzel said. “That cost two dollars apiece. We did that 150 to 200 times a day.”
So the switch to PACS sounded like a good idea, though not a simple project. One of the initial steps in the transition process was finding a vendor that could store, manage, and digitize Lourdes’ hard-copy imaging exams. Ultimately, the hospital selected SourceHOV’s Total Archiving Program (TAP) for the management and strategic digitalization of hard-copy medical images. SourceHOV’s TAP solution combines off-site storage and management of all hard-copy prior exams with on-demand film digitizing and Internet file transmission directly into the hospital’s new PACS archive.
“So what we did was take all our films out of storage and ship them to Kentucky,” where SourceHOV now manages them. “Whenever we needed something, the company would digitize it on the spot and send it to us within 30 minutes. There was a global storage fee—we could ask for the same image 10 times at no extra cost.” The pictures were scanned as needed, and when the 7-year mark passed, old images were phased out. Images for children and minors were kept longer, and mammography kept for 15.
Making the switch saved time, space, and money. “I was able to decrease front-office staff by up to 14 FTEs,” Wetzel says, although some staff members were retrained as electronic imaging technicians and two became PACS analysts. “We went from printing $600,000 of film a year to $100,000 in the first year to now nothing, except for mammography.”
Technology has helped Lourdes address the patient population with increased workflow. “We’re seeing more patients with less people than 9 years ago,” he said. When Wetzel started, Lourdes performed about 160,000 imaging procedures each year. That number has grown to 185,000. Whereas before physicians might need to climb two or three sets of stairs to retrieve an image (if it wasn’t already checked out by somebody else), now they could call up the image online on any computer that had access to the Web-based system, thereby improving efficiency.
Making the Change
When Wetzel arrived, the team at Lourdes was already on board with the proposed upgrade to PACS. Some were concerned about the cost. However, once they realized that the department spent $600,000 on film alone each year, they saw the value of the digital system, as it would pay for itself. The PACS system cost $600,000 to $775,000 with ongoing maintenance. As old film is disposed of each year, the cost of the contract goes down. The average cost during the last 2 years (including mammogram film storage) was between $55,000 and $75,000.
To ease the transition period, Wetzel didn’t pull the plug on the old system right away: “For the first week, we did both print and digital,” he said. “After a week, we cut out printing of film—we had a digitizer on site.” But not everybody trusted the digital imaging. “After 6 months, I said, ‘Enough of this.’ I shipped them off to Kentucky. I didn’t really give the team a choice!”
Wetzel likened the problem to a familiar situation: “If I want to record a station on TV, I usually ask my kids to do it. It was the same thing with the physicians, getting them acquainted with the computers.” Wetzel says within 6 months, everybody had caught on. Once that happened, they were sold. “We realized that getting the physicians educated was the most important thing. If they had a problem, we went to their office. If they had a problem calling something up [on the computer], we go and [fix it for] them.”
The Bigger Picture
Digital imaging and archiving are becoming increasingly popular. Monetary savings aside, the systems provide a solution to the challenge of managing ever-increasing workloads. Simply put, the systems save time. In the past, Wetzel says an image “would take 3 to 4 minutes to process—even on CR film—before it could be digitized, which you had to do physically. With complete digital imaging, we see the film in 4 to 8 seconds.” Wetzel says a physician he works with told him that because of the digital imaging capabilities in the hospital, for every patient he saw for whom he needed to see film, he saved a total of 10 to 15 minutes per patient.
Digitizing archives is becoming easier. Hardware has gone down in price. Storage has gone down in price. “Digital imaging is the way for every private office and hospital to go,” said Wetzel. “I think you’ll see nearly all digital in the very near future. It wasn’t unique to us. We could implement this kind of system anywhere, any hospital large or small, and you’re seeing that happen across this country. In the long run, digital imaging pays for itself.”