a successful pacs implementation monte clinton, cra dartmouth-hitchcock medical center brian phelan...
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A Successful PACS Implementation
Monte Clinton, CRADartmouth-Hitchcock Medical Center
Brian PhelanIDX Corporation
Disclaimer
This presentation is about a PACS implementation at one facility (DHMC) with one vendor (IDX) and is being given as an example of a successful PACS implementation
Other facilities and vendors can do a similar PACS implementation using this partnering program and methodology
DHMC does not endorse IDX or any other vendor’s products and services
Why Install a PACS?
Save money – Increase reimbursement Reduce medico-legal risk
• Eliminate Film and processing costs
• Reduce Film Library staff
• Improve billing collections
• Reduce medico-legal exposure
Why Install a PACS?
Improve staff and imaging room productivity
• Increased staff productivity
• Reduction in the number of staff
• Increased imaging room productivity
• Eliminate imaging rooms
Productivity Benefits of DR Source: Philips Medical System
Film Handling43%
Cassette Handling
8%
Other16%
Exposure4%
Patient Transport11%
Tube Position5%
Patient Positioning
13%
Why Install a PACS?
Improve service to your customers
• Single set of film images limits collaboration
• Minimize lost studies and revenue
• Minimize treatment delays
• Speed service to referring clinician and patient
DHMC’s Steps to Justify PACS
Internal justification – The major players
• Large capital or operating cost impact requires multiple levels of approval – at DHMC this was:
– Radiology
– Information Systems
DHMC’s Steps to Justify PACS
Internal justification – Institutional leadership
– Administrative leadership
– Finance Committee
– Board of Trustees – final go or no go
PACS: Getting Started
Outside experts – PACS consultants
Institutional experts
• Radiology
• Information Systems
PACS: Getting Started
Educate yourself about PACS
Ask your colleagues about their experiences
Attend meetings such as this one
Vendor discussions and demonstrations at trade shows - AHRA, RSNA, SCAR
PACS: Getting Started
Request for Information (RFI)
• Invite selected vendors to respond to RFI
• Get a list of their customers to contact
• How would their system fit into your facility
• RIS and PACS compatibility
Interface or Integrate
The critical relationship between the RIS and the PACS
Have the RIS and the PACS vendors worked together before?
Which vendor has primary responsibility or are you expected to do problem triage?
PACS: Getting Started
Request for proposal (RFP)
• Invite a limited number of vendors to bid
• Vendor clarification meetings
• RFP review and analysis
• Site visits at working clinical sites
• Final negotiation – Purchasing and Vendors
Paying for a PACS
Capital Purchase or Operating Expense• Capital purchase
– Major capital expense – compete for funding
– Cost to upgrade and remain technologically current
– Ongoing service and maintenance cost
• Application Service Provider (ASP)
– Costs are an operating expense
– Always kept technologically current
– All inclusive ASP charges fluctuate with revenue
The PACS Timeline
Develop a realistic implementation timeline with buy-in from all affected stakeholders
Radiology – all levels
Information Systems
Institutional Leadership
Referring Clinicians
PACS Vendor
DHMC’s PACS Timeline
• Phase 1• 1-2003 Archiving started in CT, MR, US• 4-2003 Live in CT, MR and US – stop printing film
• Phase 2• 9-2003 Archiving started in DX• 12-2003 Live in DX – stop printing film
• Phase 3• 4-2004 Archiving started in Angio and NM • 4-2004 Upgrade the RIS• 4-2004 Live in Angio and NM
Partnering with PACS Vendor
Agreement with the vendor on the timeline and implementation phases
Appoint key staff from each stakeholder
This must be a win – win endeavor
Planning the Implementation
Weekly meetings of the PACS Working Group
• Radiology Director• Radiology PACS Administrator• Radiology Clinical Operations Manager• Radiology Asset Manager• IS Director• IS Liaison
Guiding the Implementation
PACS Implementation Team bi-monthly meetings
• Chairman of Radiology
• Chief Information Officer
• Vice President of Clinical Operations
• The Six Working Group Members
Before and After Implementation
Ongoing follow-up
• Weekly calls - Radiology and vendor
• Updates to the clinical departments
• Regular updates to the Board of Trustees
• Monthly updates to the Radiology faculty
• Weekly updates to the Radiology staff
Selecting the Hardware
Involve the end user in equipment selection
• Radiologists given a choice of monitors
• Referring clinicians given a choice of monitors
Specialty sections given choice of monitors
• OR selected from 5 large flat panel monitors
• ED selected the best monitor for their use
Reading Room Design
Radiologists given a choice of layout
• DHMC rejected the modular systems
• Radiologists preferred two image monitors • Room lighting critical
• Calculate room temperature requirements
• Gradual phase out of alternators
The Archive
DHMC’s PACS Archive
• In-house dual servers maintained and remotely monitored 24/7 by vendor
• External archive backed up daily to vendor’s San Diego archive facility
• DHMC’s failsafe back-up archive -- DVDs burned daily and stored at DHMC
Kodak Drylaser
Printer - 5
Image Archive
Any Image, Anywhere, Anytime
Enterprise Access via CIS
US – 7 HDI Acuson
Dartmouth Hitchcock Medical Center Imagecast™ RISv9.8/PACS
CT GE - 3
MR GE- 4
• Dual DICOM Processors (~3 weeks)
• netCache (~6 months)
• Persistent Store (scalable life)
Offsite Disaster Recovery
DR Philips –6
U/S Kodak MiniPACS
(priors only)
ImagecastPACS databaseImaging Suite
CT Picker
MR - Mobile
Display
StationsCT/Body Read
Area (3)
Neuro Read Area (3)
U/S Read Area (2)
DX Read Area (5)
T-110 MB
Fiber
WAN/DSL/Cable
LAN-10/100 Lebanon DHMC Campus
100MB10/100 MB
T-1
IDXRad v9.8
FilmDigitizer
2
CR Philips - 3
Speare – Plymouth NH
Dated 05/05/03
US – HDI 2
ICU
ConnectRv4.0
Onsite Disaster Recovery
10/100 MB
10/100 MB
HC5
CT Rad/Onc
MR Mobile
DVD Server
RF Siemens 3
Training of the Radiologists
Vendor provided 1 to 2 hours of one on one training 2 to 3 days before activation
• Return visits after activation for more training if needed
• Give them all the time and training they want
• Ask radiologists and residents to offer suggestions for enhancements
Keep Your Staff Informed
• Being upfront about what is happening and when it
will impact the lives of staff will head off rumors
• Publish a PACS phase in plan – DHMC 1 year
• Stop hiring permanent full time Film Library
\employees a year before implementation
• Work with HR to find jobs for displaced staff
Contingency Plans
• Referring clinicians demanding film
• Acceptance of CD copies by other facilities
• Urgent results reporting
• Special requests
• System failure – power failure, virus, etc.
Partner With Your Vendor
• Clear objectives spelled out in the contract
• Agree on timeline, payment and penalties
• Clearly define facility - vendor responsibilities
• Track progress with regular reports
Make the PACS implementation a win – win program for both your facility and the vendor
What DHMC Did Right
• Developed and used a workflow analysis
• Piloted PACS with 15 referring clinicians
• Had a close relationship with the PACS vendor
• Integrated modalities in advance
• Integrated RIS/PACS with electronic medical record
A Chairman’s Perspective
“ Never in my 29 years as a chairman have I made a decision that has received such universal acceptance from both the radiologists and the referring clinicians”
Peter Spiegel, MD
Chairman – Radiology
Contact Information
Monte Clinton, CRA
Dartmouth-Hitchcock Medical Center
www.dhmc.org/dept/radiology
Brian Phelan
IDX Corporation