Legacy Health’s PACS-driven Workflow: The Imaging IT Perspective

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Over the past few years, health-care providers have recognized the potential of enhanced physician access to patient information to improve physician efficiencies and, in turn, patient care. For some, migrating to an integrated PACS/electronic medical record (EMR) configuration—instead of maintaining the legacy IT model in which PACS and the EMR exist as separate data silos—is the way to go.

Legacy Health ranks among players that have set off on the PACS/EMR integration path. Headquartered in Portland, Oregon, the not-for-profit health-care system operates five hospitals and eight clinics in the Portland metropolitan area, as well as an additional hospital in Vancouver, Washington. Each hospital works with its own contracted radiology group. Several clinics send exams to be read by radiologists at the nearest hospital, while others have specialists on staff to handle the task; in both cases, images are archived at the hospital in closest proximity to the facility.

The initiative now underway at Legacy Health entails integrating its Synapse® PACS (FUJIFILM Medical Systems USA, Stamford, Connecticut) with an EpicCare® EMR solution (Epic Systems, Verona, Wisconsin) currently being implemented to standardize the hospital system’s electronic charting platform.

The first hospital was integrated November 2010 when Epic went live at Salmon Creek Hospital in Vancouver, WA. The second hospital, Emanuel Medical Center, went live with Epic at the beginning of April. Emanuel Medical Center is a level one trauma center and includes the Children’s Hospital.

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In getting the project off the ground, Ron Serikaku, lead PACS system administrator and his colleagues needed to decide which of two methods of integrating the PACS and the EMR—PACS- or EMR-driven desktop context sharing—would best suit radiologists’ needs.

PACS-driven sharing would allow radiologists to work from Synapse reading worklists while maintaining the Epic Hyperspace module and the dictation piece of the PACS in synchronized mode. EMR-driven sharing would enable them to work from Epic Radiant reading worklists while keeping Synapse and the dictation system synchronized. Serikaku says, “We tested both and asked for radiologists’ feedback, which are important when taking so significant a step as PACS/EMR integration.”

There were minor differences between the two methods in terms of workflow speed, but the PACS-driven method won; practitioners, Serikaku states, seemed to believe that it would be easier for them to execute context sharing from the PACS side.

Under the PACS-driven context-sharing umbrella, each study opened in PACS triggers synchronization messages to Epic and the dictation system. The synchronization methods allow the Epic application automatically to navigate to the correct patient’s study; Windows® placement for Epic, the dictation system, and the worklist remains in radiologists’ control.

When a study is marked as dictated on PACS and a new study is opened, the new patient’s information is immediately brought into view on Epic. Prior studies are automatically selected and displayed in accordance with PACS properties settings.

Meanwhile, a URL integration for referring physicians permits these practitioners to use Epic Hyperspace to launch a study stored in PACS. An image-available notification message is sent to the EMR when images are received by PACS. The EMR then generates a URL and a hyperlink to the study on PACS. Because active directory is used for authentication, the user doesn’t get prompted to log onto PACS when the image window opens.

While the project is still a work in progress, and tangible benefits have yet to be measured, Serikaku notes, it has already had a positive impact on radiologists’ practice patterns. Prior to the integration, radiologists either had their own dedicated PACS workstations (with an electronic charting application installed on separate office computers) or read exams in common reading areas, with no charting computers nearby.

Streamlined Workflow

“There is much more efficiency now,” Serikaku says, “because the radiologists aren’t physically going from one system to another to get the information they need. They can dictate with all the pertinent images at hand, so nothing is missed.”

Referring physicians, too, are reaping gains, Serikaku says. For example, showing images to patients previously necessitated taking them out of the exam room and walking down the hall to tap into