A community hospital implements PACS to provide the ‘gold standard of care’ and benefit from ‘soft dollar savings’
By Aine Cryts
Starting this winter, stroke patients arriving at St. Joseph’s Hospital in Elmira, NY, will be able to obtain a consult from a neurologist based at Strong Memorial Hospital, located 120 miles away in Rochester. These patients will be able to do so because St. Joseph’s Hospital has been live on Synapse PACS from Fujifilm Medical Systems since August 2010.
Some stroke patients might still have to make the nearly 2-hour trip to Rochester—but there are others who will be able to stay right there in Elmira because St. Joseph’s Hospital will be able to facilitate this remote consult. Prior to implementing PACS, the hospital had relied on film exclusively.
The strongest argument for going digital, according to Ron Woodard, PACS manager at the hospital, was the need to provide “the gold standard of care with imaging” for patients—and to retain radiologists.
“The PACS system is about speed and accessibility,” said Woodard. “Before PACS, we had to develop films, then the technologist had to walk [the films] to the reading room, place the films [so the radiologist could read them], then the films were read, [after which] the films were brought to the emergency room physician.
“Now, anybody can access those images—literally, before the patient leaves the modality and before the images have been read. The speed factor for us is huge,” said Woodard, who notes that getting funding for the PACS purchase wasn’t a problem, since the hospital had been planning on this investment for a few years.
Beyond providing the gold standard of care for patients, a few other realities made the need to implement PACS a necessity: One, (pending approval by the New York State Department of Health) St. Joseph’s Hospital plans on merging with Arnot Ogden Medical Center (which also has a PACS system) and, two, the hospital’s agreement with the radiology group that interprets exams may end in January. While none of the group’s radiologists are currently reading exams on a remote basis, Woodard is looking forward to that possibility in the relative short term.
Asked about savings as a result of the hospital’s investment in digital imaging, Woodard said, “A lot of times, you don’t see hard dollar savings.” He discovered during his graduate school course in medical informatics that it’s more about “soft dollar savings,” meaning that “people are happy because of the system and happy about the quality service PACS can offer to the customer.”
According to Woodard, having a PACS system is key to retaining and recruiting physicians, “especially those just out of medical school.” He believes that without a PACS system in place, it can be particularly difficult to retain physicians in a small community, such as Elmira, which has a population of approximately 29,310.
As far as the functionality provided by their new PACS system is concerned, the ability to prioritize certain exams is “very valuable,” noted Woodard, who also said that hospital physicians are happy about the ability to mark some exams as “stat reads” within the system. Further, “with digital images, you can zoom and [perform] various functions, which enhances the ability to interpret and diagnose,” said Woodard, as a way of contrasting the capabilities of digital images with the static nature of film.
Going forward, the hospital intends to save about $95,000 a year in film, chemicals, and maintenance. These days, the hospital is spending more because of its investment in digital imaging, but Woodard hopes that the radiology department will be able to expand in the future. “The film library takes up a lot of space. Once it’s gone [because the necessary films will have been digitized], we could use that space for a procedure room or offices—or both.”
Woodard also has on his mind the merger that is in the works with Arnot Ogden Medical Center, so he’s going to be focused on figuring out how to “hook up our PACS into theirs.” While the merger with the nearby hospital is not yet a done deal, the state has offered “a huge carrot of $20 million,” part of which, said Woodard, could be used to create Centers of Excellence throughout the hospital.
The radiology department, said Woodard, is one of those Centers of Excellence right now. That’s due, in part, to the department’s investment in digital imaging technology.
Concerning the importance of having a PACS system at St. Joseph’s Hospital, Joseph A. Bifano, MD, chief of medical imaging, put it succinctly: “You need to have digital mammography. Our patients are listening to ‘The Oprah Show’ and other talk shows that tell them they need to have a digital mammogram done. If you’re the only facility that doesn’t have digital mammography, you’re going to lose patients. Now, with digital mammography in place, patients are migrating back.”
Aine Cryts is a contributing writer for Axis Imaging News.
PRIVATE PRACTICE: PACS POWER, PEOPLE POWER
Patients calling Park Avenue Radiologists in New York City to schedule exams are prompted to visit the practice’s Web site, which provides a form that patients can complete to request an appointment. Here they are asked for some demographic and other information—such as the type of exam needed or their availability for a follow-up phone call.
Marc Liebeskind, MD, radiologist and owner of Park Avenue Radiologists, said that the above scenario allows patients to schedule their exams months in advance, while enabling his scheduling staff to capture vital information—such as the proper spelling of a patient’s name, their insurance information, and their day and time preference for an exam.
While NovaRIS from Novarad allows his practice to receive exam request information directly from the practice’s Web site, Liebeskind believes the human interaction by his staff provides them with better control over the practice’s schedule. Instead, that information is sent to an e-mail distribution list, which includes him and members of his scheduling staff. Upon receipt of that information, someone in scheduling will contact the patient to set up their appointment.
“The end result is our phone isn’t clogged. And you get a lot of data when they submit the form on our site,” he said, noting that patients have varying degrees of tolerance for working through phone trees.
Having accurate data helps to address the challenge of getting paid in a timely manner in a managed care environment—that of charge capture. “You really want that first claim approved. [Capturing that data correctly at the beginning] reinforces the integrity of data on the incoming side,” he said.
With his practice up and running on NovaPACS and NovaRIS since May 2010, Liebeskind is pleased to have a unified solution with a single vendor, which works best for his practice since the vendor is “fully responsible.” Acknowledging that he “pulled no punches” in his requests of Novarad during the sales process, he peppered the company with questions about reporting, interfaces, IHE compliance, meaningful use implications, product roadmap, and database architecture. Another key determinant for him was that the vendor’s RIS and PACS were “fully integrated.”
It is his experience working with a RIS (since 1999) and a PACS (since 2001) that informed Liebeskind’s discerning perspective when he sought out a new partner that could provide him with a fully integrated system for his practice. “We operate as a RIS-driven facility,” he said. Therefore, what matters most to his practice is providing follow-up, avoiding chart duplication, managing the number of people who work with a patient during their visit, managing the patient experience, and submitting accurate claims to insurance companies.
More than 6 months after the implementation, Liebeskind notes that Novarad successfully migrated 19 terabytes of data from his practice’s previous PACS into the current PACS system. He is a genuine advocate for a PACS viewer that is similar across referring physicians and radiologists—a viewer that enables a radiologist during a phone consultation with a referring physician to walk through their interpretation. With a unified user interface, said Liebeskind, you don’t have situations where a referring physician “can’t get to this series” or “can’t see the labeling.” This is important, he insists, because he projects that, over the next 5 to 10 years, more and more PACS users will be referring physicians.
—A. Cryts
SOFTEK LAUNCHES NEW VERSION OF ILLUMINATE
With Version 3.0 of Softek Illuminate, administrators can track modality usage.
PACS administrators and others in the radiology department wanting to apply the power of Google—and more—to their radiology reports now have access to a similar search engine, according to Softek Solutions, which announced the release of Version 3.0 of Softek Illuminate at RSNA 2010.
According to Matthew McLenon, chief executive officer of Softek, the information supplied by Illuminate Insight, Analytics, OnPatrol, and ActKnowledge, applications within Softek Illuminate, “improves quality and efficiency in all areas of radiology.” With this solution in place, “radiologists can work faster, more accurately, and with greater confidence,” according to the company. Further, administrators can “track studies for patient follow-up, compliance documentation, proper billing, quality improvement, and modality usage.”
The system spotlights unexpected findings and helps ensure proper patient follow-up.
In addition, said McLenon, “the new system to track unexpected findings holds the potential for organizations to ensure proper patient follow-up care and avoid costly malpractice suits. Also, radiologists gain easy access to information they need as they begin to implement meaningful use measures.”
A recent press release announcing Version 3.0 of Softek Illuminate notes that the solution is now vendor-neutral. According to the company, the solution is in use at the University of Chicago and at the Veterans Affairs Medical Center in San Francisco, among other facilities.
—A. Cryts
