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Benefits of Digital Imaging and PACS

August 4, 2008
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Last night I had dinner with an old high school friend who is a Pathologist. We enjoyed the best steaks and seafood in Texas (Willie G’s) and discussed everything from old high school memories to improvements in Immunohistochemistry, Clinical Imaging and PACS.

As he explained his work in the diagnosis of abnormal cells using immunohistochemical staining, I sat in amazement thinking I can’t even pronounce immuno-histo-chemical. During this very detailed lesson on antibodies, antigens and apoptosis we discussed the viewing and examination of images taken using a digital camera attached to a transmission electron microscope. Understanding only the imaging portion of the discussion, I talked about the advances in clinical imaging and PACS as they relate to pathology and the development of pathology specific tools referencing my recent Blog posting on Pathology PACS.

My former classmate was intrigued by the topic of Pathology PACS as he understood the basics of PACS but was not aware of the many benefits that are realized through the use of digital imaging and PACS. With much enthusiasm, I proceeded to deliver my standard sermon on Computed Radiography and PACS workflow. After a generous serving of Steak Opelousas and a few Reds by the glass my friend asked, “So what is the core benefit of PACS?”

My response was simple but almost as impressive as his Immunohistochemistry lecture; the key benefit of PACS is Image and Information Exchange. I also mentioned many other benefits of digital imaging and PACS including; improved image quality, greater image accessibility, unlimited image reproducibility, dynamic image manipulation and overall increased efficiency in image acquisition and review. I concluded with the statement, “I believe the biggest benefit of PACS is the ability to store and share images and related data with anyone, anytime, anywhere.”

When properly administered, PACS provides the cure for the lost image and eliminates lengthy image return/courier times. PACS over a secure wide area network or a secure internet connection allows viewers the ability to collaborate within minutes after image acquisition even if they are hundreds of miles apart. PACS has done for images what electronic mail did for the pen and pad.

PACS may not have as great of an impact on life as confocal laser scanning microscopy but PACS has revolutionized clinical image review, retention and communications and it doesn’t matter if the images come from a flat plate CR system or a scanning electron microscope. Write back and tell me your thoughts and what benefits you have recognized by implementing a PACS.


David Thanks for your response! I got a really good laugh from your comment, "I was eight years into my five year plan before I left." This reminds me of one of my first PACS projects where we were also faced with the task of integrating multiple applications or at best allowing end users the ability to access multiple applications from a central location. I'm sure you're familiar with CCOW, which is a great concept on paper but easier said than done especially when you have older DOS or UNIX based applications or modalities.

Implementing a CPOE is another project that looks great on paper but once you kick-off you quickly realize that the physician and other personnel politics along with the technical hurdles can be a nightmare. Over the years I have learned that scope-creep and timeline extensions can be a standard part of these types of projects to no fault of the PM or project team.

It sounds like you have moved on from that rural hospital but not before setting them on a path to success!! Congratulations on the successes with AGFA.

Sometimes vendor ion can be the toughest part of an implementation and can be the pivot point to success or failure. Thanks Again for sharing your experience!!

Prior to my current Project Manager position with a vendor, I had a position of Director of Information Systems in a rural community hospital. It was a city-owned hospital with 165 beds. Besides management tasks, I also ported a Project Manager hat along with HL7 Analyst and ... Such is life in the I.S. department of ten FTE's.

When I became Director I gave my supervisor, the CFO, a five year roadmap to replace all current systems and have CPOE for clinicians. I was eight years into my five year plan before I left. CPOE was only implemented in the EDIS using MedHost. That was a winner.

My last project was PACS ion. Man, there are a lot of PACS to evaluate! I left shortly before the contract with Agfa was completed. That implementation has been a winner. Included in the scope of the project was PACS integration in the EDIS. That works well. After leaving, the hospital also purchased MedSeek web portal through Agfa. This is only currently being rolled out, but early results show a single sign-on with federated access to various clinical applications. Agfa PACS is one that is working well.

Our assessment was that CPOE for clinicians would only be a success when we could bring all needed clinical information, including images, to the computer screen without having to have the clinician sign-in to multiple applications. For a small, stand-alone, hospital, that is tough to accomplish.

David when you talk about bringing "all needed clinical information, including images, to the computer screen," are you talking about interfacing or integrating the PACS and EMR applications? I've heard images is one case where interfacing is good enough.

At El Centro Regional Medical Center (ECRMC), our assessment was that PACS images should be available through integration and not interface to the EMR. We found that the image handling software, like AGFA PACS, had wonderful tools for the clinicians to use while viewing. MedHost EDIS and MedSeek portal only have pointers that launch the study required without having the clinician sign-in to PACS. We did interface the transcribed Radiologist interpretation.

Another great image software success at the rural hospital was Healthware Document Imaging. Most of the forms that are required at registration time were NCR so that we would have multiple copies of the patient signature without making a photocopy of the original. The cost of those ranged from five cents to twenty cents per form. Integrating Healthware into the registration workflow gave us these advantages:

· We printed our ugly text facesheet to Healthware along with the HL7 ADT message. Healthware parsed the needed data and created a very user-friendly facesheet. It also printed bar-coded and icon-coded armbands appropriate for the patient encounter. Patient labels were printed along with the armband.

· Healthware printed one plain white paper copy of all forms that the patient must sign and take with them. We placed the paper on digital clipboards and captured the document with signature image. Those images all were stored and linked to the encounter in Healthware. On the next encounter, those images would appear on the screen for the registrar immediately after registration. If the required consents were present, they could be associated with the current encounter.

· The Healthware images were able to be accessed easily by the MedSeek Web Portal.

· ECRMC is now scanning EKG's with Healthware so that they are available to the clinician in the Web Portal.

· Healthware pays for itself quickly because the plain white paper costs 0.5 cents where the NCR forms ranged from 5 to 20 cents. The ROI takes into account having to purchase a scanner and digital clipboard for each registration pod and maintain the required disk array for the images.

We knew at ECRMC that if we wanted EMR, we had to find some way to pay. Many times that required getting on our knees and asking for the "very nice people" discount. We did get a lot of help from our vendors.