Executing the Digital Transformation
When Saint Michael’s Medical Center (SMMC), Newark, New Jersey, was acquired by Catholic Health East in 2009, the organization had some catching up to do in the IT department: With no PACS or electronic medical record (EMR), its clinical-informatics capabilities were behind the times. Angelo Schittone, vice president and CIO of SMMC, explains that when it was time to prioritize the many projects the hospital had been waiting to initiate, imaging was at the top of the list. “You have to look at the area where you’d have the most clinical impact and start there,” he says.
Angelo Schittone, CIO
Schittone says that a key area of dissatisfaction for many SMMC physicians was radiology reports’ turnaround time, which averaged around two days prior to PACS implementation. “Forty-eight hours is just too long,” he notes. “It was a major concern for our attending physicians. The PACS technology makes it easier for our radiologists to practice, but it also makes it easier for our other physicians.” SMMC went live with its first-ever PACS, the Synapse® system from FUJIFILM Medical Systems USA, Stamford, Connecticut, in December 2009, and several other IT-related projects were quick to follow. They included implementation of voice-recognition software and a planned installation of Fujifilm’s cardiovascular PACS, which will operate in a virtualized environment. “We had quite a few challenges to overcome in terms of our IT capabilities,” Schittone says. “We’re trying to bring our radiology department into the 21st century in six to nine months.” A Benefit for Every Stakeholder The SMMC PACS was implemented to cut film and transcription costs, Schittone says, as well as to address the all-important issue of turnaround time. “Having the radiologists start reading digitized images was a challenge,” he notes. “Some had prior experience with that, and some didn’t, but they all really stepped up to the plate to educate themselves and become familiar with the new system, which was very intuitive for all to learn.” Schittone says that the PACS implementation enabled radiologists to cut turnaround time to four to six hours immediately; the addition of voice-recognition software in mid-March helped reduce that number even further, and just five months after implementing its first PACS, SMMC’s average turnaround time for a report is under four hours. Viewing and diagnostic stations throughout the hospital, including one in the emergency department, create additional clinical efficiencies. “The attending physician can either come to the radiologist to view the images, or he or she can view them on the workstations on the floor,” Schittone says. “In the emergency department, it’s been a tremendous improvement because the physicians don’t have to wait for the radiologist to call anymore. They know immediately when the image is available, and they can collaborate on it.” PACS hasn’t just made life easier for SMMC’s attending physicians; it has also improved workflow for the radiologists. The facility is a teaching hospital, and a Synapse feature that allows users to designate images as teaching files allows faster and easier identification of future educational materials. A PACS workstation in the radiologists’ conference room enables them to instruct students within the digital environment. “Our goal was to improve overall efficiency in radiology,” Schittone says. Digital Transformation In order to make its radiology department fully digital, SMMC also upgraded its network infrastructure, replaced all of its radiology work areas, and upgraded several modalities (including radiography systems and fluoroscopy rooms) to ensure DICOM compliance, . With PACS and voice recognition fully implemented, SMMC’s next step will be adding the Synapse cardiovascular PACS to the mix. “We’re planning to become a center of excellence for cardiovascular studies, and we need the clinical abilities offered by the system to become certified,” Schittone says. “In addition, the physicians won’t need to be physically on-site to read the images.” Synergies between the two Fujifilm systems will enable physicians to go from module to module without any adjustment, Schittone says. “The products have the same look and feel, so if you’re a cardiologist, nuclear studies are presented in the same way as a chest radiograph or anything else,” he notes. Integration also yields benefits on the IT side. “When you have one vendor supporting these systems, instead of two or three, you don’t get the usual finger-pointing when there’s a problem, and diagnosing the issue is easier,” he says. “The support we’ve received from Fujifilm so far has been top-notch.” EMR implementation won’t be far behind the Synapse cardiovascular installation, which is slated to conclude in September. “PACS will be a key component in our EMR strategy, which will bring all the ancillary systems together so we have one central repository for all of our information,” Schittone explains. “From the EMR, you can use a URL to access the images in the PACS. We’ve been so technology starved here for such a long time, and now that we have some funds, we want to do everything as quickly as we can.” Deep Impact The ultimate goal of SMMC’s digital transformation is to increase ease of practice for its physicians, a change for the better that’s already beginning to show just a few months after the PACS implementation. “There are a lot of efficiencies to be gained in using this technology,” Schittone says. “Everything’s a priority, but improving efficiency in radiology has a significant clinical impact.” The impact isn’t limited to the clinical side, he adds. SMMC expects a rapid return on investment from its implementation of PACS and voice recognition, which has cut film-processing and transcription costs to almost nothing. There have been other financial benefits as well: “This year, our average length of stay went from 6.8 to 5.6 days, as of the end of April,” Schittone says. “Reducing length of stay has an impact on both financial revenue and expenses,” he continues. “I don’t attribute that only to PACS, but I have to imagine it’s been a major contributor through the reduction in radiology reports’ turnaround times it has enabled. It’s really a useful tool.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.