“We're pretty advanced in terms of imaging. We signed a deal with Siemens seven years ago,” he says, referring to Malvern, Pa.-based Siemens Medical Solutions, “one of whose major aspects was to standardize and upgrade our technology and to integrate our RIS/PACS solution.” The deal also called for Siemens to standardize and implement a number of modalities at Alegent, including a variety of MRIs, CTs, and a PET CT. The work has also included deploying Siemens' Syngo Workflow RIS, SIENET Enterprise PACS, as well as Syngo Dynamics Cardiology PACS. By November 2008, the organization was live with all the various functionalities.

As part of the broad initiative, Lawonn and his colleagues have standardized RIS and PACS capabilities and workflow across their seven-hospital system. The broad objective is to improve efficiency and clinician workflow for better patient care.

Lawonn says, among the returns on investment so far have been:

• A 55 percent decrease in overall turnaround time for radiology reports;

• Decreased turnaround time for surgical case images (from more than 9 minutes to less than 2 minutes, on average);

• Decreased patient lengths of stay;

• Improved consultation capabilities between radiologists and referring physicians;

• The “recapture” of physical space from former film libraries to space for imaging (at Mercy Hospital, a second CT was able to be installed in the space formerly occupied by the old film library);

• Elimination of 10.5 FTEs from management of the old film library at the organization's flagship hospital (most of these positions were replaced by the hiring of people for new positions, including a new systemwide PACS administrator and four radiology IT specialists).

The gains were made at a time of rapidly growing study volume, which leapt from less than 250,000 studies in 2004 to more than 310,000 in 2007. At the same time, cardiology imaging was also brought into the enterprise-wide integration initiative.

“This has all gone very well,” says Lawonn, who notes that moving forward on the system-wide initiative helped revolutionize radiologist workflow and operations. “We used to have three radiology groups that served our locations,” he says. “Now we have two; one that services one location, and one that services the other five. And all this integration has really helped them with workflow. They have two neuroradiologists who can service all the locations, who can read from one location.”

What's more, he says, “All diagnostic images and radiology results flow back to the EMR. So a study ordered in the EMR system is processed in the RIS/PACS, and the results are interpreted and brought back and stored in the EMR. It has a link, so that when referring physicians go into the record, they see the result. If they want to see an image, they can click on an icon, and launch into the PACS Web viewer.”

The imaging integration initiative is ongoing, Lawonn emphasizes, even as he takes pride in the improved connectivity, clinician workflow, and efficiency. Asked what the biggest lessons to date have been, he says one is the validation of his emphasis on infrastructure development at the outset. “One of the things that turned out to be a big plus for us was that we anticipated connectivity and bandwidth would be an issue once we implemented PACS,” he says. “So we were very aggressive in terms of upgrading our infrastructure and our network, both inside the facilities and between and among them. We didn't want the adoption or the use of the system to be hampered by the fact that we didn't have enough infrastructure.” Storage remains an ongoing challenge, but Lawonn feels the organization has laid a strong foundation for continual innovation.

Case Study: In the rural West, a community hospital system advances

In contrast to the situations at Alegent Health in Nebraska and Fletcher Allen Health Care in Vermont, the Roseville, Calif.-based Adventist Health system is comprised entirely of community hospitals, most of which are in smaller cities and towns, and in rural areas. What's more, only three of the system's 16 hospitals, spread out across California, Oregon, Washington, and Hawaii, are larger than 300 beds, while the majority are smaller than 200. Further, it is commonplace for patients to have been admitted to more than one Adventist hospital over time; and for Adventist clinicians to consult with one another over great distances. So the need for a unified image archive and an integrated clinical IS infrastructure has been a top goal of Alan Soderblom, Adventist's vice president and CIO, and Greg McGovern, the system's assistant vice president and CTO.