Arkansas Children’s Hospital: PACS Implementation Case Study a DR Systems Success Story

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: info@dominator.com
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