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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.

Have you had good radiologist satisfaction with all the improvements and changes in workflow? Jacobi: The big-picture answer is yes. There’s no question they’re more productive. Industry-wide, I think radiologists as a whole never seem to be satisfied with their RIS or PACS; those systems never seem to do enough for them. But our radiologist group has actually been able to cut one radiologist FTE out, so they’re down to 10 now from 11 people. It’s about 8.5 to 9 FTEs, but 10 individuals.

What lessons learned and advice would you like to share with your colleagues across the industry? Jacobi: From a radiology standpoint, the biggest lesson learned, and the advice I’d give anyone who hasn’t yet gone through this, is that radiology cannot be a standalone island within your organization; radiologists might want that. But radiology has to develop a close partnership with IT.

Hoyos: I would echo that. We can’t be successful without them being at the table and understanding what their needs are; and they can’t be successful without us. So we have a three-pronged partnership here—it’s radiology, IT, and Siemens. So it’s really establishing that partnership between your two departments, and working with your vendor, to establish what you need and deliver it.

Jacobi: And if you have the scenario of Vendor A for your RIS, Vendor B for your PACS, Vendor C for your front-end registration, and Vendor D for something else, it really poses a lot of problems. I think integration is the solution. I’m not sure radiologists always appreciate that, but it’s necessary. And what makes us look good now is that back in 2004, Kent and I and others were arguing for this approach.

Is there anything else you’d like to add?

Hoyos: As we upgraded our system, we provided the doctors a workstation at their homes to view the images from home, so they can eliminate some of the teleradiology costs. Additionally, one of the radiologists does some boat-captaining in Maine in the summers, and he reads and logs on from the East Coast at about 4 or 5 in the morning there and that’s about 1 AM here, so he’s doing night-reads for us, with the same home equipment. He spends about half the year here, and half the year on the East Coast.

Jacobi: And having the home reading workstations makes the radiologists very happy.

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