Changing the Playing Field with Integrated RIS/PACS RIS-driven

Cooper University Hospital

Changing the Playing Field with Integrated RIS/PACS

radiology and imaging speCialists

RIS-driven Workflow Simplifies a Complex Practice

United memorial mediCal Center

RIS/PACS Propels the Community Hospital

SPeeCH: The Next-Generation ‘Smart’ Report

RIS in the Outpatient Imaging Center

ensuring Success: RIS/PACS Consultation & Training

sUpplement toFebrUary 2008

sponsored by an edUCational grant From

ge HealtHCare

GE Healthcare

© 2008 General Electric Company

With information atyour fi ngertips, decisionsare easy to reach.Connecting to information enables caregivers to decide on a plan of action quicker and more effectively. Which is why, from streamlining clinical workfl ow to expediting revenue cycles, GE Healthcare’s Centricity™ portfolio provides information-sharing solutions that allow caregivers to view patient data across multiple applications and locations. With critical information within every caregiver's grasp, better patient care is easier to reach. Healthcare IT Re-Imagined.

www.gehealthcare.com/centricity

HealthImaging.com Rethinking RIS: Strategies to Streamline Operations �

Editorial Office: 235 Promenade St., Suite 455 Providence, RI 02908 401 383 5660 | [email protected] ©2008 by TriMed Media Group, Inc. All rights reserved. Reproduction in any form is forbidden without permission. The information, opinions and statements expressed in the articles and advertisements herein are those of the writer and/or advertiser. Health Imaging & IT and GE Healthcare make no representation as to the accuracy or completeness of the information contained in the articles. GE’s sponsorship is not intended to convey endorsement of or affiliation with the authors.

table of contents

Sponsored by an educational grant from

A supplement to

Case study › Cooper University Hospital

02 ChangingthePlayingFieldwithIntegratedRIS/PACSby Lisa Fratt

FebrUary 2008

Case study › radiology and imaging speCialists

05 RIS-drivenWorkflowSimplifiesComplexPracticeby Lisa Fratt

15 EnsuringSuccess:RIS/PACSConsultation&Trainingby Leslie K. Anderson

12 RISintheOutpatientImagingCenter:IncreasingEfficiency,MaximizingRevenueby Beth Walsh

11 Speech:TheNext-Generation‘Smart’Reportby Lisa Fratt

Case study › United memorial mediCal Center

08 RIS/PACSPropelstheCommunityHospitalby Lisa Fratt

revving Up WorkflowToday’sradiologyinformation

systemistheworkhorse

ofradiology—gathering

andorganizingradiology

departmentworkflowand

reporting.Simply,it’sthe

“brainsoftheengine,”saysRay

Baraldi,MD,chiefofradiology

atCooperUniversityHospitalin

Camden,N.J.IntegratedRIS/PACShasbeenkey

toBaraldiandhisradiologyandITteamhelping

this500-bedtraumacenterregainacompetitive

edgejustacrossthewaterfromPhiladelphia.

RIS-drivenworkflowhasspurred10to20percent

productivitygainsamongradiologists.

ThestoryissimilaratUnitedMemorial

MedicalCenter,aBatavia,N.Y.-basedcommunity

hospitalthatincludesfiveimagingcenters—and

RadiologyandImagingSpecialistsofLakeland,

Fla.,whose17radiologistsinterpret500,000

studiesformorethan100referringphysicians

annually.RISallowsadministratorstotrace

facilitymetrics,uncoveringinefficienciesand

re-evaluatingstaffing,schedulingandequipment

strategies.Trainingiskey,too,tomaximizinga

RISinvestment,asyou’llseein“EnsuringSuccess:

RIS/PACSConsultation&Training”onpage15.

Anewgenerationofspeechtechnologyalso

lookstopushtheprocess.AdvancedSpeech

Understandingisallthebuzz.ItsnativeHL7CDA

architectureintuitivelyincorporatesclinicaldata

intothereportingprocess,eliminatingduplicative

processes,savingtimeandincreasingaccuracy.

Theresult:Theradiologistgetstodictatethe

wayheorsheprefers,butthestructuredreport

producedspeaksthesamelanguageashealthcare

informationsystems.Thatspeaksvolumes—and

willstreamlineworkflow,too.

Mary C. Tierney, Editorial [email protected]

� Rethinking RIS: Strategies to Streamline Operations February 2008

casestudy: Cooper University Hospital | Camden, N.J.By LisA FrAtt

Cooper University Hospital in Camden, n.J., is a 500-bed level i trauma center that operates

in a highly competitive market. the hospital sits in close proximity to philadelphia, and the

city dominates the local healthcare market. Consequently, Cooper University Hospital faces

a tremendous challenge. it aims to retain university healthcare in the south Jersey region

and prevent patients from migrating to philadelphia for treatment. Cooper University

Hospital houses six centers of excellence that include cardiology, trauma, critical care,

neurosciences, orthopedic surgery and the Cancer institute of new Jersey. one of the latest

arrows in its competitive quiver is ge Healthcare Centricity ris-iC.

Changing the Playing Field with integrated ris/paCs

Cooper University Hospital


The combination of integrated RIS/PACS

andRIS-drivenworkflowhasreshapedthe

enterprise,enablingittoincreaseproduc-

tivityamongallphysiciansandboosttime-

linessofpatientcare.Theradiologydepart-

mentisbetterservingitsusers,too.Report

turnaroundtimehasdropped,andimages

areuniversallyavailable,streamliningcon-

sultationsandallowingphysicianstomakemoreinformedtreat-

mentdecisions.Here’showthehospitalachieveditsresults.

the journey from manual to filmless (and beyond)Cooper University Hospital operates a high-volume radiology

department.Eachyear,thedepartmentcompletes200,000studies

andoffersafullrangeofdiagnosticimagingservicesonthemain

hospitalcampusandatthreesatelliteimagingcenters.Untilafew

yearsago,theradiologydepartmentreliedonfilmandmanualpro-

cessestoserveitspatientsandphysicians.

“WhenIarrivedin2003,theradiologydepartmentwaspurelyman-

ual.Itused‘sneakernet,’whichwaschallengingonmanylevels,”recalls

JerryMullen,administrativedirectorofradiology.Thehospitalreal-

izeditneededtoimproveprocessestoremaincompetitiveandprovide

qualitypatientcare,soitbegansurveyingtheRIS/PACSlandscape.

The ideal workflow model was clear from day one, according to

ChiefofRadiologyRayBaraldi,MD.RIS/PACSusesasingledatabase,

whichstreamlinesintegrationofkeyfunctions.“TheRISisthebrains

oftheengine;PACSisreallyjustanimagedisplay,”explainsBaraldi.

The hospital focused on locating a solution to manage end-to-end

workflowfromschedulingtobilling,saysCIOKarenGraham.PACS-

drivenworkflow,ontheotherhand,isradiologist-centricandcanlead

tobrokensteps—anddelays—intheworkflowprocess.

“Theadvantageofhavingthesingledatabaseincludestheeffec-

tiveandcloselyalignedfunctionalitybetweentheRISandPACS,

andtheintegrationwiththeHIS.Integratingfromasingledata-

baseisimportantbecausethefewerdatabasesthatneedtospeakto

eachother,thebetter,”addsBaraldi.

RIS-drivenworkflowoffersotheradvantages,too.Forexample,

a sophisticated QA program monitors the number of exceptions

and lost studies.TheQAprogramshowsthatCooperUniversity

Hospitalhasreducedthesemetricstozero.Thesystemalsofacili-

tatesproactiveplanning,saysMullen,whoplanstouseittocreate

athree-tofive-yearbusinessplantooptimizePACSandgrowthe

hospital’sradiologybusiness.

Currently,thedepartmentisdevelopingadashboardtomonitor

imagingutilization.“Wecanmakesurethatthey’retrendinginthe

right direction and optimize our schedules if we need to change

them,”Mullensays.“Atonesitewherewehaveano-showrateof

about 50 percent, we triple-book to make sure that the schedule

reaches capacity. Without the report generated by Centricity, I

wouldn’tknowweneedtooverbook.”Inaddition,thefeaturehelps

Mullentrackbottlenecksatalllevelsoftheimagingchain.Finally,

projectionsprovidedbyCentricitywillprovideCooperthedatato

makesmartbusinessdecisions,answeringquestionsaboutthenum-

beroftechnologistsandequipmentneededtosupportimagingcen-

tersinnewcatchmentareas.Equallyimportant,Centricitycanhelp

Mullendetermineminimumprofitablevolumesfornewendeavors.

digital workflow delivers “Centricityhashadatremendouslypositiveimpactforallthephysi-

ciansthroughoutthehospital,”Baraldisays.“Theeaseandabilityof

ris/paCs weds it and clinical systems, and the success of an installation hinges on both partners. “the most important part of the deployment is integration within your it department. ris/paCs is a clinical tool, but it’s truly an it project; you have to engage your it department,” says Jerry mullen, administrative director of radiology at Cooper University Hospital in Camden, n.J. Cio Karen graham was a key player in the hospital’s ris/paCs project from day one, as the project dovetailed with her focus on corporate, rather than departmental, it structure.

the hospital initiated its ris/paCs project by soliciting input from the it department, sharing its clinical and workflow goals with a clinical and it-based team. the it department, in turn, evaluated the architecture of various systems under consideration to ensure a good fit with the hospital’s infrastructure. “Find a vendor that fit’s the hospital’s approach to it implementation,” recommends graham.

prior to deploying ge Healthcare Centricity ris-iC, the hospital invested in appropriate it infrastructure and digital imaging systems such as Cr and a gigabit network. it also placed ris/paCs workstations in key areas throughout the enterprise—including ors and on clinical floors.

the plan worked. Cooper University Hospital has leapfrogged over early adopters, says mullen. physicians have embraced digital image management, Cpoe and ris/paCs-embedded voice recognition to help the hospital become a filmless, paperless provider of swift, high-quality healthcare.

the it angle

casestudy: Cooper University Hospital | Camden, N.J.

[ Chief of Radiology Ray Baraldi, MD, reads images in the main reading room at Cooper; RIS/PACS has helped increase radiologist productivity with radiologists reading 50 to 100 percent more studies per day. ]


imageandreportreviewhas increasedefficiencyandproductivity

across theboard forourphysicians.Somereport10 to20percent

increases inproductivity.”Theproductivity increase is evenmore

dramaticintheradiologydepartment,whereradiologistsread50to

100percentmorestudiesperday,accordingtoJamesKovacs,MD,

sectionheadofabdominalandbodyimaging.Grahamusesadiffer-

ent stat to describe overall workflow. “Prior to Centricity RIS-IC,

radiologyworkflowcomprisedmorethan50steps.SinceCentricity,

thehospitalhasreducedthatnumbertofewerthan10.”

Productivitygainsderivefromeaseofuse,integrationwithother

systemssuchasCPOEandeliminationofmanual,paper-basedpro-

cesses.Forexample,inmanycasesradiologistsandtechnologistscom-

municateviaCentricityinsteadofbytelephone,whichreduceswait

timeandmiscommunication.Featureslikeasimpleredflag,rather

thanaphonecall,toalertradiologiststoaSTATstudyalsosavetime.

Improved patient care under the microscope Importantly, the decision to deploy Centricity RIS-IC has improved

patientcareinanumberofwaysatCooperUniversityHospital.Thehos-

pitaldefinesradiologyasaservicedepartment.Itsjobistoimagepatients

andprovideresultstootherphysicians,sotheycandeterminethenext

stepinpatientcare.“That’swhyweneedRIS/PACS,”saysBaraldi.

PriortoRIS/PACS,thehospitalreliedonfilmforimageacquisi-

tionandreviewandanantiquatedcouriersystemfordistribution.

“Itwasdifficulttodiscussfindings,”recallsEricHume,MD,vice

chairoforthopedicsurgery.WithCentricity,referringphysicians

canreviewimagessimultaneouslywithradiologistsandspecialists.

Thesystemrelaysmoredetailedinformationmorerapidly.Physi-

cianscanpointtoorlisttheslicepositionnumberandmeasureand

describefindingscollaboratively.

Digital image management also slashed radiology turnaround

time.Thebenefittopatientsistwo-fold,saysKovacs.Physicianscan

viewimagesexpeditiously,acriticalfactorinthetraumacenter.“Our

ability to get patients back to where they need to be and to relay

resultsimpactspatientcareonadailybasis,”continuesKovacs.Plus,

patientscanaccesstheirstudies,enablingsmootherreferrals.

the winning combinationGECentricityRIS-ICandRIS-drivenworkflowistheperfectcom-

binationatCooperUniversityHospital.Theacademichospitaland

trauma center has improved workflow, report turnaround time

andpatientcaresinceembracingthenewsystem.What’smore,it

enablesdata-drivendecision-makingandprovidesasolidfounda-

tionforfuturegrowth.■

orthopedics is traditionally a heavy consumer of imaging, and the orthopedic surgery department at Cooper University Hospital in Camden, n.J., fits inside the bell curve. it differs from some other sites, however, in its commitment to integrated ris/paCs, ris-driven workflow and state of the art, image-enabled surgical suites.

three operating rooms are outfitted with video capability, workstations and a display that can be pulled down into the surgical field. video routers that can pull images from a variety of different locations and monitors are scattered around the rooms. the routers can pull images from a variety of different locations. ris/paCs workstations provide access to order entry via the intranet and internet. orthopedic surgeons can navigate through imaging datasets to project images on screens

through out the room. rooms also feature light cameras, jacks for different video signals and Usb and video ports for new equipment. nine other ors include paCs workstations.

although the current configuration provides image access in all ors, the hospital plans to build several new operating rooms that further take advantage of ris/paCs, laparoscopy and other video image generating technology. the key component is a video router system and a computer with access to the internet, says eric Hume, md, vice chair of orthopedic surgery.

Centricity helps the department provide high-quality patient care outside the or, too. in the film world, the image isn’t always in the right place, forcing the physician to make a decision without the data, order another image or wait for the data to arrive by courier. these issues no longer exist at Cooper. images are always and universally available. and although orthopedic surgeons were a bit skeptical about the ability of the hospital’s standard monitors to display imaging data, their fears were unfounded. “it turns out any plain vanilla box [display] around the hospital works just fine to look at the ap lateral tibia fracture before and after the nail was put in to verify the alignment. and exploding a single Ct or mri panel on a 15- or 17-inch monitor shows detail not visible on three-by-four inch plain film panels,” says Hume.

the upshot? ris/paCs has become a business essential in the 21st century orthopedic surgery department. “it’s like email or the atm; we couldn’t do without it,” states Hume.

the digital departmentinside

[ Integrated RIS/PACS has enabled image access during surgery—a new business essential—says Cooper University Hospital Vice Chair of Orthopedic Surgery Eric Hume, MD. ]


ris-driven Workflow Simplifies a Complex Practice

radiology and imaging specialists in lakeland, Fla., is a complex radiology

practice. the group provides professional services for four hospitals in

central Florida and operates five geographically diverse imaging centers.

its 17 radiologists interpret 500,000 studies for more than 100 referring

physician offices annually. in addition, radiology and imaging specialists

leases its image management system to another practice.

casestudy:Radiology & Imaging Specialists | Lakeland, Fla.By LisA FrAtt

[ Radiologist Scott Fargher, MD, reads PET images on a GE Healthcare Centricity RIS-IC workstation at one of Radiology and Imaging Specialists’ imaging centers in Lakeland, Fla. ]


The practice’s complex configuration is

profitableintheboomingcentralFlorida

market, but it does present significant

challenges.COOandCIODavidMarichal

explains, “When I arrived in 2003, the

practicehadnoRISorPACS.Therewere

too many workflow inefficiencies for a

standardstandalonePACS.”

Marichalrealizedthatweb-basedRISarchitecturecouldaddress

manyofthepractice’schallengesbyprovidingaconsistentviewof

thepracticefromanylocation.

In2004,RadiologyandImagingSpecialistsdeployedGEHealth-

careCentricityRIS-IC,integratingthesystemwithathird-party

PACS.ThetransitiontoRIS-drivenworkflowreinventedtheprac-

tice;itfacilitatesstreamlinedworkflowforallusers,which,inturn,

trimsexpensesandimprovesservice.

the first step: workflow analysis RadiologyandImagingSpecialistswasmiredininefficientworkflow

prior to installing Centricity RIS-IC; however, simply purchasing a

systemdoesnotguaranteeoptimalresults.ThepracticedeployedRIS

andPACSconcurrentlyandbuiltitsworkflowaroundthesynergyof

thetwosystems,designatingCentricityRISastheworkflowengine.

The rationale behind RIS-driven rather than PACS-centric

workflowissimple.RISbeginsandendstheworkprocess.Radiol-

ogyworkflowstartswithschedulingandendswithbilling;PACS

cannothandlethosetasks.RISputsinformationinthehandsof

everydecision-maker—fromtheradiologisttotheschedulerand

thetechnologist,saysDirectorofInformaticsSalTejeda.

RadiologyandImagingSpecialistsundertookathoroughworkflow

analysispriortodeployment,examiningeverystepofeveryprocessof

itsbusiness.Oneofthetopcomplaintsofemployees?Paperandthe

requisitepapershufflinginanon-automatedpractice.

Prior to the RIS/PACS deployment, scheduling and billing

requiredmultiplephonecalls andconsiderablepaperwork.Both

drainedefficiency.Incontrast,theidealschedulingandinsurance

workflowsarebasedonsolid,efficientprocessesthatallowaprac-

tice to capture all necessary information for authorizations and

pre-certifications.RIS/PACSautomatestheseskeyworkflows;the

practiceisconfidentthatstaffhasefficientlygatheredallinforma-

tionneeded forboth reimbursementandpatient safety. Inaddi-

tion, items likepatientallergiesandcontraindicationsarevisible

acrossthesystemtopreventproblems.

RIS-drivenworkflowalsohelpedthepracticeimprovephysician

workflow, allowing it to deliver everything radiologists need to

accuratelyinterpretthestudyintheminimumnumberofclicks.

The patient record and images are available in a single location.

RIS/PACSalsoseparatesstudiesforreferringphysicianswhocom-

plete theirown interpretations. Imagesare inadistinctworklist

and don’t cross-contaminate radiology workflow. “Everyone is

happy,”Marichalsays.“Thepatientexamandreportdistribution

aretimely,whichsatisfiespatientsandreferringphysicians.Andwe

knowwewillbepaid.Thesearen’tmutuallyexclusivebenefits.”

From paper-driven to film-free via It Technologyisthetickettothetransitionfrominefficient,paper-

heavy radiology to streamlined,digitalworkflow.Radiologyand

ImagingSpecialistsinvestedheavilyintechnicalinfrastructureto

supportitsRIS/PACSimplementation.

Itssophisticatednetworkinfrastructureisbuiltaroundafiber

opticnetworkthatconnectsallof thepractice’s imagingcenters.

Recently, thepracticeupgraded fromaVPNmesh to ahuband

spoke-straightVLANconfiguration.Theheftynetworkalsosup-

plies bandwidth needed to share workload among radiologists.

Becausetheweb-basedsystemprovidesconsistent,universalaccess

across imagingcentersandat radiologists’homes, theycanview

andsharedailyworkliststosupporteverysite.

AnothercriticalcomponentintheITrecipeistheworkstation.

“It’simportanttoprovideapositiveexperienceforend-users.This

requiresworkstationsthatmeetRISandPACShardwarerequire-

ments,” explains Marichal. Radiology and imaging Specialists

opted forWindows-basedPCswith256RAM.Thepracticealso

redesigneditsreadingroomstoaccommodateworkflow.

“Thereadingroomsarebuiltaroundtheelectronicsystem,putting

everythingweneedatourhands,”explainsChristianSchmitt,MD,

informaticsmedicaldirector.Readingroomworkstationshaveafour-

monitorconfigurationsoclinicalinformationfromtheRISiseasily

viewedanddisplayed inadditionto thePACSviewingtoolsonthe

otherthreemonitors.Workstationsareconfiguredwith4GBofRAM

toaccommodateanytoolsradiologistsneedtoviewdataandimages.

Afinalpieceofthepuzzleisarobustdatacenterthatcanpassall

data from one location to others. The 600-square-foot center

includesanuninterruptiblepowersupply(UPS),backupbattery,

independentgenerator,climatecontrolandfiresuppression.The

resultisnear-perfectuptime.

Inside the RIs-driven practiceRIS-drivenradiologydeliversanumberofbenefits:efficient,accu-

“the patient exam and report distribution are timely, which satisfies patients and referring physicians. and we know we will be paid. these aren’t mutually exclusive benefits.”david marichal, Coo & Cio radiology and imaging specialists


ratebilling,improvedpatientcareandstreamlinedworkflow.Prior

toRIS/PACS,Radiologyand ImagingSpecialists reliedonpaper

billing.Thepracticewasnotsure itcapturedallchargesbecause

theprocesshingedonpaper.

Centricity RIS-IC, on the other hand, features an electronic

charge interface. Coders vet items before they go to the billing

interfacetosimplifyandacceleratetheprocess.

Schedulingisequallyefficient.Withuniversalaccesstoallsitesand

imagingresources,schedulerscanplacepatientsinthefirstavailable

slot. “That’s important because referring physicians want the first

availableappointment,orthey’lltaketheirbusinesssomewhereelse,”

notesMarichal.Theintegrated,brokerlesssystemalsodrivesanintense

resourceutilizationprogramatRadiologyImagingandSpecialists,in

whichthepracticeanalyzeshowmuchofthetimeslotitusesforeach

typeofexamtooptimizeimagingresources.

“CentricityRIS-IChelpstrackproductivityfromschedulersto

technologists,”notesDarlaMosley,applicationsmanager.“We’ve

beenabletodeterminehowlongapatientisintheoffice,howlong

the exam takes, and then we can adjust our times accordingly,

whichhelpswiththeschedule.Wecanaccommodatemorepatients

thanwedidbefore.”

Inaddition,ifthepracticeisbackloggedinonearea,itcanshorten

exam time a bit. Finally, the system helped justify the RIS/PACS

investment.PriortoRIS/PACS,RadiologyImagingandSpecialists

staffed each center with six radiologists. Post-deployment center

staffingdroppedtofourradiologists.Ancillarystaffhasbeenreduced

approximately10percentthroughattrition.

Optimized patient careAutomatingprocessestoimproveproductivityandthebottomline

is essential in today’s tight economic environment; however, the

firstpriorityinhealthcareispatientcare.CentricityRIS-IChelps

RadiologyImagingandSpecialistsmeetitdualobjectivesbyspeed-

ingturnaroundtimeandimprovingaccesstoimages.

Considerforexampleoncologypatients.Manytraveltodifferent

RadiologyImagingandSpecialistssitesforimagingstudies.Cen-

tricity RIS-IC collects images from various sites, making them

available inasingleapplicationforreviewatcancerconferences.

“Wecanmakedecisionsaboutthepatient’stherapybasedonade-

quateandthoroughinformationratherthanonepieceofinforma-

tionoronestudy,”saysSchmitt.

an ongoing processRIS/PACSisnotaprojectthatbeginsandendsoncertaindates.It

is an ongoing process that begins before deployment and, in an

idealsituation,continuesafterinstallationasthepracticetapsinto

thesystemtoderivenewbenefits.

RadiologyImagingandSpecialistsinitiateditsdeploymentwith

animplementationteamwithbroadmembershipincludingradi-

ologists, technologists, schedulers and IT staff. The team thor-

oughly evaluated and tested workflows to maximize efficiencies

withCentricityRIS-ICandofferedastrongtrainingprogram.The

practicewrappedintroductorytrainingintoasix-weeksimulation

beforegoinglivewiththesystem.Thetrainingincludedapostgo-

livedebriefingattheendofthefirstweek,andthepracticeholds

staff refresher training at least once a year or after product

upgrades/updates.

ThecenteraimstapintoRIS/PACStoraisethebaragain.Forexam-

ple,RadiologyImagingandSpecialistsintendstorewardschedulers

whomeetestablishedbenchmarks,whichrequiresmetricsandasolid

RISreportingsystem,saysMarichal.Centricityfitsthebill.

Reinventing the practiceCentricityRIS-IChasprovidedRadiologyandImagingSpecialists

ameanstoreinventitspractice,improvingworkflowandpatient

care across the board. The imaging center group is completing

more studies and turning them around in a shorter time frame

withfewerstaff.Inotherwords,thepracticehasfoundtherecipe

forsuccessin21stcenturyimagingcenterbusiness.■

Featuring interviews and Q&A with clinical and IT thoughtleaders from:

United Memorial Medical CenterBatavia, N.Y.

Radiology & Imaging SpecialistsLakeland, Fla.

Cooper University HospitalCamden, N.J.

VIDEO

WITH Q&A

VIEWARCHIVE


RIs/PaCs propels the Community Hospital

casestudy: United Memorial Medical Center | Batavia, N.Y.By LisA FrAtt

in some respects, United memorial medical Center (UmmC) of batavia, n.y.,

is a typical community hospital. it is composed of five campuses including a

111-bed hospital and four imaging centers. the group completes 50,000

imaging studies annually. imaging modalities include multidetector Ct, Cr-

based digital mammography, ultrasound, mri, Cr and digital fluoroscopy.

[ Carol Vanderberg, specialist assistant in radiology, at United Memorial Medical Center reviews CR-based digital mammograms on the GE Healthcare Centricity RIS-IC that links the healthcare organization’s five campuses. ]


Astheonlyhospitalinthecounty,UMMC

is somewhat challenged. For starters, it

employsasingleradiologist(supportedby

aspecialistassistant inradiology),which

canmake itdifficult tomanage imaging

volume, provide acceptable report turn-

around time and review the breadth of

modality procedures, especially subspe-

cialtyandERreads.FourexternalradiologistsbasedinBuffalo,N.Y.,

help manage the center’s daily workload, so robust digital image

managementprocessesarecritical.Secondly,themetropolitanareas

ofRochesterandBuffaloarewithinanhour’sdrive;it’simportantto

maintainhigh-qualitylocalcaretokeeppatientslocal.

Theorganization’sdecisionstodeployGECentricityRIS-IC

in2001andtopioneerPACSwith integratedRISandvoice

recognitionin2006playavitalroleinUMMC’sabilityto

provideoptimal,localpatientcare.What’smore,workflow

and report turnaround time are significantly improved

withintegratedRIS/PACSandRIS-drivenworkflow.

RIs rules Centricity RIS-IC is the workhorse behind the smoothly

functioning radiologydepartmentatUMMC.The rationale

behind the staggered, RIS-first deployment is quite simple.

TheRISprovidesameanstocaptureaccurateinformationand

populatethePACS,saysLisaFoss,medicalimagingsupervisor.An

interfacewiththeHISalsofacilitatespatientprocessingandsched-

uling.“RIS-drivenworkflowhelpsbring thepatient through the

department a lot smoother. Data like patient registration flows

fromtheHIStotheRIS,leadingtofewerdataentryerrorsandless

manual work for technologists,” says RIS/PACS Administrator

MaryNiland.

Physicians,bothreferringdoctorsandradiologists,benefit,too.

TheRIScentralizesallradiologyreportsandimagingfiles,provid-

ingstreamlinedaccesstoreportsandimagesforreferringphysi-

cians.Italsoprovidesa lineofcommunicationbetweenradiolo-

gistsandtechnologists,whichboostsworkflow.Forexample,the

radiologist can view images immediately after acquisition. If a

studyrequiresadditionalviewsoraretake,theradiologistcanrelay

thatinformationtothetechnologist—withoutleavinghischairor

breakingworkflow.

Bothparties inthe imagereportingequation—referringclini-

cianandradiologist—alsogainfromembeddedvoicerecognition.

PriortoCentricity,UMMCusedathird-partysystemthatrequired

an additional server, interface and HL7 message. The Centricity

systemstreamlinesmanagement,saysNiland,andallowstheradi-

ologisttomanagereportsfromasinglehomepage,which,inturn,

helpscutturnaroundtime.

DanIreland,vicepresidentofclinicalsupportservices,credits

thecenter’sworkflowsuccessstorytoacompletepre-RISworkflow

analysis.“Ourgoalwastousetechnologytostreamlineactivities,”

Ireland says. By strategically locating status boards within the

department and placing barcode scanners in radiology rooms,

UMMChasslasheditspaperconsumption,replacingpaperwith

electronic data flow. The workflow analysis helped the hospital

track pressure points to help it determine where to place PACS

workstations.Wall-mountedunitsandmobilecartscomplement

fixedworkstationstoprovidephysiciansaccesstoimagesandlab

resultsanywhereinthehospital,includingatthepatientbedside.

CentricityRIS-ICenableselectronicbilling,anothercriticalwork-

casestudy: United Memorial Medical Center | Batavia, N.Y.

implementing ris/paCs is a major undertaking particularly for smaller, community hospitals.

United memorial medical Center (UmmC) in batavia, n.y., has optimized ris/paCs to improve service at all levels, slash paper and film use and grow its business. its ris/paCs team offers some advice for colleagues

looking to purchase a system.

Cost is a key focus, says medical imaging supervisor lisa Foss, but it should be tempered. “everyone has to use the system. if it’s difficult to

use and navigate, price becomes much less relevant.”

train, train, train. UmmC ris/paCs administrator mary niland established training centers to educate staff and clinicians from various departments. she also visited referring physicians’ offices to set up the system on their computers and complete one-on-one education. the efforts helped persuade reluctant physicians to give up film.

tap into internal and external resources. Colleagues can provide a wealth of information on peripherals like Cd burners and modality integration. on the internal side, carefully track workflow of all film users to understand areas that can be improved by digital workflow.

Look at compatibility between the HIs, RIs and PaCs. the ris and His must communicate effectively on a daily basis. a single vendor ris/paCs reduces integration challenges and streamlines the end-user experience. think single password, single log-in.

Plan for site visits to see systems in action. try to visit a facility of similar size and needs as your own. it can be very helpful to arrange to visit sites that use the same ris and His as yours as well, says darren Kazmierczak, director of radiology.

✓

✓

✓

✓

✓

advice from the Field

[ Mary Niland, RIS/PACS administrator, UMMC ]

[ Darren Kazmierczak, director of radiology, UMMC ]

�0 Rethinking RIS: Strategies to Streamline Operations February 2008

flowbooster.PriortoCentricity,UMMSusedacourierserviceto

ship hundreds of billing reports to its billing company every day.

Now,reportsaregeneratedautomaticallywithinCentricityandsent

electronically to the billing company, saving the time and dollars

associatedwiththepaperapproach.Inaddition,billscanbegener-

atedmorerapidly,whichtranslatesintoacceleratedcollections.

Centricity RIS-IC provides other significant advantages, too.

TheRISincorporatesdata-miningcapabilities,helpingthemedical

centeroptimizeresources.Forexample,whenevening technolo-

gistscomplainedabouttheirworkloadandclamoredforanother

FTE,Fossranatechnologistproductivityreportforsevendays.She

foundthatvolumewassignificantlyhigherduringthe3to7p.m.

period. Insteadofhiringanadditional techorauthorizingover-

time,Foss juggledthescheduletoprovidetriplecoverageduring

thedepartment’sbusiesthours,savingthehospitalcriticaldollars

andkeepinghard-to-replaceemployeessatisfied.

Theworkflowanddata-miningbenefitsofCentricityRIS-ICand

PACSareongoing,saysDirectorofRadiologyDarrenKazmierczak.

“We’re constantly reevaluating our workflow to see what we can

changeefficiently,andit’sallbasedonhavingRIS/PACS.”

Customer satisfactionCustomerservicecanbeatallorder,particularlyintightdepart-

mentswithasingleradiologist.CentricityhelpsUMMCmaximize

its single radiologist and provide outstanding service to internal

andexternalcustomers.

Takeforexampletheemergencydepartment.ERphysicianshave

specific,criticalneeds—specificallyrapid,accuratereview.Thehos-

pitalrunsweeklyERreportstomonitorturnaroundtime.“Whenwe

firstimplementedCentricityRIS-IC,wemeasuredturnaroundtime

inhours.Nowwemeasureitinminutes.Weturnaround68percent

of ER reports within 15 minutes,” Niland says. That rapid turn-

aroundhelpsphysiciansprovidetimely,informedpatientcare.

AnotherbugaboointheconventionalERisdiscrepancytracking.

PriortoRIS/PACS,UMMCreliedonamanualprocesswiththeradi-

ologydepartmentstaffwalkingtotheEReverymorningtochase

filmsandbringthembacktothedepartmentfortheradiologistto

review.AnydiscrepanciesbetweentheinitialERreadandtheradiol-

ogist’sreviewrequiredpaperformsandphonecalls.Now,imagesare

sharedelectronicallybetweenthedepartments.Ifaradiologistfinds

adiscrepancy,CentricitygeneratesanotetoinformtheER.

“Our ER physicians are much more satisfied,” sums Ireland.

“TheycanreviewimagesrightintheER,andtheycansharethem

withpatients.”Centricitystreamlinesconsults,makingiteasyfor

physicianstotransmitimagestoBuffalohospitalsforsub-specialty

reviewasneeded.

Thedigitalsystemalsohelpsthehospitalmaintainacompetitive

edgewithreferringphysicians,specificallybyhelpingthehospital

minimize report turnaround. Some primary-care physicians

admittedtoreferringpatientsoutoftowninthecenter’spre-RIS/

PACSdaysbecauseitwasdifficultforthesingleradiologisttomake

a timely diagnosis, says Ireland. Since Centricity, however, some

havereturnedtoUMMCbecausetheradiologistcanreturnresults

withanhourofthestudy.Infact,inthelastyearUMMCimproved

on its5percent annualgrowth rate, achievingaphenomenal19

percent growth. Ireland credits the growth to Centricity. “With

RIS/PACS,we’reabletoprovidethelevelofserviceexpectedbyour

primary-carephysiciansandpatients.”

Onepatientgroupparticularlysatisfiedwithdigitalimageman-

agementmodelisSTATpatients.“Patientswhocometothehospi-

talforSTATworkcanwaitinthewaitingroombecausereportsare

completedsoquickly.Theradiologistcancallthereferringphysi-

cianwithresultstofindoutifthepatientshouldgototheoffice,ER

or home. Patients aren’t driving home to find out they should

returntothehospital,”explainsFoss.

a perfect fitCentricity RIS-IC is a perfect fit for UMMC. The community

medicalcenterhasachievedkeygoals sincedeploying the inte-

grated system. Customer service is improved via rapid report

turnaround;businessisboomingandphysicians,technologists,

and patients are satisfied. The system provides access to data,

helping the center continue to improve services. Paper is gone,

andfilmconsumptionisnegligible.■

“our er physicians are much more satisfied [since we added ris/paCs]. they can review images right in the er, and they can share them with patients.”dan ireland, vice president of clinical support services, UmmC

“patients who come to the hospital for stat work can wait in the waiting room because reports are completed so quickly. ”lisa Foss, medical imaging supervisor, UmmC

HealthImaging.com Rethinking RIS: Strategies to Streamline Operations ��

The mediocre adoption rate is some-

whatparadoxicalparticularlyinradiolo-

gyasthereportisthefinalproductofthe

radiologist’sworkandnecessaryforpay-

ment and clinical decision-making. One

reason behind the less-than-enthusiastic

acceptanceofspeechrecognitionismost

systems are add-ons to radiology work-

flowratherthananintegratedpartofthe

workflowprocess.

GEHealthcareaimstore-drawthespeech

market by injecting new utility into voice

recognition.Thecompanyiscollaborating

withM*Modaltodevelopanext-generation

naturallanguageprocessingsystem.

The evolutionary solution—Advanced

SpeechUnderstanding—wedssophisticat-

edtechnologyandworkflows.Thespeech

engine is embedded in Centricity RIS to

makereportingpartof thenaturalwork-

flow. Advanced Speech Understanding

meetsthedualchallengesfacingspeech.It

makesspeechanintegralpartoftheradi-

ologyworkflowandcapitalizesontherich

patient data available at every step of the

radiologyprocess.

AdvancedSpeechUnderstandingdeliv-

ers added value by incorporating clinical

dataintothereportingprocesstoeliminate

duplicativeprocesses.Forexample,during

theschedulingprocesstheschedulercap-

turesdata likesignsandsymptoms.Such

datacanbefoundateverystepoftheimag-

ingchainandiscriticaltothefinalradiol-

ogyreport.AdvancedSpeechUnderstand-

ing pulls the data through the imaging

workflowtomakeitavailabletotheradi-

ologistforthereport.

The enabling technology for the next-

generation solution is a structured docu-

mentationprocessbasedonHL7Clinical

DataArchitecture(CDA).ThenativeHL7

CDA architecture combines and re-uses

data, allowing radiologists to spend less

timeworkingonreportswhilesimultane-

ouslyproducingahighervaluedocument.

AdvancedSpeechUnderstandingbridg-

esbothflavorsoftraditionalspeechtech-

nology—free-form documentation and

structuredreporting.Structuredreporting

offerscertainadvantages,particularlythe

abilitytoexchangedatawithotherhealth-

care information systems. Radiologists,

however,tendtoshunstructuredreporting

because it can be more time-consuming

thanfree-formdocumentation.HL7CDA

providesameanstodictateinthewayradi-

ologists prefer and produce a structured

report that speaks the same language as

otherhealthcareinformationsystems.

speech: the last wordSpeechisoneofthenextfrontiersinradiol-

ogyworkflow.Effectivespeechrecognition

canhelpaddressthetoughchallengesinthe

radiology world by boosting productivity

andimprovingthefinalradiologyproduct.

AdvancedSpeechUnderstandingrepresents

theevolutionofspeechrecognitiontechnol-

ogy. It will boost adoption and improve

radiologyworkflowandproducts.■

By LisA FrAtt

[ Advanced Speech Understanding is the next generation in speech—which automatically incorporates clinical data into the reporting process. GE Healthcare is imbedding Centricity RIS-IC into its Speech Understanding from M*Modal. ]

standard voice recognition technology is far from cutting edge. in fact, voice recognition has existed in various forms since the 1960s; however, after 40 years on the market, healthcare has not tuned in to speech. in fact, fewer than half of all hospital specialties embrace voice recognition technology.

The Next-Generation ‘Smart’ Report

�� Rethinking RIS: Strategies to Streamline Operations February 2008

ris in tHe outpatient imaging Center

Increasing Efficiency, Maximizing Revenue

With the economic challenges of the deficit reduction act (dra), marketplace

competition and the quest to streamline processes facing outpatient imaging

centers, anything that can help increase efficiency is more than welcome. a

good ris helps centers track patients, physicians and revenue—while staying

on schedule and on budget. the right tools can even help organizations

determine when and where to expand their services.

By Beth WALsh


e set out to produce a RIS that

increasedtheefficienciesandmax-

imizedrevenuewithinthefacility,”

says Rhonda Eckstein, director,

Product Management, Dynamic

ImagingSolutions,GEHealthcare

IntegratedITSolutions.

One way the RIS increases effi-

cienciesiswithkeyeventmonitoring.“Thatensuresthateachstepof

theprocess iscompletedbeforethepatientcanmoveontothenext

step,”shesays.Forexample,beforeapatientisconsideredregistered,the

systemmakessurethatallrequiredinformationhasbeencollected.

Relying on RIs“WerelyontheRISveryheavily,”saysMarkWeathersbee,CIOat

JeffersonRadiology,auserofGE’sCentricityRIS-IC.

Jefferson uses Centricity RIS-IC for scheduling, creating call-

backlists,arrivaltracking,exammemos,communicationbetween

technologistsandradiologists,andtohelpthegroupgotoapaper-

lessreadingroom.

The paperless reading room was a new initiative last fall that

Weathersbee says was primarily physician-driven. “They decided

ontheirownthattheydidn’twanttodealwithsomuchpaperwork,”

hesays.Thebiggestobstacle toapaperlessreadingroomwas the

doctorshavingtomanuallyinputpatientnumbersratherthanuse

the bar-coded documents. Once the doctors adjusted to the new

process,it“reallymadetheworkflowgoaloteasierandquicker.”

Electronic reports have been beneficial for referring physician

practices,saysWeathersbee.About60percentofaccesstotheonline

reportsandimagesisbythepractices’nurses,staffandsupportper-

sonnel.TheabilitytofacilitatethataccesshasimprovedJefferson’s

positioninthemarketplace,hesays.

TogetthemostoutofitsRIS,Jeffersoncustomizedit

inmanyways,Weathersbeesays.Onewaywasschedul-

ing.“Schedulersneedtohavealotofclinicaldata,”he

says.Forexample,doesaparticularCTexamneedcon-

trast? Frequently the schedulers would arrange one

studyandthen,atthetimeoftheappointment,clini-

cianswouldmakechanges.“Basedoninformationin

themedicalrecord,theprotocolwasdifferent,”Weath-

ersbee says. “Itwasaconstantburden for schedulers.

Theradiologistsandtechnologistswerealwaysasking

whytheschedulerscouldn’tscheduletherightexam.”

Tocombattheproblem,thepracticedecidedtogo

withsimple,genericschedulingthatinvolvesanexam

listforeachorganization,themodalitycodeandthe

bodypartcode.ThelistisdrivenoffoftheCPTlist,

butit’sgeneralizedandallowsschedulerstogetthekey

components of what the physician office wants to

know—location,dateandtimefortheexam.

Once the appointment can be confirmed with the office, the

referringpracticecallercangetoffthephone,whichisappreciated.

“Oncetheexamisscheduled,wecollectauthorizationinformation

asneeded,”Weathersbeesays.Thegenericexamsarecreatedinthe

RISasanon-billable/non-reportableexam.“Thatkeepsthemfrom

going through the system by accident,” he explains. “They can’t

reachthefinalizedsignedstateasagenericexam.Thetechhastogo

inanddoanEnter/Editoftheexamtomakeitaspecificcodethat

makestheexambillableandreportable.”

ThisprocessisagoodexampleofJeffersonRadiology’sabilityto

configuretheRISinauniquewaythatsolvedabusinessproblem

andletthepracticeimproveitscustomerservice,Weathersbeesays.

Italsohelpedimprovethepractice’srevenuecycle.Theprotocoling

worklistswithintheRISallowproofingagainsttheauthorization

codes.“ThroughreportswecancreateintheRIS,wecanmakesure

wehavetheproperauthorizationsandwe’renotperformingexams

forwhichwe’renotgoingtogetpaid.”

Jeffersonrecentlyacquiredapracticewithtwolocations,foracur-

rent totalofeight locations.Withinthenext fewmonths, thetwo

[ Jefferson Radiology in West Hartford, Conn., manages radiology workflow for its eight locations—from scheduling through reporting and billing—via GE Healthcare’s Centricity RIS-IC. ]


newsiteswillbeconsolidatedtooneandanewfacilitywillopenina

differentarea.TheRIShelpedthepracticeevaluatetheoverallvol-

umesforthemodalitiesbeingimplementedatthosetwoadditional

locations,Weathersbeesays.“DatacapturedintheRISwasdefinitely

adecisionpointindecidingwhattodowiththosetwooffices.”

New RIs for new locationsLibertyPacificMedicalImaging

chose Centricity RIS/PACS-IW

(formerly Dynamic Imaging’s IntegradWeb RIS/PACS) when

developing new imaging centers in Castro Valley, Calif., and

Columbus, Ohio, in the beginning of 2007, says CIO Anthony

Draye. When developing new centers, the organization had to

decidewhethertocontinuewithanunder-performing,legacyRIS

oremployanewRIS,accordingtoDraye.Theydecidedtolookfor

anewRIS.“DynamicImaging[whichwasacquiredbyGElatein

2007]hadwhatwewerelookingforandhavingonevendorforboth

RISandPACSintheoutpatientworldaddsefficiency.”

LibertyPacificappreciatesthattheCentricityproductisa“very

modern and well-engineered software product.” Choosing RIS

softwarethathasaforward-thinkingtechnologyroadmapbehind

itgivesimagingcenterspeaceofmindthattheirsystemswillevolve

withthem.Usingaproductthatisup-to-datewithmodernsoft-

warestandardsensuresthatitis“futureproof.”

ThebillingcapabilitiesoftheRISalsoappealedtoLibertyPacif-

ic,Drayesays.“Inthecurrentenvironment,billingisveryimpor-

tant.”Plus,“wedidn’thavetobuythird-partysoftwaretododocu-

mentmanagementorotherspecific functions. It’sall in thisone

product.It’sacompleteRIS.”

Liberty Pacific probably gets the most bang for its RIS buck

throughthedaily,weeklyandmonthlyperformanceanalysiscon-

ductedthroughthesystem,Drayesays.“TheRISproducesthedaily

reportsweneedtomakesurewe’refillingourscheduleefficientlyso

thatourpatientshavethebestpossibleaccesstoourimagingser-

vices.”Weekly,hecanseehowtheorganizationistrackingtoward

volumeandcollectiongoals.Monthly,reportsareproducedtotrack

progresstowardannualgoals.“Asystematicapproachtoreviewing

ourperformancedataisveryimportanttous,”hesays.“It’ssome-

thingwereallylikeaboutourRIS.”Anotherplusisthat“itdoesn’t

takealotofmanpowertoproducethatdata.”

Thosereportingabilitiesprovidea“snapshotviewofallkeyindi-

cators,” says Eckstein. That includes volumes and revenues, out-

standingaccountsreceivableandunbilledaccounts.Usersalsocan

monitorstaff,physicianreferralpatterns,unbilledaccounts,and,

most importantly,medical reports—thefinalproduct.“A timely

interpretationiswhatthereferringphysiciansarelookingfor,”she

says. “Wehavemanagement reports that allow facilities to track

closelywherethosemedicalreportsare.”

OneelementoftheRISisDRALogic.Formultiple,same-

dayprocedures,someinsurancecompaniesreducethetech-

nicalcomponentby25percent.“Webuiltthatlogicin,”says

Eckstein.Usersonlyneedtoloadtheirpayercontractand

thesystemwillautomaticallycalculatethe75percentreim-

bursementofthetechnicalcomponentanddisplayexpected

net revenue. Without that, users wouldn’t automatically

takesuchdiscountsintoaccountand“havenowayofknow-

ingifthey’regettingthecorrectpayment.”

TochoosethebestRISforyourorganization,Drayesayshe

would“encouragesomeonetotryandmatchtheirworkflow

withtheRISproductsthey’reevaluating.Theyshouldimaginethem-

selves using that RIS and think about its features and the most

importantaspectsoftheirworkflowandmakesurethetwoarein

synch.”BecauseaRISisnot“onesizefitsall,”hesays,“itrequireslots

ofefforttoproperlyintegrateasystemintoanorganization’swork-

flow.ChoosingtherightRISiskeytosuccessfullyachievingthat.”

Coming soon…GEhasplentyofnewfeaturesonthehorizonforCentricityusers.

ThecompanyrecentlyreleaseditsCPTlevelbillinglogic,Eckstein

says.“Ourcollectorsdesktopworkqueuesareindevelopment,as

wellasauthorizationalertsforthosepayorsthatrequireauthoriza-

tion before a study is performed.” The collectors desktop tool

involves user-specific worklists that will automatically display a

user’saccountstobeworkedforfollow-upbasedonsystemrules.

Asidefromthesekindsoftools,EcksteinsaysGEhaskeptthefocuson

auser-friendlysystem.“Wetriedtoremainconsistentonallscreens.

Specificdatafieldsalwayslinktheusertoaspecificplace.Wekeptthat

consistencyfromscreentoscreen.Thathasmadeitveryuser-friendly.”

Withalloftheseconsiderations,Ecksteinsaystheproduct“trulyisan

entiresolution—withasingledesktop,schedulingthrough,zerobal-

ance,billingandcollectionsystem—thathopefullyincreasesefficiencies

andfacilitatesmaximumreimbursement.That’swhatit’sallabout.”■

[ Liberty Pacific Medical Imaging chose Centricity RIS/PACS-IW (formerly Dynamic Imaging’s IntegradWeb RIS/PACS) when developing new imaging centers in Castro Valley, Calif., and Columbus, Ohio. Centricity RIS/PACS-IW includes a contract management module that incorporates complex logic to estimate net revenue based upon payor use of DRA, HOPPS or both DRA and HOPPS fee schedules. The highlighted areas are calculated for each visit and enable centers to accurately project the impact of DRA on their patient/payor mix versus budget. ]


eNsuRINg suCCess

ris/paCs Consultation & training

Kick-off to go-live WiththeflipofaswitchonSept.10,2007,Blountwentlivewith

GECentricityRIS-IC10.5andCentricityPACS3.0.1tomanage

the120,000-plusimagingproceduresthemainhospitalperforms

annually. As part of the contract with GE, Blount received an

arrayofconsultingandtrainingservicestohelpthemmaximize

benefitsfromthenewsystemfromtheclinical,IT,management

andoperationsperspectives.ItwasevidentthatdaythattheRIS/

PACSconsultationandtrainingservicesfromGEhadpaidofffor

the 305-bed community hospital in

Maryville,Tenn.

Phil Berler provided management

consultation services from GE from

kick-off through post go-live. “Phil

knows the radiology business,” says

D.CharlesPrice,RN,Blount’sclinical

analyst, project manager, information systems. “He managed a

radiologydepartmentfor17yearsinNewYorkCity.Heknowsthe

systems from the technologist and management standpoint. For

me, I was a staff nurse before I took the technology job and he

helpedmetounderstandtheprocessfromageneralstandpoint.He

wasalwaysreadywithananswer.”

Berler,oneoftheseven-memberteam,spentseveraldaysonsite

evaluatingtheworkflowatBlount.“Thefirstfewtimeshewatched

flowinthedepartment—beginningwithadmittingandscheduling,

casestudy:Blount Memorial Hospital | Maryville, Tenn.

What happens between a facility and a technology vendor after they ink a contract

can make the difference between success and failure in a ris/paCs implementation.

Having just experienced the smooth “go-live” of their new integrated Centricity ris/

paCs from ge Healthcare, blount memorial Hospital radiology staff members know

firsthand the value of solid consulting and training services.

By LesLie K. Anderson

[ PACS administrators at Blount Memorial deployed super-users such as this one as RIS/PACS training resources for the entire facility. ]


through obtaining images and archiving—he sat with various

employeesorstoodindifferentareasofthedepartmenttowatchhow

wedidbusiness,”saysPrice.“Hewasonsiteatleastfivetimes,plus

sent emails and conducted conference calls.” From there, Berler

draftedafutureworkflowreportbasedonthecurrentworkflow.

under the looking glassAsanexample,oneoftheproblemsBerlerdiscoveredwasoverbooking

andinsufficientuseofschedulingpersonnel.“Beforewehadonlyone

personpermodalitydoingschedulingatthefrontdesk;nowwehave

threewhocanschedule[appointments]forallofthemodalities,”says

John T. Cadieux, BS, RT (R), technical coordinator, radiology. The

schedulingchangehasallowedformoreefficientuseoftheimaging

equipmentwithlessidletimeforeachsystem.“Philhelpedusdoaway

withschedulingbooksandstreamlinepatientthroughput.”

Throughouttheplanningandtestingprocess,Berlermadesub-

sequentvisitstoseehowBlountstaffwasdoingwiththechangesin

workflow and suggested adjustments as necessary. For a period,

boththeoldsystemandnewsystemranconcurrently,followedby

a simulation where the new system was put through a dry run.

“Duringtheplanningphase,theteamplannedforacertainpieceof

theimplementationtogoacertainway.Butduringthesimulation,

wefoundoutthatprocesswouldnotworkinreal-time.Wehadto

lookattheprocessagainandmakechanges,”saysCadieux.

training mustsTrainingwasanotherkeytoRIS/PACSsuccess.“GEhada‘trainthe

trainer’mentality,”hesays.Amastertrainingprogramprovided

special emphasis on creating super-users, who became the go-to

people onsite. Master-user training was very thorough, Cadieux

says,includingonsitetraining,onlinetrainingusingWebEx,and

trainingforbothsystemsatGEtrainingfacilities.

Cadieux says he and PACS Administrator Mike Headrick, RT,

spokewithsupervisorstodecidewhothesuper-userswouldbe,ask-

ingquestionslike:“Whocanwetrusttohandlethisresponsibility?

Whoisgoingtotakeonthisresponsibilityandhandleitwell?”

Oncechosen,super-usersweretrainedonwhatwasrelevantto

their jobs,Cadieuxsays.“Wesetupanintroclasstothesystem,

begantwo-tothree-hourtrainingsessionsaweeklaterforthree

technologistsandthreeschedulersatatime,andthendidanother

trainingsessiononemonthbeforego-live.”CadieuxsaysthatGE

assistedwiththeinitialsuper-usertrainingsessiontoensurethings

wentsmoothly.“Afterthat,weandthesuper-usersbegantraining

therestofthefacility,”hesays.

“Wehopedthatthetrainingwouldprovidethesuper-userswitha

baseofknowledgeofwhatthesystemadministratorsdosothatwe

wouldnotbebombardedpostgo-live,”saysCadieux.“Ifthereareonly

twopeoplewhoknowhowtofixtheproblem,thenyouaregoingtobe

swamped.Havingasuper-usertohandlethesmallthings—suchas

patientexammerges—keepsworkflowmovingonmyend.”

answering the call to actionInJanuary,theRIS/PACSandtrainingwasputtoabigtest.Blount

experienceda“codeblue”astheresultofanicestorminthearea

causingtheemergencyroomtooverflow.“Ifwehadn’ttrainedand

implementedthewaywedid,wewouldnothavebeenabletohandle

thecatastrophe,”saysCadieux.“Wewereabletogetalotofpatients

throughquickly.TheGERIS/PACSmadeitsosmooth.”■

John sundnas, ris/paCs administrator for dartmouth-Hitchcock medical Center in lebanon, n.H., has 25 years of experience implementing and supporting pathology and radiology clinical information systems, including successful go-lives for ge Healthcare’s ris and paCs.

a key component to a successful go-live, says sundnas, is analyzing facility and patient workflow. part of that involves including the entire facility in the workflow analysis and documentation process.

according to sundnas, dartmouth-Hitchcock performed a workflow analysis to determine how film flowed among the center’s 400 healthcare providers and to find the best way to provide access to digital images. sundnas says that by using a recommended implementation plan from ge, they were able to create a workflow plan that they were able to alter and adjust as needed throughout the entire process.

analyze & document Facility Workflowspend time up-front to conduct a workflow analysis of all staff and their activities including schedulers, technologists, residents, fellows and staff radiologists. pay close attention to the image library to determine how film flows to viewing workstations. ask yourself: “where were images being used, and how do we provide filmless viewing at those stations?”

analyze & document Patient Imaging Workflowlook at patient workflow in relation to imaging. ask yourself: “if patients come in with their own films, are they leaving the office with their films?” if a film leaves the office, how does film get back into the department to be interpreted by the radiologist?

Involve everyone to be Fully Vested in the systemsundnas says that by including multiple departments and staff members in the workflow analysis prior to go-live helps to vest everyone more fully in the implementation. get them involved by providing a weekly forum for them to express their concerns, give insight into their day-to-day activities to accept changes that are coming and make the transition successful. sundnas says they continue to hold weekly meetings within the department to share information and bring up concerns about the system and how it is working.

✓

✓

✓

WORKFLOW aNaLysIs is a Key Component to any sUCCessFUl gO-LIVe: daRtmOutH-HItCHCOCK

GE Healthcare

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Do your images showyou the full picture?Improving patient care is about more than viewing images and capturinga vast set of data. It’s about insight —seeing the nature of complex situationsand applying the right course of action. From accelerating clinical workfl owsto innovating enterprise-wide image analysis, Centricity® Imaging helps organizations of all sizes transform information into insight. That means accessto patient data where and when it’s needed. And now with Dynamic Imaging’s top-rated IntegradWeb® Web-based technology, you’ll see our vision ofWeb-based imaging portability like never before. Bringing you the big picture. Healthcare IT Re-imagined.

© 2008 General Electric Company. All rights reserved. GE, the GE monogramand Centricity are registered trademarks of General Electric Company.

GE Healthcare


GE Healthcare andDynamic Imaging join forces.The simplicity and power of Dynamic Imaging’s Web-based solutions has combined with GE Healthcare’s broad suite of IT offerings. Together, a new generation of GE quality and innovation will bring fl exibility for radiologistsand referring physicians worldwide. Enhance patient care and portabilitywith clinical interpretation and convenient results review access, by any authorized user, of any diagnostic imaging study, anytime, anywhere. Healthcare IT Re-imagined.

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Documents

Changing the Playing Field with Integrated RIS/PACS RIS-driven