Transforming the PACS Vendor Relationship

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Radiologists at Yale University figuratively equate their PACS with a toolbox and themselves with artisans, from whose hands now spring forth remarkably useful pictures: namely, manipulated and reconstructed digital images of what lies beneath the epidermis.

Over time, the PACS acquired by Yale in 2003 required, in the department of diagnostic radiology’s estimation, an expanded tool assortment to meet the department’s evolving needs. The radiologists asked their PACS vendor to accommodate them.

imageRobert Cooke

At the time, the requested extras were nonexistent, but what transpired next would give the department tremendous encouragement. Some at Yale and within the ranks of the vendor (FUJIFILM Medical Systems USA, Stamford, Conn) began talking, wondering whether it might be possible to fashion a partnered process through which the additional PACS capabilities desired by the radiologists could be developed, refined, and formally introduced.

One thing led to another, and before long, a formalized Yale-FUJIFILM collaboration was born, out of which have already arisen several valuable enhancements to FUJIFILM’s Synapse PACS product. More are in the pipeline.

T. Rob Goodman, MD, Yale’s vice chair of radiology, says, “The significant thing here is that we are not involved with our vendor in the customary way, wherein user feedback is informally passed along from the sales staff to the product-design team. In our situation, we are almost serving as a vendor to the vendor.”

imageT. Rob Goodman, MD

Robert Cooke, FUJIFILM’s vice president, network business management, says, “Academic medical centers have a unique challenge to balance their research mission against their health care mission. They are also facing many of the same challenges more typical radiology environments are facing due to changes in reimbursement, radiology shortages, increased volumes, and even outpatient for-profit imaging. After a successful implementation of Synapse in the Yale environment, it became clear there was more we could do to enhance our relationship and our products.”

Adding Value

By way of illustration, Goodman describes a few ideas that his group has passed along and then seen brought to life. “We provided Fuji our thoughts about Synapse’s multiplanar-reconstruction (MPR) package,” he says. “We told them we liked the fact that it comes integrated with PACS, rather than being available only as stand-alone postprocessing workstation, but our wish was that this package include the ability to measure objects on the MPRs. FUJIFILM is working on this right now. The solution being developed looks promising.”

Also in development at FUJIFILM, in response to input from Yale, is a smart worklist. “At the moment, imaging studies come up in the order they were performed by the technologist, but a smart worklist would allow studies to be prioritized automatically by Synapse based on acuity, patient location, or other parameters we might choose,” Goodman says.

Meanwhile, FUJIFILM recently previewed, for the Yale radiologists, a proposed redesign of the Synapse graphical user interface. “Fuji clarified that this was just a work in progress and was eager for our feedback regarding not just where icons were placed on the screen, but also the choice of display colors, text fonts, and sizes.”

Attention to seemingly trivial details is appreciated, Goodman adds. “The initial iteration we were shown of the Synapse display screen highlighted, with italics, the identifying information for whatever study was currently selected,” he says. “While helpful in distinguishing that study from others on the displayed list, the italicization worked against us by making it harder to read for purposes of typing in accession numbers, which is something we must do with a fair amount of regularity. When we shared our concern with Fuji, they were quickly responsive. The result was an easier-to-work-with font style the next time the work in progress was shown to us.”

A Busy Organization

Indeed, while many of the suggestions from Yale for improving PACS may seem inconsequential, they will facilitate radiologists’ comfort and efficiency. Those are vitally important because productivity is the name of the game for Yale’s 40-doctor radiology group, which provides imaging services to 944-bed Yale–New Haven Hospital, Connecticut’s largest tertiary referral center (staffed by 2,500 attending physicians and handling 503,000 emergency and outpatient visits and 50,000 inpatient