Arkansas Children’s Hospital: PACS Implementation Case Study a DR Systems Success Story Photo by Kelly Cooper ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 2 Contents Introduction............................................................................................. 3 Training and an Easy-to-Learn System Ensure a Fast, Smooth Implementation......... 3 Custom Features, Streamlined Work-Flow and Seamless HIS Integration Provide Faster and Better Patient Care ......................................................... 5 PACS Cost Savings Build A Strong Business Case ................................................ 7 About the Contributors............................................................................... 8 ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 3 Introduction Saving time is a constant pursuit at Arkansas Children’s Hospital. The facility works each and every day to streamline its operations to cope with the economic results from reduced reimbursements and ultimately provide quicker response and greater efficiency in patient care. And, as the only pediatric facility in Arkansas, time is even more of the essence with young lives on the line. As evidence of this on-going pursuit, the hospital was one of only two nationwide to receive a Race for Results Award from the Child Health Corporation of America. The award recognizes excellence and improvement in the delivery of efficient and effective clinical care. Within days of receiving the award, Arkansas Children’s Hospital (ACH) launched another major effort towards efficiency and effectiveness as the hospital went live with a new PACS (Picture Archival and Communication System) from DR Systems on April 23, 2004. PACS was one of the steps in the ACH plan to implement an Electronic Medical Record (EMR) where all records in the hospital would be connected and maintained on the network and accessible with a single logon. An aging teleradiology system had outlived its usefulness. The related film-based imaging, developing, printing, and storing equipment was big, bulky, expensive, and required a dedicated staff just to maintain it. The medical center’s 5,800 referring physicians often couldn’t get their hands on the radiology records they needed because the film jackets were in an office, on a desk, or in a conference, rather than in the central filing system. Dr. Bruce Greenberg answers the phone while reading CT studies. Before PACS, CT and MRI studies were read on dedicated alternators, with no way to view them from other areas in the facility until radiologists finished their interpretations. “I think we all got tired of hearing, ‘Where’s that film jacket I asked for yesterday?’” said Keith Smith, ACH’s senior project manager in the IT department. “The problem was compounded because we’re a teaching hospital, so film was often checked out and sitting in a briefcase where it was going to be used in a presentation or paper.” Training and an Easy-to-Learn System Ensure a Fast, Smooth Implementation DR Systems works to ensure that each PACS implementation includes a rapid rollout. The company, which was founded by two radiologists, believes that an intense training and installation “immersion” in the system is the most efficient and least disruptive way to integrate the system into hospital ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 4 operations. Prior to installation, a DR Systems Project Manager is assigned to the customer to schedule training both before and after the implementation. DR also will train “Site Champions,” usually a radiologist, a PACS administrator and an IT staffer, who can provide ongoing training and support to others within the hospital. Support is available from DR Systems at any time by entering service tickets via a secure website or via a toll-free number. Doctors, technologists and other ACH employees embraced the immersion strategy, and the system was live within one week after installation. After the initial launch date in April, the new digital PACS system spread throughout the hospital, offering doctors a convenient way to view studies and improve patient care for the thousands of children treated each year. By July, the system was implemented in all departments except ER; that department completed the transition to filmless radiology in August. Before the advent of PACS, Dr. Sally Klein interprets films from patients in the CVICU and PICU. Studies were hand-loaded each morning and throughout the day to ensure prompt reading. “The transition was amazingly smooth,” said Dr. Donnal Walter, a Neonatologist. “It was easy to learn and our experience has been excellent. It does everything we need it to do.” The ACH-DR Systems PACS server implementation is on clustered HP DL380s connected via fiber to its HP/Compaq EVA 5000 storage area network (SAN), plus another DL380 that is a web server. For archive storage, Smith chose spinning disk technology, rather than burning files to CDs or DVDs for storage. ACH uses EMC Centera content addressed storage (CAS) systems that interfaces with DR System Guardian archive tools. “I can pull back a 400-slice MRI or CT in less than 15 seconds,” says Smith. With the new PACS in place, Dr. Klein reads a STAT exam from CVICU. Ordering physicians know they can listen to the voice clip to hear the radiologist’s impression without calling radiology for results or waiting to see a preliminary report. Another module that ACH chose is the DR Systems Instant Reporter, a complete, integrated transcription/reporting package. Instant Reporter includes dictation, voice recognition, transcription, printing, faxing, and web distribution of reports. By eliminating tapes, dictation phone lines, lost dictation, and ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 5 unidentified exams, the package reduces time spent on reports and improves accuracy. The system automatically imports patient demographics and generates reports based on the exam type. Custom Features, Streamlined Work-Flow and Seamless HIS Integration Provide Faster and Better Patient Care Beyond the clear advantages that updated technology offers for patient care, improvements in radiology work-flow enhance the quality of the doctorpatient relationship: • Radiology techs get images – including several viewing options ready for viewing in minutes. • Records are integrated with the MEDITECH HIS (hospital information system) and RIS (radiology information system). • Using an easy-to-use, common system interface, radiologists can quickly produce a montage and attach text and audio reports. • Automated email notification lets the referring physician know the record is available. • Doctors can access radiology records from MEDITECH at any location including their home or office – with broadband Internet access. • Simultaneously access by many physicians enables real-time collaboration. James Aronson, MD, the chief of Pediatric Orthopedics at ACH and a professor in the Department of Orthopedics at University of Arkansas for Medical Sciences (UAMS) College of Medicine said, “Using the PACS on a daily basis, I’ve found the system very helpful in several areas,” Aronson said. “We get much better resolution and detail using the magnification, contrast and brightness controls, so you get much more accurate measurements. The system also makes it easy to download images to a printer or PC.” The ACH system is vastly superior to others in a number of areas, according to Dr. Walter. “We find the DR Systems PACS easier to use with its large monitors and we also have access to our studies on PCs,” he said. “ The rapid turnaround let’s us provide easier and better patient care.” ACH narrowed a field of seven PACS system vendors to four for final evaluation. DR Systems was awarded the contract Wall-mounted CSLAs throughout the operating suite, emergency department and orthopedic clinic helped achieve the goal of going filmless. ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 6 based on a few key attributes of its PACS system, according to Smith. Dr. Charles Glasier reads the morning portables. Since PACS was installed, ordering physicians were able to access images by logging into any PC or by going to dedicated PACS workstations in conveniently located patient-care areas. The first was DR’s ability to fully integrate with MEDITECH HCIS®. Also, DR could utilize the HP EVA5000 SANs that were already in place. That ability meshed well with the hospital’s strategy to implement an Electronic Medical Record system where a singlelogon interface will get physicians to everything they need, rather than requiring separate work stations for each function. This strategy was developed under the direction of ACH Chief Information Officer Darrell Leonhardt for greater physician convenience and improved patient care. DR Systems’ core expertise is PACS. The company works to enable its product to interface with just about any Health Information System (HIS). The team at DR has built a comprehensive set of interfaces to the leading HIS/RIS products. As a result, patient demographics and personal information can be easily accessed and attached to radiology reports by using already established information management systems. Operators and physicians can integrate front office billing and appointment functions as well. And Smith credits DR Systems with making adjustments on-the-fly, to tailor the system to fit unique requirements. “We needed some additional features because of our workflow and DR was able to help us in a very timely manner,” said Smith. “The DR Instant Reporter needed to be customized to allow us to attach one report to multiple exams. We attended a user meeting in San Diego and sat down with the president of the company and the developers and talked about adding those features, and they’ve done it.” Another deciding factor, and a pleasant surprise to Smith, has been the DR Systems-exclusive voice clip feature. Radiologists use a microphone at the Dominator reading workstation to dictate and attach a voice clip about what they see in the images in each case. Though some members of the acquisition team wanted it, Smith couldn’t see the value until the system was implemented. “It has decreased calls to our radiologists by 90%,” Smith said. “Our referring doctors know that they can walk up to any computer and log in and listen to the impression of a study instead of having to track down the radiologist that read it and see if he/she remembers what they saw.” Paula McElhanon, PACS Administrator at ACH, was also quickly sold on the feature, “The best feature in my opinion has been the voice clips. It has saved our radiologists enormous amounts of time with the decrease in phone calls and interruptions.” ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 7 PACS Cost Savings Build A Strong Business Case Not only did the DR Systems implementation save time for physicians, the system is long on cost benefits as well. Along with the PACS system, ACH initiated a remodel of its radiology reading room physical plant. The remodel facilitated new data and electrical connections for online access and for PACS work stations, but resulting reductions in film reading hardware, and freed 1,400 square feet of prime hospital floor space when the radiology file room was moved offsite. They were also able to remove an old dry laser printer. Selling the printer eliminated $19,000 per year in expenses with the cancellation of its maintenance contract. Photo by Kelly Cooper The PACS team: (from l to r) Darrell Leonhardt, Chief Information Officer ; Keith Smith, RT, Senior Project Manager, Information Technology ; Paula McElhanon, RT, PACS Administrator, Radiology ; Richard Leithiser, M.D., M.M.M., Radiology Medical Director. “There was a bit of inconvenience during the remodel. Our radiologist had to work in a temporary facility for six weeks, “said Smith. “but they didn’t complain because they knew the advantages of the system we were installing.” And the ultimate goal of eliminating film-based radiology has paid off in a big way as well. In the last full year of non-PACS operation, film expenses were $368,000. ACH has saved $276,000 during the past year of transition, a savings that will actually grow now that the operation has moved into a full film-less mode. The PACS implementation at ACH shows that what may seem to be a daunting process, can actually go quite smoothly and quickly. Smith gives credit to the DR Systems staff for that. “Their service people are the best I have seen,” Smith said. “They do PACS and that’s all they do. I don’t think we’d get that service from someone who sells light bulbs and film.” It all adds up to time saved for the ACH team. And time saved in diagnosing and treating all who enter the hospital’s doors helps Arkansas Children’s Hospital continue to be one of the best places to find Care, Hope and Love for the region’s youngest patients. ARKANSAS CHILDREN’S HOSPITAL: PACS IMPLEMENTATION CASE STUDY a DR Systems Success Story 8 About the Contributors About Arkansas Children’s Hospital Arkansas Children's Hospital is the only pediatric medical center in the state and is one of the ten largest in the nation. Comprehensive, highquality medical care is offered to children from birth to age 21, and ACH has cared for children from all over the United States and all over the world. ACH has a medical staff of around 500 including 101 pediatric residents. Through a partnership with the University of Arkansas for Medical Sciences (UAMS), ACH is the site of pediatric training for medical and nursing students, post-doctoral residents and paramedical professionals. More than 11,857 patients were admitted in 2004. There were 251,540 outpatient encounters which included 39,029 visits to the Hospital’s Emergency Department. From its humble beginnings as a Children's Home Finding Society in 1912 to the major pediatric medical center it has become today, one thing remains the same – Arkansas Children's Hospital cares about children. About DR Systems, Inc. DR Systems, Inc. is a leading provider of film-free medical image and paperless information systems with an integrated PACS, RIS, dictation, reporting and Internet-based distribution solution for hospitals and medical imaging centers. DR Systems’ DICOM-compliant system includes the Dominator Diagnostic Reading Station with available DR Instant Reporter (automated voice recognition ,dictation, and report distribution), the Catapult Technologist QC Workstation, the RIS Admin Station, the DR Central Server and Communicator Web Server, the Ambassador Clinical Review Station, the Messenger Diagnostic Portal, and the Guardian Archive System. DR Systems’ ease of implementation and user training allows customers to rapidly achieve financial and clinical success. With a modular design scalable for growth, DR Systems RIS/PACS can handle current and future medical image and information management needs. DR Systems, Inc. 10140 Mesa Rim Road y San Diego, CA 92121 Toll Free: 1 (800) 794-5955 y Tel: 1 (858) 625-3344 y Fax: 1 (858) 625-3334 Web: www.dominator.com y Email: [email protected] Copyright © 2005 DR Systems, Inc. All rights reserved. DR Systems, Inc. reserves the right to make changes in technical and product specifications at any time without prior notice. DR Systems, DR Systems logo, Ambassador, Catapult, Communicator, Dominator, Guardian, Instant Reporter, Messenger, Universal Manager are trademarks of DR Systems, Inc. The DR System’s products and equipment described in this document are manufactured under one or more patents, including U.S. Patent #5,452,416. 60-76-00-1447A