Ideas in Hospital-Based Imaging

by Cat Vasko

Modular MRI Proves an Attractive Option
HIS/PACS for Community Hospitals
Seven Years of Remote Hosting

Modular MRI Proves an Attractive Option

Saves Money, Simplifies Construction

When Concord Hospital, Concord, NH, needed an MRI suite for its new 3T system, the obvious next step was to begin the process of searching for a contractor. But Jay Mazurowski, MD, director of radiology services, had another idea.

“A hospital in our area had a GE magnet for sale, and they were looking for someone to buy out their contract,” Mazurowski said. “Their MRI system happened to be housed in a modular building, so I started exploring that option and getting more information.”

Jay Mazurowski, MD, director of radiology services

The hospital was housing its MRI in a modular diagnostic imaging suite manufactured and sold by PDC Facilities Inc, Hartland, Wis. The company specializes in modular buildings for MRI with integral RF shielding and custom modular buildings for CT and PET/CT, all sold at a fixed price free from contingency budgeting. Mazurowski’s interest was piqued. Was this a solution that would satisfy the needs of both the radiology department and the hospital administration?

“It’s very cost-effective because you don’t have to worry about delays,” Mazurowski said. “They give you a very specific timeline, and they really adhere to that. The day they promise delivery is the day they deliver.”

Concord purchased the 14- x 55- foot “Diagnostic Imaging Suite” building, which is the smallest and least expensive hospital-grade MR building manufactured by PDC. It would be delivered on the designated date fully finished—inside and out—and would meet all New Hampshire state building codes, HHS federal design guidelines, state health department regulations, and specific MR installation and servicing requirements. This was a particularly crucial selling point for Concord Hospital, which was in the process of adding a new wing and needed the simplest, most expedient construction solution available.

“We were definitely competing for resources, and outsourcing the construction to PDC was a great solution,” he said. “All we were responsible for was the site preparation, and PDC is very specific and helpful—they guide you the whole way.”

When it came to housing its new 3T MRI, Concord Hospital was seeking a cost-effective and relatively easy solution. The institution worked with PDC Facilitie, Inc, and the result has satisfied the radiology department, hospital administrators, and patients.

Site prep includes laying down a pad to support the modular unit and working with a PDC representative to determine whether additional features, like frost walls, are necessary. “Once it’s done, they really do just drop it into place and bolt it in,” Mazurowski said. “It’s plug and play.”

There are, of course, a few caveats. The PDC units can be installed only on the ground level of a hospital and have to be bolted to an exterior wall; additionally, their size and shape are both fixed. But other elements are customizable. “You can put facades on the outside to make it match the building,” Mazurowski said. “And from a patient’s perspective, when you enter the MRI suite, you don’t realize you’re in anything other than the hospital.”

When it was time to install Concord’s new MRI suite, the team at PDC trucked the unit along a pre-established route and delivered and installed the unit in 1 day—in the middle of one of the worst snowstorms of the season. “They just dropped it onto the pad and bolted it into the building,” Mazurowski recalled. “It was in place within a day, and the finishing touches took just a few more days.”

Those finishing touches, included the company’s piece de resistance—tuning the new suite to the MRI magnet for optimum image quality. “They created the best possible imaging environment,” Mazurowski said. “It’s definitely something I would do again.”

HIS/PACS for Community Hospitals

Community hospitals face unique challenges. For one thing, these institutions can be short-staffed—and that includes IT implementation staff. But Nueterra Healthcare, Leawood, Kan, believes it has found a smart solution.

McKesson Corp, Atlanta, recently announced that its HIS and PACS solutions had been selected by Nueterra for three community hospitals the organization is building. For its EHR and financial management systems needs, Nueterra selected McKesson’s Paragon HIS system; for electronic access to images and reports, the company selected the Horizon PACS.

“We’re in the process of developing and expanding our services to include community hospitals,” said Mike McCoy, president of the community hospital division at Nueterra. “This is a growing market, and watching the growth and proliferation of ambulatory service centers, the next logical place to go is community hospitals. We provide services where the community needs and wants a facility and the physicians want to be a part of it—we broker that deal and get it off the ground.”

McCoy, who calls himself an “operations guy,” says the key reason he and his team selected McKesson’s solutions is their intuitiveness. “This system is integrated, and it’s simple,” he said. “In the space we’re working in, those are extremely important features. We don’t want to reinvent the wheel, or come up with a new kind of wheel. We need basic, good, reliable health information systems to operate our facilities, and that’s what Paragon offers.”

Jason Berry, vice president of services and support for Paragon, notes that the platform is ideal for the community hospital market because of McKesson’s high degree of involvement. “Typically, the solutions implemented in the community hospital market are similar in complexity to what the rest of the market implements, but they don’t have the staffing,” he noted. “The average tenure of a member of our implementation staff is 18 years. We’re able to bring a very unique approach to the process. We hold their hand through the whole thing.”

For McCoy, starting on the ground floor with advanced, integrated PACS technology is an important part of getting the community hospitals up and running. “PACS as a technology is certainly advancing,” he said. “Imaging is going to continue to revolutionize health care, and we’re going to see it playing a dominant role in diagnostics in the future. Having a PACS system in place puts in the foundation we need.”

Joe Bigel, vice president of product management for Horizon Medical Imaging PACS, says that the same principle that applies to Paragon in the community hospital environment also applies to the combined HIS/PACS solution. “When you look at the typical community hospital environment, there are much fewer IT resources than at a larger hospital,” he noted. “In some cases, there are fewer IT resources than there are sites. So how do you get all the advantages of a modern PACS system in that environment? You need to get it operational quickly, without having to come up with resources that aren’t in the budget. We can get a hospital from analog to digital in a weekend, and that’s very powerful in this market.”

McCoy echoes those sentiments. “Our foci are similarly aligned,” he said of Nueterra and McKesson. “We need to scale things for a smaller market, but we need to do them effectively and efficiently. Some of the systems out there try to be a lot of things to a lot of people, but we can’t be cost-effective with that kind of infrastructure.”

Seven Years of Remote Hosting

Marion General Hospital, Marion, Ohio, recently signed on for 7 years of remote hosting services for the Centricity Enterprise solution from GE Healthcare, Waukesha, Wis. The arrangement will allow the hospital to implement a comprehensive clinical information system while maintaining a flexible technology model bolstered by remote upgrades and services.

“We’ve never had hosting here on-site,” said Charles L. Tudor, director of information systems at Marion. Tudor explains that OhioHealth, Marion’s umbrella health care system, was using IDX Systems’ LastWord enterprise clinical record program, which Marion connected to via phone lines. (GE Healthcare subsequently acquired IDX in 2005, folding LastWord into its Centricity solution.) “Our workload has dramatically increased since then,” he said. “We’ve grown from a department that implemented LastWord to a department that’s using 30 different kinds of software.”

Tudor describes the process of learning to use LastWord as a “10-year curve we don’t really want to abandon. We like the flexibility of it, the ability to tailor things.” To move to an on-site solution would mean working with a more basic software system. “It would be a step backward for our users, who are used to getting that kind of flexibility from software,” Tudor said.

Tudor looks forward to being able to do his job better thanks to the 7-year contract. “We’ve gone from a registration-order-charge system to a robust suite of clinical applications,” he said. “Sending that off-site allows us to concentrate on the support we really need to be doing while outsourcing some of the more routine stuff.” That “more routine stuff” can take hours out of the day, he says—time that needs to be spent addressing the day-to-day IT needs of a 165-bed hospital. “Clinical end users are not very forgiving folks,” he noted. “They want things fixed very quickly—the world they live in demands that. So we’re looking to see a lot more functionality out of Centricity, especially in the clinical documentation area, than we saw in LastWord, even though we were using all the clinical stuff LastWord had to offer.”

Centricity’s remote hosting will also free up the information systems team at Marion to pursue new ventures, including the implementation of clinical information systems, decision support tools, barcode medication administration, multidisciplinary documentation, and much more. “This is a platform that will support some other stuff we’d like to do,” Tudor said. “We’re going to be looking at single sign-on, loading multiple applications from one screen. CPOE [computerized physician order entry] is also a big part of this. And we’re looking into upgrading our document imaging software and integrating it with some third-party folks GE works with.”

Meanwhile, GE will be managing software updates and disaster recovery—two major headaches for most IS departments. “GE will be responsible for the new releases, which is great because we tend to run behind that curve,” said Tudor. “And they’re going to replicate everything to Seattle, so we’ll get out of keeping tapes to restore from, either locally or at another site. Having the vendor take responsibility just seemed like the smart thing to do.”