Riverside University Health System springboards from PACS upgrade to EMR collaboration

Nearly two decades ago, the PACS race was on in Southern California’s Inland Empire. The main event pitted the regional medical center, 439-bed Riverside County Regional Medical Center, against the larger 719-bed Loma Linda University Medical Center (LLUMC). In 1998, Riverside won the race by about six months, installing the first PACS in the region and, in the process, becoming the first hospital in the U.S. to select Sectra PACS.

Fast-forward to 2016. Riverside University Health System (RUHS) now comprises not only the medical center but also numerous clinics and practices dispersed around Riverside County. It’s affiliated with three medical schools. RUHS also is closely cooperating with, rather than competing against, its larger neighbor LLUMC. In October 2016, the two intently joined forces to form the third-largest EPIC Electronic Health Record (EHR) clinically integrated network (CIN) in the nation.

The story only gets more interesting from there.

On Aug. 28, RUHS ("roose") upgraded from Sectra PACS 15.1 to Sectra PACS 18.1. Five weeks later, in a related development, RUHS and Loma Linda University Health—together—went live with an EPIC EMR system linking the two institutions and all their satellite and affiliate sites in Riverside and San Bernardino counties. Without the seamless Sectra PACS upgrade, the EPIC integration and CIN would still be only a dream and not a reality.

For Bret Geisel, MBA, director of radiology at RUHS, these two events represented the culmination of a career spent serving the people of the Inland Empire at both institutions. A year ago, Geisel moved over to RUHS. Earlier in his career, as a radiologic technologist at Loma Linda in 1998, he remembers the beginning of the PACS technology race between the two organizations.

“It’s funny and ironic for me, I was on the losing end of the PACS race 18 years ago and I’m on the winning side now,” he says. “It’s also funny, I was skeptical of Sectra when first coming to RUHS, because at Loma Linda we went with a different vendor. With the upgrade [at Riverside], Sectra came through with shining colors, demonstrating their ability to be a top contender and convincing us, again, they could meet all our needs as we move ahead into enterprise imaging. We have a 30-year plan, given the rise of enterprise imaging and expect the Sectra system will get us there.”

Geisel adds, he was never worried about Sectra’s ability to meet the immediate needs of his department. “Where this county hospital is going, especially with our relationship with Loma Linda and other healthcare systems within the Inland Empire, the story wasn’t going to end with the PACS upgrade,” he says. “But today, having worked with Sectra, I feel very comfortable saying to our C-suite: ‘We made the right decision.’ This thing is ready to rock. We’ve had a long relationship with Sectra, and it’s going to continue.”

A truly epic EMR integration

The PACS upgrade was a victory in its own right for RUHS’s radiology department, but the ease with which it rolled out, had stakeholders exchanging fist-bumps throughout the enterprise. That’s because the subsequent EPIC EMR integration was truly epic, Geisel says, and its success hinged on the large part of the painlessness migration of the PACS upgrade project. 

Earlier in the year, RUHS’ PACS had moved from Unix to Windows to get ready for the EMR integration. “That was a huge piece of the puzzle,” says Geisel, adding the PACS upgrade had to be completed before the EMR could go live.

PACS Administrator Gail Miller says the upgrade went “very quickly and very smoothly. We really didn’t have any issues, and our radiologists said they were extremely happy with the features Sectra version 18.1 added.”

Among the pluses, the rads like are click-free scrolling through film images using the mouse wheel and the ability to select cases by age, which allows them to easily create pediatric work lists. (These and other attributes led to Sectra PACS repeating as “Best in KLAS” among hospitals with more than 200 beds.)

“Each radiologist has something different they like about it. Some are more into customizing than others,” says Miller. “We also acquired Powerscribe 360 and integrated it with the Sectra PACS, and they love that as well as the integration with EPIC. And all of this just went very smoothly.”

A skeptic becomes a believer

RUHS’s relationship with Loma Linda subsists in one key area of activity—sharing the EPIC EMR to run a clinically integrated network. Loma Linda had EPIC in place, since early 2013, when the decision to share took shape, says Geisel.

“We bought Loma Linda’s platform, but there is no joint venture. Neither one of us owns the other. We’re sharing a clinically integrated network via EPIC. That saved our hospital about $50 million and improved how we take care of our patients here in the Inland Empire.”

When RUHS made the decision to ride on Loma Linda’s EMR, an inevitable second question popped up: Would it be best to also use the same PACS—despite Loma Linda’s reliance on a different PACS vendor?

Geisel initially leaned toward yes.

“We had to re-educate ourselves on what Sectra technology is all about, what their capabilities are,” he recalls. “What is the relationship we want to have with our PACS vendor moving forward? We knew that, once we did the PACS upgrade and did this clinical integration with Loma Linda, this is it. We’re not making another change for probably 30 years.”

Long story short, Sectra won over Geisel and RUHS senior leadership, too.

“We’re making history because of what we just went through. If it wasn’t for Sectra, the integration with Loma Linda would not have gone so smoothly,” says Geisel. “Sectra has an incredible relationship with EPIC, and everything they told us they could do has proven true. A lot of things had to go right. We now consider Sectra ‘our EPIC’ in the world of radiology and in the world of enterprise imaging.”

Easy to like

Enterprise imaging figures large in RUHS’s strategic planning. Along with radiology and cardiology, many other clinical departments are likely to be availing themselves of Sectra PACS in the coming months and years, Geisel says.

Currently the system is handling CT, MRI, ultrasound, general x-ray and nuclear medicine. Plus, obstetrics is using it for some prenatal and perinatal ultrasound images.

“In the near future, we’ll bring in cardiac echo, a new cath lab that’s going live a few months from now and lots more,” Geisel says. “We’re talking about ECGs, EKGs, a new medical office being built in about three years. We are in the midst of a growth spurt, and more modalities are going to be coming into Sectra PACS.”

Miller likes the sound of that, as she’s found her job has gotten a bit easier with the PACS upgrade.

“We just converted to an active directory, which means I’m not having to put in names and passwords and all that stuff anymore,” she says, adding that Sectra’s familiarity has bred affection and near-instant adoption. “The new version is better than the previous one, and yet it’s very similar.”

Meanwhile, with the workstations upgrading from Sectra’s PACS 15.1 to Sectra PACS 18.1, Miller may have expected to hear some grumbling as users realized they had to learn a new interface.

That didn’t happen. “I didn’t hear anything,” Miller says. “I don’t even know if they knew there was an upgrade. Everything was so much the same. There are extra buttons that some people have found, and they’ve said, ‘Oh, this is great. Now I can do this or that.’ I definitely didn’t hear anything negative.”

‘Our PACS is our heartbeat’

Looking back on all RUHS’s radiology department has accomplished over the past year, Geisel is clearly satisfied. He’s seen big jobs done well by all who had a hand in them. And he has complete confidence and trust in his relationship with Sectra.

“I felt we were really susceptible,” he says. “Our PACS is our heartbeat. Our Radiology Information System (RIS) is changing and it, too, had to be integrated into EPIC. There were 20 things that could have gone wrong.”

There also were a lot of people who could have complained about this or that decision. Some did just that during the integration of Sectra PACS and EPIC’s RIS.

“There was plenty of finger-pointing among the various vendors, and none of it came from Sectra,” Geisel says. “The company is like one of those great employees you don’t know much about because you spend so much time with your problem employees. It was the same thing during this integration.”

“Sectra doesn’t blame things on somebody else. They never took that road of, ‘Well, it’s really the other vendor’s product, not ours.’ I loved working with them during this time of major transition. As I said, they came through with flying colors. I look forward to working with them for many years to come.”