In the island state of Hawaii, there is a four-hospital system, based in Honolulu, called Hawaii Pacific Health (HPH), with outposts and imaging technology deployed throughout the Hawaiian archipelago. This system is served by four different radiology practices, reading approximately 300,000 studies annually.
About three years ago, a systemwide upgrade gave radiologists improved reading from all locations with unprecedented access to everything from physicians’ notes and laboratory reports to referrers’ phone numbers and emails with the click of a tab on their desktops. Effectively, from the radiologist’s perspective, PACS is now driving the electronic medical record (EMR).
It is unclear whether this access is speeding up or slowing down radiologists, according to Robert Lipman, MD, a member of the 10-radiologist group that covers Straub Clinic & Hospital (Honolulu) and seven satellite sites on the island of Oahu. There is, however, no doubt that desktop context sharing has provided radiologists with ready access to information that has resulted in greater clarity in reporting and improved patient care. “It makes us do a better job,” Lipman says.
Consider this: A radiologist reviewing a CT exam of the abdomen encounters a slight lucency in the femur. Is it or is it not a bone lesion? At HPH, the radiologist hits a button labeled problem list on the EMR (which the PACS has opened to the correct patient’s record) and discovers that the patient has lung cancer. “It would have been nice if the referring physician had put that in the history sent to me, but now that I know it, that bone lucency has significance,” Lipman says.
How It Works
The enriched reading environment for radiologists at HPH didn’t happen overnight, but instead, occurred in stages as the IT infrastructure (and the system itself) evolved from individual information systems to an integrated whole. Each of the four hospitals in the system and the HPH women’s health center has its own PACS server (Synapse®, FUJIFILM Medical Systems USA, Stamford, Connecticut), and they all share images via Fujifilm’s CommonView® platform. The EMR (Epic Systems, Verona, Wisconsin) is housed on a single server at a data center, and each individual PACS is now interfaced with the Epic EMR.
Prior to the tight integration, HPH had the EMR, but there was no integration with PACS, so the radiologists had to open a separate window, enter an eight-digit patient identifier, and (if they managed to get to the right place) they could search the patient record for the information that they needed.
“Before that, it was worse,” Lipman notes. “We had a RIS, we had a laboratory system, and we had a clinic-notes system. For each different thing we wanted, we would have to log onto that application, and we had to put in a patient identifier. Now, Synapse takes care of that part by identifying the patient to the entire EMR, which includes all of the pieces that used to be individual.”
In the current configuration, Epic is always open on the desktop, but PACS drives the workflow. When a radiologist logs onto Synapse and opens a case, Epic synchronizes with PACS and goes directly to that patient; by hitting a tab, the radiologist has access to Epic Radiant (the RIS portion of the Epic EMR) or any number of resources, including clinical history, laboratory results, and phone numbers and email addresses for the patient and his or her physicians.
The radiologists at Straub Clinic & Hospital read on five-monitor workstations: Four black-and-white monitors display images and one color monitor displays the EMR and what Fujifilm calls its Power Jacket. “The Power Jacket tells you about prior imaging,” Lipman explains. “It tells you that the person had an ultrasound of the liver—and if you are reading a CT of the liver, you might want to look at an ultrasound of the liver.”
The EMR, open in the leftmost monitor, includes a view called Snapshot, which Lipman uses to get information on medications and allergies, phone numbers, and Chart Review—the bulk of the record. Chart Review features 13 tabs, including notes, imaging, procedures, laboratory results, medications, cardiology, and another seven categories of useful information.
Different specialists can choose to access information in different ways. For instance, rather than retrieving laboratory results through Chart Review, Lipman prefers to use a different view called Results Review, which displays laboratory values