(From left) St. Alexius Hospital?s Brian Schaab, PACS Administrator, and Bob Ellis, Director of Radiology, managed the hospital?s conversion to an alldigital workflow.

St. Alexius Hospital is located in an impoverished area of southern St Louis, where most of its patients receive Medicare/Medicaid benefits. Given limited government reimbursement rates, securing financing for new equipment investments is often a challenge. However, hospital executives have worked hard to procure state-of-the-art technology to ensure local residents receive high-quality health care.

The first steps in this technology upgrade began with installation of fully featured PACS and CR systems. The hospital conducts 35,000 imaging exams a year serving both inpatients and outpatients. It also has a busy emergency department that accounts for 34% of its total imaging volume and is served by a 5-year-old DR room.

The 160-bed hospital’s all-digital workflow now interfaces a new CARESTREAM Vue PACS and three CARESTREAM Elite CR systems with an existing RIS and Powerscribe voice recognition system. This streamlined process enables faster reporting and equips on-site clinicians and remote referring physicians with convenient online access to both reports and imaging studies.

The most dramatic improvements in patient care are achieved in the ER. Reports for patients are now available from the PACS in just 10 minutes so ER physicians can begin immediate treatment. Previously, it often took up to an hour or more for radiologists to issue reports—and they were available only on paper.

“The PACS has greatly improved care for all patients, but it has revolutionized the level of care we can provide for ER patients. Stat reads can now be conducted in just a few minutes, and radiologists can read exams from home using the same tools we have available at the hospital or our offices,” said James Junker, MD, FACR, president, Scott Radiology Group Inc.

“The PACS has a sticky note feature that allows ER physicians to provide observations of the patient’s condition and allows us to immediately communicate back to them. They can ask questions and we can respond. This feature tracks all the communication notes we have about a patient. It’s a small feature that creates a huge step forward in patient care.”

Clinicians at St. Alexius Hospital say their CARESTREAM Vue PACS has improved care for all patients and has revolutionized care for ER patients.

Enhanced Access to Images, Reports

Two Elite CR systems serve the general radiology department, and a third CR system is located in the ICU. Worklists are used to input patient information for all types of imaging studies including nuclear medicine, CT, fluoroscopy, ultrasound, CR, and DR. Technologists print exam orders containing a bar code accession number. Radiologists scan the bar code to retrieve patient information and dictate their findings using the voice recognition system. Once the radiologist has signed off on the report, it is uploaded to the RIS and automatically forwarded to the PACS.

Radiologists read exams on-site during the day, and then use the hospital’s VPN to log into the PACS to read exams from home until 10 pm. A nighthawk service takes over from 10 pm to 5 am. After-hours preliminary reads are reviewed by on-site radiologists when they come on duty the next morning.

Hospital clinicians and referring physicians enjoy convenient online access to studies and reports from the VPN, so the hospital’s reading area is no longer filled with physicians waiting to talk to the radiologist for a diagnosis. Orthopedists, cardiologists, pulmonologists, and other physicians also appreciate electronic access to exams and reports from their offices and homes.

The hospital placed a PACS workstation on a cart for use in the operating suites, which are equipped with wireless networking capabilities so surgeons can view imaging studies electronically.

The technology upgrade at St. Alexius Hospital included the installation of three CARESTREAM Elite CR systems, one of which is used in the ICU.

The capabilities of the hospital’s 7-year-old RIS are limited, and a RIS module within the hospital’s new EMR will replace it. EMR implementation will take place in stages, with the billing module being the first to go online so the hospital can meet Medicare reimbursement deadlines. All other clinical applications are scheduled for completion by the end of 2012.

St. Alexius also has established a Bariatric Surgery Center of Excellence that is certified by the American Society for Metabolic and Bariatric Surgery (ASMBS). A variety of tests and imaging studies are used to determine whether a patient is a good candidate for surgery, along with presurgical and postsurgical imaging exams.

Marketing Effort Targets Local Health Care Providers

The hospital is now marketing its upgraded radiology services to referring physicians, nursing homes, and other health care providers in the area. The hospital has a senior care department that arranges transportation and scheduling of on-site imaging studies for nursing home patients. Specialists such as orthopedists, neurologists, and urologists see patients and order imaging studies if they are needed. Those exams are conducted immediately. The senior care department has a mobile PACS workstation, so specialists can take the workstation into the exam room to display images while discussing treatment options with patients.

The hospital’s physician liaison who visits referring providers tracks increases in referral volumes. For referring providers, online access to imaging studies and reports is a critical element in optimizing the delivery of health care.

St. Alexius Hospital is proud to provide excellent quality care for the community it serves. Many of the hospital’s indigent patients use public transportation, so being able to obtain high-quality care close to their homes is an important advantage. Hospital executives and radiology staff members wanted an efficient digital environment that could improve staff productivity while enhancing patient care. They achieved both goals, and the new systems have exceeded performance and workflow expectations.

Bob Ellis is director of radiology and Brian Schaab is PACS administrator at St. Alexius Hospital in St Louis.