Informatics Report: Workflow! Workflow! Workflow!
SCAR Becomes SIIM, and Other Announcements from the Annual Meeting
FDA Approved: Totoku Receives FDA Approval for FFDM on 5-MP LCD
Running the Numbers
From Nighthawking to Bedside Manner, PACS Administrators Dish
Maxant Achieves Medical-Grade Status for Digital Workstation
Radiology Ltd Obtains Precious Backup Minutes from InfraStruXure

Informatics Report: Workflow! Workflow! Workflow!

by Michael Mack

Advancements in medical-imaging technology are complementing the work of oncologists, improving health outcomes for cancer patients, and benefiting economic productivity, according to experts at a recent Capitol Hill briefing.

Michael Mack

When evaluating and purchasing a PACS, many terms are used very frequently. Every salesperson’s arsenal includes these buzzwords, but I believe the most abused and misunderstood word is “workflow.” Think back to the presentations you’ve seen. How many times have they been about anything other than workflow, workflow, workflow?

The word workflow is overused because, for one thing, it is very rare during the sales cycle that a salesperson truly has any clue about your radiology workflow. And it is virtually impossible to propose any post-PACS workflow without a complete and thorough understanding of the current workflow. The majority of facilities jump directly to a completely filmless environment; commonly, they overlook the transition period from film to digital. Unfortunately, someone can’t pull out a template for each facility that explains how to make this transition happen. As I have mentioned in almost all of my columns, there is no one perfect PACS product, but there are products that can work in your environment. How that product will migrate into your workflow is something that only you will know, because you are the expert on your workflow. Keep that in mind when deciding which vendor’s product will be the best fit.

Key workflow components to be considered are film file room, technologist, radiologist, and the emergency department to radiology. Depending on your PACS vendor, each workflow can address key elements in several ways. I recommend beginning with how you are working currently. Document the existing workflow in each of these areas as it pertains to film and master jacket movement, paperwork required through the process, patient flow, image acquisition, and preparation for radiologist interpretation and dictation.

Evaluate how you are delivering hard-copy data to your technologists and radiologists today. Modify how that information should be delivered in soft-copy form. Understand how your radiologists read current exams. What was supplied in the past for previous pertinent exams? How will they review previous reports? What reports will they need to review? How have they reviewed them in the past—on hard copy or in the RIS? What films have they required previously?

Wherever you can leave a step the same, do so, because so many new and unknown activities will be added via automation to the new workflow. Also, because all of your pre-PACS films and reports will be available as they were, you will need to merge them together during the transition period. If certain aspects for previous films worked before, leverage them during the transition phase. Do not introduce additional complexity if you can avoid it.

The old adage, “If you fail to plan, you plan to fail,” is very true for workflow. So be sure to have multiple discussions as a team; agree to what each person in the workflow can expect to be delivered and how it will be performed. Finally, be prepared to adjust, tweak, or—sometimes—make major changes during your “go-live” transition.

The one constant is change, and every facility and staff is different. The migration from film to soft copy requires a well-planned workflow. Everyone should know exactly what to expect in their position of the workflow as well as what to prepare for the next team member in the workflow process. Everyone needs to understand that, as a team, they can make changes to better meet each other’s needs in a new, uncharted workflow during the transition phase. An efficient post-PACS workflow meets the needs of the entire radiology team.

Michael Mack is VP of business development at The Thomas Group Ltd (Anaheim, Calif). Having more than 20 years of experience in the medical imaging industry, Mack now specializes in PACS planning and implementation.


SCAR Becomes SIIM, and Other Announcements from the Annual Meeting

During its annual meeting in Austin, Tex, April 27?30, the Society for Computer Applications in Radiology (SCAR of Great Falls, Va) announced that it was changing its name to the Society for Imaging Informatics in Medicine (SIIM). The name change is part of a larger move to expand the Society’s focus to encompass other clinical specialties beyond the field of radiology. “Although we are quite determined to stay true to the Society’s roots in radiology, in reality, medical imaging is expanding across the health care enterprise,” said SCAR Chair Richard L. Morin, PhD, of the Mayo Clinic, Jacksonville, Fla.

SIIM also announced that the organization is on the move—to Leesburg, Va. The Society’s new mailing address will be 19440 Golf Vista Dr, Suite 330, Leesburg, VA 20176. The move is scheduled for early July.

Perhaps the Society’s most wide-reaching news was the announcement of the formation of the Certification of Imaging Informatics Professionals (CIIP). “This certification program will assess professional competency and is, therefore, likely to elevate the credibility and professionalism of certified individuals,” said SIIM Executive Director Anna Marie Mason. “SIIM will play a major role in developing, promulgating, and monitoring standards that thereby elevate the quality of services delivered by the certified imaging informatics professionals.”

SIIM is developing a test blueprint that will determine the topics in which an imaging informatics professional should be proficient in order to become certified. Throughout May, SIIM requested feedback on this text via its Web site. The organization hopes to have the first exam available by September 2007. For more information, visit www.scarnet.net/ciip/.

The CIIP program will be based on National Organization for Competency Assurance (NOCA of Washington, DC) and American National Standards Institute (ANSI of Washington, DC) standards to guarantee validity and fairness of the program.

“We want to ensure that this board—which will eventually be divested from SIIM, though always closely aligned—will be an independent organization, and we want those who become certified to be aware that we don’t have any vested interest,” said J. Anthony Seibert, PhD, chair of the Imaging Informatics Administration Certification Committee and immediate past-chair of SCAR. “Our goal is for members to develop an esprit de corps among those in the field and to have an opportunity to come together as imaging informatics professionals.”

FDA Approved

Varian Medical?s Vitesse system makes it possible to see the placement of HDR brachytherapy needles within a volumetric ultrasound image.

Totoku Receives FDA Approval for FFDM on 5-MP LCD

Totoku North America Inc (Irving, Tex) has been given 510(k) approval from the US Food and Drug Administration (FDA of Rockville, Md) for its ME511L, allowing it to be used in all digital mammography applications.

Totoku’s ME511L is a 21.3-inch, DICOM-calibrated, diagnostic display with a 11.9-bit grayscale palette, 750 cd/m2 brightness, and 2048 x 3560 (5-megapixel) resolution. The liquid crystal display provides film-like images, touts wide viewing angles, and interfaces with Totoku’s performance-monitoring software for remote display status.

“Totoku’s ME511L is a proven, cost-efficient solution for viewing all mammographic diagnostic images in a PACS environment,” said Herb Berkwits, product manager at Quest International Inc (Irvine, Calif), one of the US distributors of Totoku’s medical displays. “Full-field digital mammography [FFDM] systems provide increased throughput, and the Totoku ME511L gives radiologists the confidence of film-like reproduction on each and every read.”


Running the Numbers

67% of physicians use speech recognition in radiology 100% of the time. Other usage figures: 12% use it 90%?99% of the time; 13% use it 70%?89% of the time; 4% use it 50%?69% of the time; and 4% use it less than 50% of the time. These figures are based on April?s 2006 Speech Recognition Report by KLAS Enterprises LLC (Orem, Utah). Visit www.healthcomputing.com for more information.

From Nighthawking to Bedside Manner, PACS Administrators Dish

Munish Goel, director of IT and PACS/RIS administrator at TrueMetric Imaging Medical Group (Bellflower, Calif), described his responsibilities in nighthawking from three different perspectives during a session called “What’s My Job” at the recent meeting of SIIM, April 27?30, Austin, Tex. As network administrator, workflow manager, and PACS administrator, handling all three aspects is imperative for successful nighthawking and involves such tasks as network feasibility, setting up the virtual private network (VPN), and setting up the routing (as a network administrator); determining the proper workflow for transmitting images, setting up protocols for sending requisitions and images, training on requisitions and images, and defining the life cycle for a study (as a workflow manager); and setting up modalities, creating or modifying DICOM tags for clear identification, setting up transfer syntax and compression parameters for image transmission, and checking image quality for diagnostic reading (as a PACS administrator).

Some of the tough nighthawking issues that Goel faces are slow image upload and retrieval because of limited bandwidth, lost network connectivity, an unresponding DICOM receiver/sender, studies that are missing images, and reports that aren’t making it to hospitals. To make his life easier, Goel explained, he provisions the proper hardware and software at hospitals, and he ensures that the proper resources are in place before he obtains contracts. He also tests workstation calibration before fielding, and he uses image-compression applications, such as JPEG2000.

“I love my job,” Goel admitted. “I love that it’s a constant learning process, and I love the everyday challenges.” What would make his job easier in the future? Goel said he wants a real-time dashboard of the PACS to adjust productivity of radiologists and modalities. He also would like a truly integrated PACS and RIS.

Next up was Lance P. Ford, IT director and PACS administrator at Arkansas Medical Imaging (Little Rock). “This is a highly technical world,” Ford said, “and a PACS administrator is expected to know everything with extreme knowledge and the bedside manner of a family doctor.” Some of Ford’s recommendations for doing just that included knowing the linguistics—for example, when a radiologist says, “The network is down,” what does it truly mean? Is the PACS not working? Is an image not loading? Or is it something else? Ford advised, “Figure out who you are talking to and how they communicate. But be sure not to talk down to anyone or talk below his or her level.”

Ford advised remembering who the customer is, and that it’s everyone from physicians and technologists to assistants and administrative personnel. He added, “If you fix the customer, you fix the problem. Just keep in mind that the real customer is the patient.”

David R. Fox, MBA, CRA, director of radiology at Baptist Health Medical Center?Little Rock, spoke next. Fox explained that his responsibilities include day-to-day operations—”meaning hiring, firing, and counseling.” The day-to-day also includes fiscal, project, and human resources management; professional development; and marketing—”Be a difference maker!”

As the director of radiology at a nonprofit, community, faith-based hospital with 767 beds, Fox is a communication resource for radiology, which includes being available via e-mail, phone, and pager. Then, it’s knowing who to rely on for informatics, which includes the chief information officer, the PACS/RIS administrator, and information-technology support. And then, it’s knowing when to call on them, “which is before the problem occurs,” Fox said. His job also entails knowing how to get things done. “To do that, I must trust in the ability of the people I have,” he advised. “To do that, I need to hire and promote the right people.”

Fox also was adamant about strategic planning. “Build a support team, involve the team, nurture the team with positive encouragement, and, above all, listen,” he advised. “Then, perform a look back and ask, ?Did we meet our goals?’ ” Then, make adjustments accordingly, he added. In short, Fox said, “Radiology administration is work, but it is rewarding with the right team.”

Finally, Session Chair Charles W. Socia, RT(R)(CT)(QM), vice president of operations at Arkansas Medical Imaging, closed out the session. He noted a few trends in imaging informatics, including that educational opportunities are becoming more readily available, technologies and platforms are becoming standardized, developmental cycles are shortening, and imaging informatics is being recognized as a vital role in health care. In fact, some of the career opportunities for imaging informatics professionals (IIPs) now include positions within hospitals, imaging centers, application service providers, vendors (in support and in sales), research and development, consulting, project management, radiology/IT leadership, and government.

Socia, who spent 13 years as a CT technologist, is part of the Certification of Imaging Informatics Professionals (CIIP) program. (See “SCAR Becomes SIIM, and Other Announcements from the Annual Meeting” above.) He noted that for him, one of the goals of the certification is to have a minimum requirement of qualifications for the individuals he hires. Some current needs in imaging, he said, are the need for defined roles for IIPs, the need for university-based professional curricula, the need for a diverse skill set to be required, and the need for professional recognition. He added, “This certification is one step.”

A. Lucas

Maxant Achieves Medical-Grade Status for Digital Workstation

With its recent FDA marketing clearance, the MediPort from Maxant is safe for PACS- and DICOM-viewing software.

Maxant Technologies Inc (Niles, Ill) has received 510(k) clearance from the US Food and Drug Administration (FDA of Rockville, Md) to market its MediPort line of fully integrated digital workstations. The clearance provides Maxant with the ability to market the MediPort as a safe and effective platform for PACS- and DICOM-viewing software. The areas for intended use of the MediPort include all hospital environments, imaging centers, physician’s offices, and clinical laboratories.

Additionally, the MediPort has met all of the specifications of the Underwriters Laboratories Inc (UL of Northbrook, Ill) 60606-01 classification for medical-safety standards. “The continuing evolution of digital applications in radiology is expanding into electronic imaging outside of traditional diagnostic viewing environments and into sensitive patient-care areas,” said Maxant COO John Patterson. “As this occurs, it is essential that health care facilities furnish their staff with FDA-cleared medical devices that also meet the rigorous UL safety standards when viewing electronic images.”

Radiology Ltd Obtains Precious Backup Minutes from InfraStruXure

To accommodate and complement its rack and battery backup solution, Radiology Ltd (Tucson, Ariz) has installed InfraStruXure from American Power Conversion Inc (APC of West Kingston, RI), an on-demand architecture for network-critical physical infrastructure (NCPI) that integrates power, cooling, rack, management, and services. Radiology Ltd owns and operates 10 imaging centers across southern Arizona and provides MRI, CT, positron emission tomography (PET), nuclear medicine, bone and joint imaging, and diagnostic and interventional neuroradiology services as well as overnight teleradiology services for four hospital emergency departments.

According to Eric Nied, director of information technology at Radiology Ltd, a few of the benefits of InfraStruXure include ease of management and security. He said that the system also provides a modular, scalable approach. “We knew that we needed at least 15 racks to get started and would need 15 more shortly thereafter,” Nied said. “We also required that the UPS [uninterruptible power supply] work in conjunction with our 500-kW, 625-kVA backup generators. Our failover tests have shown that we average 30 seconds on battery before the generator power kicks in. InfraStruXure now gives us 5 minutes at full capacity, which is enough time to shut down critical applications in case of generator failure.”

Nied also cited the protection of the RIS, PACS, billing, document scanning, and critical financial systems as an additional benefit.