At Palm Beach Radiology Institute, operated by Palm Beach Radiology and Imaging Associates (PBRIA), there is no film, there never has been film, and no one expects ever to see film. When the outpatient imaging center opened a year ago, it was already an all-digital environment, built from the ground up to accommodate a digital infrastructure and a paperless workflow.
The patient accesses the digital file from the RIS and verifies the information by signing a signature pad; the RIS routes the ordered exam to the modality; the patient is escorted to the exam room, where the images are acquired and sent to the PACS; when the study appears on the worklist, the radiologist interprets it and dictates the report, which is saved to the RIS; a remote transcriptionist transcribes in real time into the RIS; and within half an hour of the images hitting the PACS, reports are automatically faxed or emailed to the referrer from the RIS.
“I would estimate it is 30% to 40% more efficient than a nondigital environment.” —Scott Studdard, IT manager, Palm Beach Radiology Institute, North Palm Beach, Fla
The multimodality center occupies 4,000 square feet in a North Palm Beach medical center, sandwiched between a rehabilitation center and an orthopedics practice. Its wood floors, granite countertops, crown moldings, and natural lighting belie its medical purpose. Three patient-prep rooms feed patients into six exam rooms, one for each modality: X-ray (computed radiography), digital mammography, 1.5T MRI, 16-slice CT, ultrasound, and bone densitometry. All modalities are positioned around two central reading rooms, where two radiologists practice near–real-time interpretation. A staff of roughly 14 serves the imaging needs of 40 to 75 patients per day.
When Scott Studdard was contracted by PBRIA as IT manager six months before the center opened, in the summer of 2007, he was charged with shepherding all modalities and information systems into an efficient and productive whole. Because PBRIA was all-digital from the outset, Studdard says that it is difficult to calculate the cost efficiencies of the filmless and paperless workflow. There are no film-world benchmarks for comparison. The real savings come from increased productivity, and Studdard says that Palm Beach Radiology Institute is ahead of schedule in recouping its total investment of about $4.2 million.
Studdard is quick to point out that a tightly integrated RIS/PACS—the result of a partnership between FUJIFILM, Stamford, Conn, and Empiric Systems LLC, Morrisville, NC—is a key to the center’s operational and clinical efficiency. Last year, Empiric Systems signed a reseller partnership with FUJIFILM that allows it to provide a combined RIS/PACS to hospitals and imaging centers like PBRIA. The solution combines both applications under a single sign-on process and provides a single graphical interface for the radiologist and the clinician.
Blazing Clinical Efficiency
Two radiologists, who own the center with two associates, perform interpretations. The primary reading room has a full-blown Fuji Synapse workstation with three-head five-megapixel monitors, a computer-aided diagnosis station, and a third Synapse workstation for all outside images.
A second, smaller reading room with a single workstation and three-head five-megapixel monitors comes into play when both radiologists are on-site, but also provides a measure of security in case one workstation fails.
Though most reading is done on-site, the PACS does have the ability, using the Synapse SSL server, to push overflow images to an outside workstation to be read by part-time radiologists. PBRIA goes to great lengths to move reports to referrers faster than its competitors can—another advantage of being completely digital, Studdard says.
Once acquired, the images show up on the worklist and are read within 15 minutes by the radiologists, who dictate their interpretations into the RIS. Patient information has already been entered into the RIS by the patient at check-in and by the scheduler. A remote transcriptionist logs into the RIS and transcribes the dictation into the RIS. The report is automatically faxed from the RIS to the referrer.
The goal is for the radiologist to have completed the interpretation within 15 minutes of the exam reaching the PACS, giving the transcriptionist 10 minutes to complete it so that the referrer has the report half an hour after the imaging was done.
“We’ve got a quick turnaround