On August 29, 2005, Hurricane Katrina—the deadliest storm of its kind in U.S. history—made its final landfall near Bay St. Louis, Mississippi with a 28-foot storm surge and a storm tide of more than 30 feet deep. Like 80 percent of New Orleans, many neighboring parishes, and a multitude of other coastal towns along the Gulf of Mexico, Bay St. Louis was devastated by the hurricane.
Neither Hancock Medical, Bay St. Louis’ community hospital, nor its radiology department were spared: The hospital building suffered extensive damage and had to be rebuilt, while more than four feet of flood waters destroyed the radiology department’s entire cadre of imaging equipment.
There has been a silver lining to this cloud, however. Now licensed for 47 beds and performing approximately 18,000 imaging exams annually, Hancock Medical harnessed its recovery from the storm as a launch-pad for an entirely new RIS/PACS configuration and IT infrastructure. The changes have wrought significant improvements in patient care and workflow efficiencies, as well as opened doors for other enhancements.
Bare-bones equipment
Before Hurricane Katrina struck, Hancock Medical utilized “fairly bare-bones,” non-integrated RIS and PACS systems, explains Wes Griffith, the hospital’s director of information technologies. The radiology department had a minimal supporting IT infrastructure and maintained only a small server rack within its physical bounds. Images were stored at an off-site, third-party facility in Tennessee.
“The PACS was really just an image repository, and we didn’t leverage the RIS much because of its limited capabilities,” Griffith says. For example, the shortcomings of the RIS were such that clinicians from the contract radiology group that serves Hancock Medical could not use the system to view images from their office 90 miles away from the hospital. Similarly, referring physicians were unable to tap into the RIS to access audible or written versions of radiologists’ reports.
Complicating matters, the PACS was incompatible with the department’s mammography equipment. Clinicians were forced to use a separate diagnostic workstation for this modality, and the hospital had no option but to maintain a contract with a separate mammography imaging solutions provider in order to offer mammography services.
The fact that the hospital’s data storage network was vendor-managed caused additional headaches: Referring physicians whose systems were incompatible with those of this particular vendor could not get the reports they needed. Initiating any kind of technology-related change, for instance, relocating a modality to another room, proved difficult as well.
Control was a priority
Temporary repairs to the hospital took roughly six to eight months; in the interim, the radiology department, along with the emergency department, operated outdoors in tents that resembled “something you would see on the television show M*A*S*H,’” Griffith recalls. But even before the new construction was complete, a decision to replace the RIS/PACS—hastened by the bankruptcy filing of the hospital’s original RIS and PACS vendor—was made.
Hancock Medical’s administration asked members of the IT department to weigh in on criteria for a new vendor and RIS/PACS. Griffith and his team wanted to work only with a vendor that would support a virtual, software-only PACS environment and would not need to manage the storage network. Their objective: To give the IT department the freedom and flexibility to be dynamic and to grow Hancock Medical’s IT infrastructure without relying on any outside entity. “We were not interested in waiting for help from the vendor each time we brought in a new modality,” Griffith says. “Control was a priority.”
In addition to a virtual configuration, requirements for the PACS encompassed support for all modalities, including mammography. Meanwhile, for the sake of functionality and efficiency, the RIS had to integrate with the PACS. It also had to afford any referring physician Web-based access to images, written reports, and audio report files, no matter their technology platform.
Hospital administrators and IT team members assessed several possible RIS/PACS options, eventually selecting Synapse® RIS/PACS from FUJIFILM Medical Systems USA. “The system met all the criteria that had been set, and (the vendor) had already completed the successful installation of a PACS in a virtual, software-only environment at a large hospital, at a time when that was almost unheard of,” Griffith states. “We felt very comfortable that if it worked there, it would work here.”
He adds that images and data are no longer stored off-site. A storage area network (SAN) and on-site data center administered and controlled by the IT department support the virtual RIS/PACS and other technology used at the hospital.
Meeting objectives
The new RIS/PACS is satisfying all objectives, according to Griffith. Access to critical information that can make or break the caliber of patient care is unimpeded by technological barriers, he said.
“Radiologists and the medical community as a whole can be mobile,” Griffith asserts. “Every image and report is available on every PC resource in the hospital. Instant access means even (non-radiologists) can start their own interpretations sooner.”
Just as significantly, the system works with all modalities. The separate diagnostic mammography workstation—and the cost of contracting with the mammography solutions provider—have been eliminated, with no negative impact on report-reading quality.
Hancock Medical is also benefitting from having attained its goal of tight RIS/PACS integration. Clinicians and referring physicians can now access images (including mammograms) through the RIS, regardless of where they happen to be working. This fosters increased workflow efficiencies and faster report turnaround time, which, in tandem with affording a more comprehensive view of patients’ conditions, contributes to a higher standard of patient care.
Improvements in imaging services provided to emergency room patients constitute a key example of such change. The previous lack of connection between the RIS and the PACS necessitated that reports of imaging exams performed on these patients be sent via facsimile transmission to the emergency department.
However, some reports were lost or misplaced, and others reached their intended recipients only after a prolonged wait. This is no longer the case; emergency room physicians can even avail themselves of instantaneous access to audio report files through Synapse’s PowerJacket component.
“Report turnaround time for the emergency room has been drastically reduced—and we get consistent compliments from physicians there about the caliber of patient care they are able to provide,” Griffith says.
A tidy interface
An interface between the RIS/PACS and the EHR system, which Griffith says was made easy by FUJIFILM Medical Systems’ extensive experience with the HL-7 standard, offers advantages as well. “Our EHR is not the best reporting tool, but the tie with the RIS/PACS simplifies matters,” Griffith observes; for example, completed reports can be simultaneously delivered to the EHR and the RIS.
The same is true of managing the storage network internally rather than through a third party. Recently, two imaging modalities had to be relocated to different areas within the radiology department. While such a task would previously have entailed “calling the vendor, waiting for a response, and stretching fiber-optic cabling across the hospital,” the entire move was handled by the IT department in the course of 15 minutes, Griffith said.
He adds that the purchase of the SAN and the establishment of the onsite data center infrastructure as a support mechanism for the virtual RIS/PACS environment have also fostered global improvements in patient care.
“We are able to add other (care-enhancing services and technology) that leverage the hospital-controlled IT infrastructure we put into place for virtual RIS/PACS—and at a financial savings,” he explains, citing a new bedside patient monitoring system as an example. “We know we have superior backup and data replication capabilities because they are in our hands. When everything is within our control, much more is possible.”