Douglas M. Tucker, PhD

The Agfa organization, based on the knowledge that it has acquired through the installation of more than 400 picture archiving and communications systems (PACS), understands that it is vital to perform work-flow analysis well in advance of PACS implementation. In particular, this process is needed in order to eliminate any difficulties that might occur during the transition from film-based radiology to digital operation. For this reason, Agfa is pleased to sponsor the publication of this Intelligence Report focusing on work-flow analysis.

To permit other organizations to benefit from the experience that it has gained at the Massachusetts General Hospital, Boston, and many other institutions, the Radiology Consulting Group, Boston, has created a pre-PACS implementation plan that is described beginning on page 4. The objectives of this program should be part of any work-flow analysis: to replace inefficient operating methods with better systems before they become automated, to help PACS providers understand the operational needs of the institution, to plan for the electronic distribution of images throughout the enterprise, to predict the effects that PACS use will have on operating methods, and to gather operational statistics that will serve as a baseline for future evaluations of the impact of PACS.

Other important parts of a pre-PACS work-flow analysis are consideration of space requirements and limitations, scheduling processes, work flow for technologists and radiologists, and peak throughput needs and expectations. These components of evaluation are highlighted in reports covering pre-PACS work-flow analyses at three sites: an integrated delivery network (Intermountain Healthcare, Salt Lake City, Utah); a large clinic (the Wichita Clinic, Wichita, Kan), and a medium-sized hospital (Waukesha Memorial Hospital, Waukesha, Wis).

As all four of the articles in this issue make clear, the degree of success achieved by a PACS implementation depends heavily upon the training support provided for the system’s users. The training process also begins with work-flow analysis prior to PACS installation. An evaluation of the skills and training needs of technologists, radiologists, referring physicians, film librarians, and the institution’s information-services staff should be undertaken; institutions should bear in mind that the most profound changes (and, therefore, the greatest need for training) are likely to be found in plain-film radiography areas.

Work-flow analysis does add to the time and effort needed to prepare a facility for PACS implementation. As the Radiology Consulting Group points out, however, this investment provides an ample return. Work-flow analysis allows the composition of a highly accurate request for proposal, making the facility’s relationship with its PACS vendor run more smoothly. Moreover, work-flow analysis gives the institution the chance to correct problems of long standing. For example, processes can be improved, work flow can be fine-tuned, and staff time can be deployed to better advantage. Given these benefits (in addition to the enhanced cost effectiveness and ease of information management produced through use of the PACS itself), it is clear that work-flow analysis before PACS implementation is not an additional step, but an indispensable one.

Douglas M. Tucker, PhD