Thanks to sophisticated PACS systems, small community hospitals are able to access top-notch radiology talent and treat complex medical conditions.

Synapse PACS from Fujifilm.

Patients who wind up in the 25-bed Riverview Healthcare Association hospital in Crookston, Minn, probably don’t know how lucky they are. However, the reassuring sound of the Siemens Somatom 256 Dual Slice CT scanner, combined with the sight of crisp computer stations, may offer a hint of the sophistication within.

Thanks to complex PACS systems, the small hospital may indeed be the best hospital. And while the days of traveling to the big city for “proper care” are not necessarily over, they are rapidly disappearing. It’s a new way of thinking, and even some physicians at Riverview are not quite on board.

When a nearby tornado spiked activity at the hospital’s already busy emergency department, Dawn Bjorgo, radiology manager at Riverview, had to remind one clinician that capabilities were indeed up to snuff. The disagreement started when one doctor expressed the opinion that an injured patient should be transported somewhere else for a proper image and read. “Our ER doc reminded him that we have the best CT equipment, and we have PACS that will allow the image to get read as soon as we get it done,” said Bjorgo, who has been at Riverview for 18 years. “We were able to do the imaging here, get a chest tube in, save her life, then ship her out. We had everything set up with people on the other end waiting to read it.”

The “other end” happened to be in Colorado, but it could have been Los Angeles, Omaha, or anywhere else for that matter. The PACS ultimately makes for a smooth image transfer, while also fostering business for Riverview that otherwise would have been impossible.

With large hospitals not far away, Riverview’s advanced technology makes it an attractive place for specialty physicians looking to avoid the hustle and bustle of the big facilities. As early as 2 years ago, digital mammography at Riverview was a thriving reality when no one, not even the big hospitals, had it.

Patients with a wide variety of medical conditions end up at Riverview because the hospital’s reputation has spread among patients and clinicians. “We have an orthopedic surgeon who does a lot of back work,” explained Bjorgo. “His primary location is Alexandria, Minn , just a few hours from here. He can pull up everything sitting at his desk there. When you are in a rural setting, you don’t always have a radiologist on-site, so our reads are done within 30 minutes most of the time. We had PACS long before the large hospitals around us, and we would not be where we are today if it were not for PACS.”

Bjorgo helped Riverview acquire its first PACS system 7 years ago, but the radiology veteran of more than 30 years has not hesitated to change the system when improvements came along. About 2 years ago, she chose to discard her old PACS in favor of a new Intelerad system, a move that so far has been worth the trouble and expense.

Bjorgo recommends getting a HIS and RIS before replacing, updating, or acquiring a PACS system. This will make for a less painful and more seamless transition.

From Scratch

When Steven W. Lambiase, MBA, NCT, RT (R, N, CT), arrived at 126-bed Pekin Hospital, Pekin, Ill, about 2 years ago, the facility had a digital archive with Internet access (plus a RIS and HIS from a separate vendor), but nothing that could be called a true PACS. With almost 30 years in the business, and a long history of working with and installing PACS, it was Lambiase’s job to get Pekin Hospital into the 21st century.

IntelePACS from Intelerad.

After choosing a Carestream system, he and company officials started the arduous process of data migration. Lambiase was determined not to repeat mistakes of the past that involved using too many vendors. “The worst nightmare that we have ever had when I worked at a different facility was trying to integrate one vendor with another,” said Lambiase, director of imaging services at Pekin Hospital. “Nobody stopped to think about how many interfaces would have to be written, and who was going to be responsible for writing the interfaces. You must think about the integration of all the systems that are going to be used with the PACS—every piece—because there are few hospitals that are single-vendor based across all pieces of equipment.”

In a relatively remote location, efficient and timely communication between facilities is more important than ever, and the all-digital environment fostered by the PACS is essential. “It is incredible,” said Lambiase. “We don’t send anything [films] anymore. You just push a couple of pictures over to the other facilities. In the old days, you would have to send out a film request to a facility, they would receive it, someone would set it down on a desk for 2 or 3 days, then they would finally get around to it. It would finally find its way to the mailroom and then get sent out.”

Radiologists now have access to the same reading tools on-site, or from remote locations, which enhances efficiency. The Carestream platform chosen by Lambiase makes it possible for on-site clinicians to confer with remote radiologists on difficult cases. A feature called the PowerViewer provides automatic registration of current and prior volumetric studies. “Radiologists love the convenience and the ability to spend more time evaluating the data and less time with manual preparation of these data-intensive exams,” added Lambiase. “The hospital had RIS and HIS previously, but just converted from film to PACS.”

These days, all of the clinicians have familiar workstations with intuitive controls that require minimal training. All employee physicians of Pekin Hospital were outfitted with the same PACS reviewing stations. “If you are an outside physician, you can actually network into the system,” Lambiase said. “We give VPN (virtual private network) access to the outside physicians who request it. We allow them restricted access to pull the images they need without the ability to access information regarding other physicians’ patients.”

Service and Servers

Outdated, underpowered, and too numerous summed up the server situation at Hendricks Regional Hospital, Danville, Ind. Radiology director Stanley Metzger, MBA, RT (R,N), CNMT, RDMS, CRA, knew the 11 on-site servers were less than efficient. He eventually contacted representatives at Fuji (his existing vendor) who showed him how a newly updated PACS system could lower the number and streamline work processes. Thanks to a process called “virtualization,” Metzger drastically reduced the server number to three, while gaining performance.

Right off the bat, service contract costs decreased primarily due to the server reduction from 11 to three. IT personnel appreciated the lightened workload, additional space, and the reduced heat emanating from the work spaces.

Unlike Bjorgo in Minnesota, Metzger opted to update his system instead of calling a new vendor. By sticking with his existing provider, he avoided headaches associated with the dreaded data migration, a process that can be extremely expensive.

When Metzger first installed the system nearly 5 years ago, he already had digital mammography, and thus two reading stations were required. Subsequent updates have since made it possible for one station to accommodate both PACS and mammography. Much like the reduced servers, fewer reading stations also add up to fewer service dollars.

From a workflow standpoint, physicians are now able to tailor the way they look at images. “Viewing protocols are now physician-specific or user-specific,” said Metzger. “We also upgraded our voice recognition, and we did change vendors to Dictaphone Power Scribe. We also went to the BARCO 6 megapixel monitor so now, instead of having two 3-megapixel monitors side by side, the physician just has one monitor and it is also color.”

Training is always a consideration during any upgrade or installation, but the process at Hendricks Regional was a bit easier thanks to the consistent interface, which remained the same for radiologists and referring physicians. “They are all looking at exactly the same thing,” said Metzger. “If we have a referring physician at his office who is looking at an image, a radiologist can look at it. If the radiologist wants to highlight something or manipulate the image, he can tell the physician and he does not have to translate between different software in the physician’s office and the PACS. So we didn’t have to retrain any of our referring physicians either, which made the upgrade simpler.”

In the final analysis, managing expectations is one of the keys to a successful PACS. Strangely enough, many clinicians are spoiled by PACS and actually expect more than what the system can deliver. Even if the system can accommodate great speed, the hospital may be so busy that other priorities interfere. “It used to take 2 or 3 days to get films read,” said Bjorgo. “Now we have reports in around 4 hours. However, some doctors are so used to PACS that they think they can get reads in just 10 minutes. Doctors have to know that it will take time. They get used to the speed and then fast is never fast enough.”

Greg Thompson is a contributing writer for Axis Imaging News.