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Leveraging RIS/PACS and EHR Development for Improved Productivity

November 25, 2011
by Mark Hagland
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In upgrading and replacing their EHR and imaging systems, leaders at Pomona Valley Hospital Medical Center have been strategizing towards optimization

Like the leaders at a lot of hospital organizations these days, those at Pomona Valley Hospital Medical Center, a 453-bed community hospital in Pomona, Calif., have been facing down multiple IT implementation issues at the same time. Not only did they recently begin converting their core electronic health record (EHR) system from the Siemens Unity to the Siemens Soarian platform (both from the Malvern, Pa.-based Siemens Healthcare), they have also been evolving forward in terms of their RIS/PACS (radiology information system/picture archiving and communications system) infrastructure, with their first RIS implementation going back to 1995 (when the vendor was still known as SMS, before SMS was acquired by Siemens), and with an integrated Siemens RIS/PACS solution replacing that older system in June 2004.

And, even as they move forward towards a full computerized physician order entry (CPOE) go-live, scheduled for March 1, 2012, Pomona Valley’s healthcare IT leaders are strategizing forward on how best to make everything work optimally together. Recently, Kent Hoyos, vice president of information technology and CIO, and Robert Jacobi, administrative director of radiology, spoke recently with HCI Editor-in-Chief Mark Hagland regarding their collaboration and the current opportunities and challenges in imaging informatics development. Below are excerpts from that interview.

How much volume are you producing in the imaging informatics area?

Kent Hoyos: We’re producing about 195,000 radiological studies a year.

We’re a Siemens Unity customer, and we knew that the Unity application wasn’t something with a long-term growth path for us; and in the 2002 timeframe, we were happy with where Siemens Soarian was going, and we signed a deal with them in 2004. But we weren’t going to install it until the system was ready. We had to grow our IT infrastructure, too. And at the same time, we chose our Siemens PACS.

How have you been strategizing forward on radiology workflow?

Robert Jacobi: When I started here back in 1997, the hospital had just done the SMS upgrade, and during my first year to year-and-a-half here, we were starting the next upgrade, and there wasn’t really much of a link between IS and how radiology and the ancillaries ran. But we began to come together, and from 1997-1998 on, we’ve had a very close working relationship with IS. And I’ve never looked at radiology as a standalone island, and we’ve really leaned on IS to help us grow.

Hoyos: It’s been a very successful partnership between the two of us, and we’ve managed the team as a pool of resources between the two of us.

Jacobi: This was our first foray into RIS and PACS, and like everyone else out there, we wanted to become more productive, and eliminate all the problems with lost films, lost jackets, things like that. And we went to RIS/PACS and are completely filmless, and are nearly paperless; we still generate a requisition, but by March when we go live with Soarian, that will end as well.

You’ve been able to eliminate some film librarian positions, correct?

Jacobi: We had 19 FTEs in the film library/radiology. And as that transition moved forward, with fewer reports needing to be filed, and with film being eliminated, during 2004 and 2006, there just wasn’t the need for that job function anymore; it simply goes away. What worked out well was that we had a very good communications stream with our staff, and none were laid off. Some took other jobs here at the hospital, and some left the hospital. About half stayed and found other clerical jobs within the organization. We also created a centralized scheduling area within the department, and some work there as well.

Can you describe the evolution of workflow, as IT development has moved forward in radiology?

Jacobi: When you look at the workflow of the department, we made a broad decision that we were going to change the whole registration function as an organization, and probably in about 2005 or 2006, we made an organizational decision about how the registrations would be done, and we eliminated a dedicated radiology waiting room here, and we redesigned an outpatient registration area in the hospital and sent patients there. So traditional radiology reception and film library functions just moved out of radiology.

What have been the latest developments in the past two years?

Jacobi: The biggest thing has been voice recognition adoption and the radiologists going to self-editing.

What vendor solution is involved?

Hoyos: It’s the Dragon solution within Nuance, but baked into the Siemens RIS/PACS solution.

When did the voice recognition go live?

Jacobi: About August 2007. And that has basically allowed for the total outsourcing of the transcription function here within the past year.

Hoyos: And that is an example of where we really had the benefit of getting more efficient and having a much quicker turnaround time, to where our average turnaround time on reports is now an hour; and we’re up at 80 to 85 percent radiologists self-editing now.

And the turnaround time has been improved dramatically, correct? Jacobi: That’s right; from the time the procedure/exam is completed, to when the radiologist signs off on his/her report, we’re currently averaging an hour-and-a-half to two hours for the interpretation to come back for 97 percent of all our images.

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