Blue Mountain Health System may not have been early to the digital revolution when it implemented its first RIS/PACS in 2010, but it has moved further than many larger health systems in the intervening four years.

Since implementation, the two-hospital community health system has dramatically reduced turnaround time, increased technologist productivity and improved patient satisfaction and safety. Much of that improvement can be attributed to Blue Mountain’s crowning achievement: It has achieved a 100% paperless workflow in the radiology department.

RIS/PACS is a significant purchase for a community hospital, and Elisa Condon, RT(R), director of imaging services, Blue Mountain Health System, Penn., was determined to make the most of the technology investment. Condon was PACS administrator at the time.

“Our former administrator Lois Richards, who has since retired, empowered me to make some decisions, and going paperless was one that I strongly encouraged,” Condon shares. “If we were going to invest in this technology, let’s really use it and put it to our advantage. It was a big investment for a community hospital, so we are trying to use every bit of it that we can.”

Catalyst for change

Between the health system’s 93-bed Gnaden Huetton campus, 61-bed Palmerton campus, and an outpatient-imaging center, the department performs 60,000 exams each year in caring for the citizens of Carbon and Monroe Counties in Northeastern Pennsylvania.

Prior to acquiring the Synapse® RIS/PACS from FUJIFILM Medical Systems, Stamford, Conn., radiology department workflow was a paper-based sneaker-net system. Radiology appointments were scheduled through a central scheduling department, but the reports and department data were manually compiled and distributed.

“Once the reports returned from transcription, they were manually separated by members of our clerical staff, and they were then hand-faxed or hand-delivered wherever they needed to go,” she recalls. “As you might imagine, that took a significant amount of time. The department data was also done manually so there was room for error, definitely, and it was time consuming.”

The decision to supplement the two on-site radiologists with the services of Foundation Radiology, a 71-radiologist radiology services company based in Pittsburgh, Penn, was the catalyst for change. “We needed a way to get our images and our requests to the remote radiologists,” Condon says. “That is what drove us to do it, but what we hoped to achieve was to increase productivity, increase referrer satisfaction, and improve communication among the staff: Information was not always available to more than one person at a time.”

An immediate leap

With the implementation of the RIS, communications took an immediate leap forward, both within and outside the department. Instead of passing information through a booklet that staff had to physically pick up and read, Condon uses the RIS to communicate with the department’s 60 technologists and three support staff multiple times a day by posting messages on an electronic bulletin board.

“Whether they are working at the campus where I am at or a remote location, they have access to that information,” she says.

Now that reports are available as soon as the radiologists sign them in the RIS, turnaround times (TAT) have plummeted from 48 hours to six hours for an average study, vastly improving referrer satisfaction. Blue Mountain recently converted its imaging center x-ray technology to CR, extending the RIS to the outpatient site, and Condon tracked TAT before and after, successfully reducing stat TAT from 24 hours and 15 minutes to 22 minutes.

Workflow in the department has changed completely, Condon says. Technologists always know if a patient needs to have multiple studies and can direct them to their next destination. All documents are kept in the RIS, including consent forms, pre-certifications and alerts; for instance, if a deaf patient needs a communicator.

“The techs live in the RIS,” Condon says. “We are paperless, so we don’t do anything anywhere else. They put all of their comments in there, they scan all of their documents into the RIS, and they communicate with each other through the RIS. We even put pre-certs in the RIS so that we know how long it is good, what types of study it is good for and when it expires, to make sure we are getting paid for our exams. We completely live in the RIS.”

With all information always available at their fingertips, technologists can expedite the completion of an exam and move more quickly to the next. A post-implementation study found a 13% improvement in productivity. “We haven’t done one yet this year,” Condon says.

However, patients don’t feel rushed. With access to patients’ history and prior studies, technologists can provide patients with a sense of continuity of care. “They know what the patient had had done before, and they know the prior results,” Condon says. “It gives patients a better feeling of being taken care of on the whole.”

Maximizing the investment

Aside from enforcing a paperless workflow, Blue Mountain has maximized its RIS investment by leveraging the technology to schedule procedures for multiple departments. Central scheduling is now using Synapse RIS to schedule not only radiology examinations, but vascular, respiratory and sleep exams—as well as FPU infusions.

“We have added those areas, and customized the RIS to work that way,” Condon says.

“For the sleep lab, their exams are 15 hours long, so we had to change how we built our schedules. It works very well. Once we understood what we needed, we were able to build those things into the RIS.

“Even our pharmacy is now accessing the RIS,” Condon adds. “It gives them a daily worklist, so that they know what medications they need prepared for their infusions for the FPU (short procedure unit) for the next day.”

Condon implemented the RIS with limited in-house IT support. “We had a small IT staff, and they designated one person to help me with the RIS,” she says. “But basically, we were on our own. Everything that I learned, I learned from the Fuji team, but I can’t say it was difficult.”

Condon traveled to Raleigh, NC, for training with the Fuji team. “Their training was outstanding,” she said. “Whenever I had a question, especially during that first year, they were only a phone call away, and they were great about helping me figure out how to do things if I wasn’t sure myself. It was fun to learn and implement, and while it was a lot of work, I enjoyed it.”

Leadership tools

Having ready access to all of the department’s information has been a great asset to Condon, as department administrator. “Within a few minutes, I can run any report that is necessary for administration, or for my own knowledge as far as utilization by modality, or utilization by a certain referrer,” she says. “I do volume reports every Monday so that I know where we are for the week and whether we are meeting our goals. It gives me a lot of real-time feedback.”

Recently, Condon noticed that MRI numbers were not on target, so she met with the team and they changed the scheduling slots to fit in a few more appointments per day. “Since they’ve done that, we are not only meeting, we are exceeding our target goals,” Condon says. “That’s one example of real-time feedback that we were able to fix right away.”

If Condon notices that a particular modality is not measuring up to its goal, she may initiate more aggressive outreach in the form of physician education or site visits.

Few department administrators can include PACS administrator on their resume, and Condon says that benefits her most in being able to understand a staff member’s problem with the RIS and help them address it. “If there is a problem with an order or things aren’t transferring over to our Pittsburgh system, I know how to help them with that,” Condon says. “I think it helps to reassure staff that you still are part of the team and understand what they are going through.”

The RIS feature radiologists use most is the worklist, but having access to all documents that come in with an order, which have been scanned into the RIS, has enabled the radiologists to reduce reschedules. If a patient needs premedication or if they need to stop a blood thinner, the radiologists know before the patient arrives in the department.

No one disputes the benefits of the paperless workflow at Blue Mountain Health, but having the discipline to enforce the paperless policy takes constant vigilance. “It is a challenge,” Condon says. “Somebody always wants to creep something back in.”