The expanding use of PACS technology in surgical suites, both inpatient and outpatient, has been one of the more striking, yet perhaps under-reported, developments in the imaging sphere over the past several years.
In large hospitals across the country, CIOs, facility directors, surgery and radiology department leaders, surgeons and radiologists are all working together to implement the latest imaging technologies and, even more importantly, make them as useful as possible.
At the 897-bed Northwestern Memorial Hospital in the heart of downtown Chicago, an ongoing upgrade of imaging capabilities in surgery is underway, reports vice president and CIO Tim Zoph and vice president of operations Jay Anderson.
Last fall, executives at Northwestern proudly showed off the opening of the new Prentice Women's Hospital, a replacement facility for the organization's women's care area, featuring the latest imaging technologies and viewing capabilities, including diagnostic imaging machines built into surgery tables, PACS viewing stations within the ORs, and large ceiling- and wall-mounted flat-panel screens capable of being remotely operated. The new technologies bring surgeons live images and beam images remotely for educational purposes.
And while the most advanced technologies have been built into the 10 ORs of the new Prentice Pavilion, the 32 ORs in the organization's Feinberg Pavilion (its core facility) and the 10 ambulatory ORs at Northwestern are also outfitted with upgraded imaging capabilities, Zoph confirms.
But furnishing Northwestern's ORs with advanced imaging technologies is taking place in a very strategic context, Zoph emphasizes. “One of the ways we think about this is in terms of what kinds of tools our clinical programs need in order to advance their own strategic objectives,” he says. “For us, overall, technology, which encompasses imaging, has to be used.”
At the same time, Anderson adds that it's extremely important to consider several elements when planning for new or upgraded implementation of PACS technology in the OR. Coordinating medical technology planning with facility planning, working together on strategy and tactics with clinicians, and considering how the ability to stream live images to surgeons during surgery is converging with the trend towards more minimally invasive surgery overall is key. Only through a holistic view can CIOs make the best planning, purchasing, implementation, and support decisions in this area.
A host of obstacles to overcome
As it turns out, the folks at Northwestern Memorial remain on the leading edge, with imaging automation and such advances as live image streaming into ORs still offered only in a minority of hospitals.
“Five or six years ago, I really thought that surgery PACS was going to take off,” says Scott Grier, a director at Abrio Healthcare Solutions, Nashville, Tenn. But instead, a number of procedural and process issues have hampered rapid advancement in this area, says the Sarasota, Fla.-based Grier.
One of the biggest stumbling blocks has been the realization on the part of everyone involved — IT, surgery and radiology leaders — that imaging management is now an enterprise-wide concern, and must be managed as such. That means moving the locus of control away from the radiology department, and any department for that matter. Second, he says, some very practical considerations have become obstacles to the use of diagnostic images in surgery, such as maintaining the sterility of the surgical environment while facilitating image-viewing by surgeons.
Marc Deary, a senior project manager at the El Segundo-based Computer Sciences Corp. (CSC; formerly First Consulting Group), says that many hospital staffs are assigning an IT support individual to go into surgery, be made sterile and gowned up, and manipulate and stream images within the OR. In other cases, hospitals are assigning a “dirty nurse” to sit at an imaging workstation technically within the OR, but at a distance, and follow the surgeon's instructions on what images he or she wants to view.
Managing issues around the sterility and maintenance of imaging equipment within the OR is also a practical issue that needs to be worked out, notes Abrio's Grier.
Dallas moves forward
At the 15-hospital Baylor Health Care System based in Dallas — comprising 113 surgical suites and where over 67,000 surgeries were performed last year — executives and clinician leaders have been working hard to outfit every OR with imaging capabilities.
For senior vice president of information services and CIO David Muntz, it's all about providing surgeons with the tools they need to deliver the highest level of patient care in the most efficient way. “You find you want images delivered just in time to surgery, and you need to deliver them regardless of where the images were,” he stresses.
One of the major initiatives going on in this area, confirms Kelly Murphy, system director of radiology at Baylor, is the deployment of a system-wide unified RIS/PACS, a step necessary to optimize image management across the Baylor enterprise. “Today, there are nine PACS systems serving the different Baylor hospitals,” Murphy notes. “We're moving forward on our unified RIS/PACS deployment.”
At the same time, some facilities have more advanced set-ups than others. Murphy and his colleagues are proud of the deployment of the image viewing and management system built into the surgical suites at the new Baylor Plano facility. “It's very sophisticated there, with three monitors mounted on the ceilings coming down from booms in each OR, and with an integrated plasma screen,” he notes.
The Baylor hospitals follow the protocol of using a “dirty nurse” who operates a workstation sitting on a counter or mobile cart, working within the surgery suite but at a distance from the sterile operating table area. Surgeons at Baylor have been pleased with the organization's deployment of imaging technology in its ORs, he adds.
Going forward, Northwestern's Zoph says, “Systems like PACS are coming into our domain, and image management is becoming as important as any other kind of data management in an organization. So it's very important for CIOs to work very closely with their organizations' clinician leaders to keep up with the developments and work together, and become an integral part of the planning process with surgery, with facility planning, and make sure you get out ahead in front on the planning.”
Few doubt it will be crucial for CIOs to work with surgeons, radiologists and facility planners to get the IT and workflow right in this evolving area. It will be a gradual process, everyone agrees, but one that offers the potential to strongly improve patient care and surgical throughput in the future. And those hospitals with robust solutions will likely have a competitive edge in their markets when it comes to surgeon satisfaction.