Best-of-breed RIS is equalizer between rural hospital and big-city counterparts

To Cory Cino, the history of Wyoming County Community Health System in Western New York divides neatly between “before RIS” and “everything since.”

The PACS administrator vividly recalls his radiology department doing patient scheduling and tracking on sheets of loose-leaf paper in three-ring binders and reporting via cassette-tape transcriptions on a homegrown database. Then there was perhaps the most cumbersome practice of all: storing pretty much everything the department produced—reports, tapes and, prior to PACS, films—wherever an untaken spot could be found…including on the roof.

“It’s actually kind of fun to talk about where we were,” he says. “It helps us appreciate where we are now.”

Where they are now is in their sixth year with Synapse® RIS from FUJIFILM Medical Systems, Stamford, Conn., in large part, for how seamlessly it integrated with Synapse PACS, which WCCHS had previously implemented to great satisfaction.

The complexity of “trying to pseudo-organize multiple locations based on years and folder sizes” was becoming unmanageable, adds Cino. “We could talk a lifetime about how we used to do things in comparison to how much more efficiently we do those things now.”

WCCHS is a 62-bed, 103-year-old institution about equidistant from Buffalo and Rochester. An attached skilled nursing facility with 138 accredited beds and an adjoining mental health care unit with 12 bring the total bed count to 212.

The radiology department is accessed by 13 radiologists who collectively read the institution’s 30,500 exams—CT, MRI, ultrasound, mammography, bone densitometry, nuclear medicine and, of course, x-ray—per year.

The health system’s utilization of a best-of-breed RIS stands as a sterling example of how this technology can help a rural community hospital offer patients and referring physicians radiology services that match, stride for stride, those found at the biggest and best urban medical centers.

Then and now

Cino’s supervisor, Director of Radiology Peggy Hise, remembers the six-month process that led up to the selection of Synapse RIS. The choice came after a buying committee led by Hise and Cino sat through several vendor presentations and spoke with numerous RIS-experienced colleagues at other hospitals. “The Synapse system had the functionality we were looking for, and it was in the price range that the hospital was able to afford,” she says. “At a community hospital, price points are very important.”

Hise adds that a WCCHS-affiliated radiologist proved a crucial champion of the drive to modernize. “She often worked alone, and we had three different reading rooms where we would be hanging film and reports, stapling papers together,” she says. “The stacks of x-ray jackets were all over the place in her office. Trying to keep that all organized was a continual project.”

Hospital leadership began getting comfortable with the idea of a RIS purchase when they observed the manual processes in action, noting the strains these put on both staff and patients. The deal was sealed when they realized that RIS automation would allow them to right-size the overstaffed—yet paradoxically overworked—radiology department.

“There’s not an aspect of our day-to-day that we didn’t improve when we acquired the Synapse RIS,” says Cino, “from the way we schedule patients to the way techs complete exams to the way radiologists dictate reports to the way we transcribe them. The levels of efficiency and organization we have now are just miles ahead” of the old way.

For Hise, a favorite benefit has been the interdepartmental team building the RIS facilitates. Communications between the main office, the techs and the radiologists are all conducted swiftly via electronics, she says, and that has markedly improved working relationships.

“We also use a lot of the alerts functionality,” she adds, giving as examples a warning that appears when a doctor calls to book an MRI for, say, a patient with a pacemaker, along with notations on patients’ special physical needs and allergies to contrast agents.

“Cory did a great job interfacing us with the lab, so when we need to have lab results prior to contrast material, the tech just clicks on ‘Lab Results’ and it pops right up,” she says. “You don’t have to go to another system, log in again”—and risk not thinking of everything.

“Fast lab results is a big patient-safety factor,” Cino adds. “It’s one of the things in our RIS that makes our radiology department as good as any radiology department in any large hospital with a lot more money.”

Gratified user groups

Since installing the Synapse RIS, WCCHS’s radiology department has seen little to no extended periods of unplanned downtime, Cino says. “I’ve talked to a few different radiologists and PACS administrators at other hospitals who struggle with failures and downtime, sometimes hours-long,” he says. “The Synapse system is a secure, structural, hardy system. It’s very simple and intuitive for users, and it doesn’t require attention from our hospital’s IT staff.” In this way, it has helped make the radiology department self-sufficient.

It helps, adds Cino, that the Fuji support team has become like “extended family. Our local Fuji engineer and the on-call support staff for the Fuji RIS have been tireless. They’ve worked very closely with me on fixes, enhancements and customizations. In the process, they’ve become friends even though I’ve never met them in person.”

The closeness has enabled WCCHS radiology to provide topnotch service to end-users of the Synapse RIS:

·       Radiologists have been delighted with the system’s customizable worklists, which they can set for multiple modalities. “They have very simple, 1-click ways of launching exams,” says Cino. “They can start this process with a single click and, just like that, read 50 cases.” Signing has vastly improved as well. “When I train a new radiologist, I treat signing as one of the nicest features, as it’s integrated with our Synapse PACS.” That includes the Synapse PACS Power Jacket—which replaces the historical x-ray jacket by combining digital images with radiologists’ reports, technologists’ comments and patient histories—and which the integrated Synapse system makes instantly accessible to both radiologist and referring physician.

·       Technologists have applauded the feature by which an exam order is placed on a work list as soon as it’s generated. “The tech sees the order and can begin the exam; there’s no need for paper filing of the scripts we need for historical reasons,” says Cino. “They can complete the exam and, after that, type in the appropriate history so that all the relevant information automatically populates on the radiologist’s work list.”

·       Referring physicians appreciate that they can instantly view any and all reports relevant to a given patient. “Before, they would have to physically come in, address the front office staff and request the patient’s x-ray jacket—only to have to file through a bunch of papers,” says Cino, adding that some patients had folders scattered in various locations. “Now everything is right at the referring physician’s fingertips. The doctor scrolls through a couple of pages and it’s all right there on his or her screen.”

Ripple effect

The years since WCCHS installed its Synapse RIS in 2008 have seen numerous upgrades—not only in the RIS but also in the hospital as a whole.

The ways in which the RIS has enabled the radiology department to raise the bar on workflow has positively impacted the entire hospital, Cino explains. “We finally got an electronic medical record spanning the hospital. The technical ability of our IT department is way ahead of where it was when we first implemented Synapse. And, just recently, the hospital created a new department—nursing informatics.”

Radiology doesn’t claim credit for all that growth and development. “But the entire hospital has completely changed for the better over the past six years,” Cino says.