Most U.S. healthcare providers are now approaching their second- or third-generation of picture archiving and communication systems (PACS). The staff at St. John Health System in Tulsa, Okla., was no different. They were looking for a standards-based PACS that facilitated integration with existing hospital information systems and radiology information systems (HIS/RIS), as well as existing imaging archives. The St. John staff also needed a platform with advanced features to improve diagnostic accuracy, while simultaneously boosting productivity.
The healthcare system includes four hospitals, with the 721-bed St. John Medical Center being the flagship facility. The system also includes three smaller hospitals, 14 imaging centers and three urgent-care centers. Together, these facilities conduct 310,000 imaging procedures a year and see about 1,500 patients a day.
After narrowing the field, two vendors delivered workstations for side-by-side testing at the hospital. Ultimately, both the radiology IT staff and radiologists agreed on the same platform, the CARESTREAM PACS from Carestream Health.
"One of the key advantages offered by the product from an IT perspective was its ability to efficiently interact with the facility's 2.2-terabyte imaging archive that represented seven years of imaging exams," says Rick Adams, St. John's PACS administrator. The PACS offers an archive-takeover utility that migrates existing meta data to the new PACS and then synchronizes this meta data across multiple PACS platforms to provide rapid, automatic access to prior exams.
Imaging studies still reside on the existing RAID archive, allowing the facility to continue to merchandise its investment in this system. Users retrieve these studies on demand within three seconds. "Prefetching is not performed, since image access is rapid and the volume of requests would overwhelm the hospital network," Adams explains.
Converting seven years of meta data to the new PACS database took one week, with the conversion taking place in the background on the hospital network. The PACS also migrated 10 years of radiology reports from a legacy RIS system that had already been replaced and needed to be retired. That process was conducted over six weeks via the hospital network, Adams states.
The PACS also integrates with the existing HIS and two-year-old RIS via a Mitra broker that allows authorized users to review the exam order, radiology reports and imaging studies. This streamlined work flow has replaced previous manual processes for retrieving patient records, Adams says. Faster access to records is especially important in the trauma center, where past radiology reports and imaging exams can be pulled immediately using the patient name.
According to Adams, the platform's advanced streaming technology delivers large imaging exams quickly, even over 10-megabyte connections. The software streams full-resolution images related to the region of interest first, so radiologists can begin reading immediately while the rest of the study continues to load. Compression is applied to each individual slice to achieve the twin goals of high speed and image quality.
Rapid remote access to imaging studies and radiology reports is attractive for referring physicians - and has led to higher referral volumes. "Neurologists, surgeons and other specialists appreciate the convenience offered by rapid delivery of large imaging files," says Adams.
The PACS is integrated with PowerScribe speech-recognition software and, for the first time, dictation capabilities are available remotely as well as on-site. "The combination of faster transmission speeds with built-in dictation enables our radiology group to read after-hours and portable exams from home. This flexibility leads to faster reporting for patients throughout the healthcare system," Adams notes.
New reading tools further enhance both the speed and quality of interpretation for complex exams where data sets need to be compared. The platform's PowerViewer builds a single virtual study with real-time volume matching of all relevant studies to automatically register and synchronize them in one click. Synchronizing views of the region of interest from multiple data sets makes measuring and comparing tumors, nodules and other anatomical structures faster, Adams explains.
Fully featured mammography tools are also available. The hospital installed multimodality breast-imaging workstations from Carestream Health to equip radiologists to read general radiology and all breast imaging exams on the same workstation. Integration with Confirma CADstream enables radiologists to see CAD markers for breast MRI studies at their desktop. In the past, radiologists used two different workstations for breast imaging modalities. General radiology exams were read at a different workstation in another location.
"Being able to deliver exams from all modalities to the same desktop enables faster throughput during peak periods, as radiologists throughout the healthcare system pitch in to read cases," Adams reports.
A new licensing structure has made expanding image access more affordable for the hospital. In the past, access to advanced applications was limited to a few licensed workstations. Fees were based on the number of users and workstations. Now, St. John's licensing fee is based on the number of concurrent users, so the hospital can make advanced functionality - including 3D or mammography tools - available at any onsite or remote workstation, Adams says.
"The CARESTREAM PACS is attractive from an IT perspective since its architecture offers flexibility, ease of integration with other systems, and the ability to reduce operating and licensing expenses," says Adams. "At the same time, radiologists and referring physicians gain the ability to use new diagnostic tools from any location, and new transmission methods make it fast and convenient to view reports and imaging studies remotely."
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