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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
HealthImaging.com Rethinking RIS: Strategies to Streamline Operations �
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. ]
� Rethinking RIS: Strategies to Streamline Operations February 2008
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. ]
HealthImaging.com Rethinking RIS: Strategies to Streamline Operations �
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. ]
� Rethinking RIS: Strategies to Streamline Operations February 2008
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
HealthImaging.com Rethinking RIS: Strategies to Streamline Operations �
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
� Rethinking RIS: Strategies to Streamline Operations February 2008
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. ]
HealthImaging.com Rethinking RIS: Strategies to Streamline Operations �
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.
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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
HealthImaging.com Rethinking RIS: Strategies to Streamline Operations ��
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. ]
�� Rethinking RIS: Strategies to Streamline Operations February 2008
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. ]
HealthImaging.com Rethinking RIS: Strategies to Streamline Operations ��
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. ]
�� Rethinking RIS: Strategies to Streamline Operations February 2008
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.
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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
© 2008 General Electric Company. All rights reserved. GE, the GE monogramand Centricity are registered trademarks of General Electric Company.
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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