This content is part of the Essential Guide: Conference coverage: RSNA 2013 annual radiology meeting
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PACS integration, scheduling, other elements streamline radiology IT

Getting your radiology IT house in order begins with PACS integration. Do it right, and you'll positively affect the bottom line.

As part of centralizing patient records and making them available to patients and other clinicians, many hospitals are reviewing their current system's IT integrations and opportunities and connecting different systems. The medical imaging department particularly is in the spotlight as the need to exchange more than just basic imaging information increases.

Hospitals can seize this opportunity to enhance the productivity of the radiologists.

Because of this, many organizations are evaluating the current integrations available to them and identifying the different possibilities they may have access to. The key to radiology, of course, is the picture archiving and communications system (PACS), the image repository. It's typical that a facility has multiple PACS that often are noninteroperable. PACS integration, then, becomes the jumping-off point for bringing radiology into EHR workflows, meeting meaningful use criteria, and electronically delivering imaging studies to referring physicians and patients.

The PACS isn't everything, however. In the radiology department, there are various software components used in the imaging process; the final goal is to get the data into an enterprise content archive. Typically, the CIO will have to integrate some or all of the following IT elements:

Scheduling system: This manages patient appointments and referrals as well as reason for visit.

MIS server: This generally sends details about the patient, such as demographics as well as his upcoming study and notifies the work list server.

Picture Archiving Communications system, which contains these three distinct parts:

  • Modality/scanner: In this stage, the information on the procedure is created at the point of care (X-ray, MRI or CT scan, etc.) and written in a DICOM format, which will be added to the modalities and studies performed.
  • Viewing station: The client software package that presents the resulting imaging to the radiologist end user.
  • PACS server: The system that receives and retains the study in order to make it available for any requesting system.

Harmonizing the data stored in the above systems -- in some cases, hospitals are dealing with multiple imaging systems due to acquisitions -- often presents a number of challenges. Some of these obstacles have pushed many facilities to upgrade or replace of their PACS. And there are several reasons why one should do so, starting with the lack of accessibility and scalability.

Hospitals have seen significant growth in the past few years. As part of this growth, the increase in patient volume has forced some to reevaluate their existing PACS as performance bottlenecks and scalability issues arose. In addition, radiologists have multiple ways to remotely review studies, presenting an integration challenge.

Hospitals participating in meaningful use also recognize the changes that stage 2 requirements bring to the table. One criteria requires patient images to be available electronically and easily accessible. This means that PACS must not only be queriable through radiology information systems or other imaging systems, but studies also should be linked to EHR products and health information exchanges as a menu criteria built into EHR incentives specifically for radiologists.

Believe it or not, paper is still a roadblock to PACS integration, too. Cases where paper-based workflows are used to order studies and submit information to the PACS still exist. Unfortunately, this has caused many radiologists to be less efficient in their workflows and face significant challenges when using some of the legacy PACS products. Meaningful use stage 1 started to address this by requiring some studies to be ordered via computerized physician order entry, and stage 2 increases the percentage of procedures that must be ordered electronically.

Data consistency is another issue. Wherever there is limited integration, then data is being duplicated and entered in a nonstandardized way.

As we begin the process of evaluating functionality offered in leading PACS products, decision makers must think about how any upgrade will provide benefits. The following requirements should be hardwired into any purchasing decision:

  • Seamless integration and standardization: For any PACS to integrate with external systems, the appropriate support for all the commonly used exchange standards is a must. DICOM, HL7 and DMWL are some of the widely used standards.
  • Remote access: Like accessing data on the Web has become a commonly expected feature, more users are now demanding mobile access via tablets or smartphones to imaging. A PACS should offer medical data and its reports electronically across multiple devices (tablets, laptops, Web portals and traditional view stations).
  • Flexible workflows: Radiologists are continuously seeing cuts in their reimbursements. As a result, more emphasis is now put on efficiency and automation, whether it is to automate critical results or improve notification systems.
  • Enterprise content archive: With the need to integrate and facilitate the access to patient health information, any PACS product must be able to publish its data and integrate with an enterprise content archiving system. These are the systems that we will continue to see in health systems. They offer a centralized repository of all patient imaging for referring physicians to review records, whether it is a bone density scan, ultra sound, MRI, or CT scan.

There are certainly several factors to consider when evaluating a new PACS, from the ability to scale and the PACS integration with the hospital's EHR, to costs and radiologist feedback. However, if the system is replacing a legacy product that lacks many of the critical components listed above, then a new PACS becomes a must-have. Hospitals can seize this opportunity to enhance the productivity of the radiologists, improve care and boost their competitive strategy.

About the author:
Reda Chouffani is vice president of development with Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email or contact @SearchHealthIT on Twitter.

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