As picture archiving and communications systems (PACS) are implemented more and more widely in inpatient and outpatient settings across healthcare, one of the core historical motivations for implementing PACS in the first place — satisfying the needs of practicing radiologists — is morphing. Thus, as PACS moves from being a “departmental solution” for radiologists to becoming a component of an enterprise-wide clinical computing solution, CIOs are now looking to satisfy the needs of specialist physicians across the spectrum of clinical care.
And how does this shift play out in the real world of PACS implementation? Just ask David Ziolkowski, senior vice president of support and ancillary services and CIO, Sampson Regional Medical Center, Clinton, N.C., located about 40 minutes east of Raleigh. Ziolkowski has implemented PACS across numerous specialties and care settings, from radiology to cardiology, oncology, orthopedics, in the emergency department, operating rooms and ICU.
“The biggest challenges,” Ziolkowski says, “involve embracing workflow and process changes, and questioning why we're working the way we work. Because the majority of times, the answer to any question is, ‘That's how we've been doing it for years.’ The good news,” he adds, “is that changes in bandwidth, data storage, and system performance have made huge leaps in the last few years, so a lot of technological barriers have been removed.”
Now, it is process change issues that have come to dominate.
Chris Galanda, CIO of Wyoming Valley Health Care System in Wilkes-Barre, Pa., has had the same kinds of experiences.
“The biggest challenge,” says Galanda of her hospital's ongoing work in this area “has been trying to get the physicians to change the practice of what they do.” For example, she notes, though the 412-bed community hospital has had diagnostic images available online for over four years now, a number of physicians still — out of habit — go down to the old radiology department film room where they once reviewed images on film to look at diagnostic images on digital workstations, even though the same digital workstations are available throughout the hospital.
For PACS implementations to work for all medical specialists, Galanda says physician behavior and clinical workflow efficiency must be examined. However, in the case of the “old film room,” Galanda admits even she gave in and put workstations there to accommodate old patterns.
That said, Galanda and her 30 colleagues in the IT department have been keen to accommodate the diagnostic imaging needs of all the hospital's physicians.
For example, most of Wyoming Valley's neurosurgeons prefer to view digital images on wall-mounted screens in the OR, while many of the orthopedic surgeons prefer portable viewing stations; as a result, both are available in the hospital's ORs.
In some cases, viewing preferences are purely individual, and those have been accommodated as well. What's more, as at Sampson, physicians at Wyoming Valley can access images securely from virtually anywhere in the enterprise, as well as securely via the Web from physician offices and beyond.
The challenge, says Galanda, is quickly becoming storage, particularly in an era of emerging 64- and 128-slice diagnostic imaging equipment. In four years, Wyoming Valley has acquired more than 200 terabytes of images.
Making all this work will mean acting strategically, CIOs say. Indeed, Ziolkowski says, “PACS has to be viewed as one piece of the electronic health record.” The era of PACS as a separate computing silo is ending, he says, and those IT executives and clinician leaders who fall into the trap of thinking of it as still being a departmental solution will end up wasting time, money and effort in implementing PACS unless they understand where the market is headed. Indeed, in order to please the physicians who will in some way be using PACS (and these days, that's nearly everyone); they need to think enterprise-wide and even community-wide, CIOs say.
And sometimes that means thinking outside the box about issues around image-viewing enablement and market competition. That's what's been happening in the Spokane, Wash., area, where Jon Copeland, formerly CIO and now CEO of the business division of a large specialist physician group and director of that group's affiliated hospital's RIS (radiology information system) and PACS, has dramatically enlarged image access for the region's physicians.
At a certain point, Copeland says, it became clear that he and his colleagues at Inland Imaging (which encompasses 68 radiologists and six vascular surgeons) had reached a strategic fork in the road. Because of the far-flung geography of the region's service area, patients are scattered across several counties and portions of three states (eastern Washington, the northern handle of Idaho, and far northwestern Montana). “And we had to decide whether we should allow potential competitors to use our PACS or not,” Copeland says. “And we said we're going to take the high road, because we want an integrated patient care solution. So, we enabled PACS use for cardiologists, PCPs, orthopedic surgeons and neurosurgeons, all using Inland Imaging (Spokane, Wash.) PACS with their own modalities to archive their exams,” across not only the 700-bed Sacred Heart Hospital in Spokane (for which his organization provides PACS coverage), but also across 12 other hospitals in the region, as well as at Kootenai Medical Center in nearby Coeur d'Alene, Idaho and two multispecialty clinics in Seattle.
Doctors across the region have been highly satisfied by this arrangement, and it has actually become a market differentiator for his organization, Copeland adds.
In addition to the storage issues that are emerging, CIOs will have to think about infrastructure questions in order to satisfy physicians in the future, says Henri “Rik” Primo, director of marketing and strategic relationships in the image and knowledge management division of Siemens Medical Solutions USA, Malvern, Pa.
“The new multi-slice CTs are capable of producing thousands and thousands of images, and that could become a problem for image management across multiple departments,” notes Primo. “CIOs will have to deploy thin-client technologies to succeed.”
And that, in turn, will require a lot of technical development in areas like security and single sign-on. With the right strategies and tactics, Primo and all those interviewed agree, CIOs can help satisfy their organizations' physicians in this burgeoning area; but they need to think broadly, about their entire organization, and about all its physicians.