Sharp HealthCare (San Diego, California) has undertaken multiple initiatives aimed at implementing organizational and service improvements, as well as enhanced patient care and clinical outcomes. Its latest endeavor is the imminent addition of a PACS that will accommodate non–DICOM images and that, as such, will facilitate enterprise image sharing across specialties, modalities, and facilities (as well as with clinical entities outside its boundaries).
A recipient of the 2007 Malcolm Baldrige National Quality Award (and the first health-care system to be named a gold-level award recipient by the California Council for Excellence), Sharp HealthCare includes four acute-care hospitals, three specialty hospitals, two affiliated medical groups, and a health-care plan. In imaging-related information systems, it maintains one radiology PACS; one cardiology PACS; two electronic medical record (EMR) systems, one for the hospitals and one for ambulatory care; a health information exchange (HIE); and a patient portal from which radiology results can be accessed.
Under the current Sharp HealthCare imaging umbrella, radiology and cardiology are the only specialties within which DICOM images are captured and made available electronically. Other departments—including (but not limited to) anatomic pathology, dermatology, endoscopy, gastroenterology, and ophthalmology—rely on manual methods to capture, store, and print images. Images obtained at facilities outside the Sharp HealthCare system are provided to the appropriate physicians on CDs, DVDs, or printed film.
In mid-2012, a decision was made to implement an enterprise PACS strategy that would permit the electronic transmission and receipt of images generated across the various specialties and systems, regardless of format. Danielle Noe-Griego, who serves as Sharp HealthCare’s manager of clinical imaging, cites several reasons that the health system came to this conclusion.
“One was the need to support a high quality of patient care by minimizing delays in procedures and diagnostic interpretations that can happen when relevant images are not readily available. We also knew that better patient care—and workflow efficiencies—can be achieved when clinicians can work from any system and get a consolidated list of imaging records across all departments and modalities.”
Complementing this rationale was a strong desire to conserve costs and resources by migrating to a paperless system. Some departments, Noe-Griego adds, were seen as especially ripe for change. She cites gastroenterology as an example, given the high volume of image printing occurring in the department, the hefty price of film, and the expensive legacy equipment used there. “It was obvious that we had to get away from proprietary processors and rely on them only for downtime backup,” Noe-Griego states.
Noe-Griego and other Sharp HealthCare constituents subsequently compiled a list of requirements for the new non-DICOM PACS. Topping the roster was the ability to capture and display images via (as well as integrate with) the two EMRs and the HIE. Other nonnegotiable features included the ability to acquire, store, and display images within patients’ electronic records at the point of care, regardless of image formats.
A multidisciplinary team evaluated 10 different PACS against these criteria by. The team included the CMIO and representative executive leadership from the hospitals and medical groups, as well as department leaders, champions from each affected medical specialty, and members of the IT department.
“It was important that all of these individuals participate in the assessment process because they are all stakeholders, from a usage or support standpoint,” Noe-Griego says. “When stakeholders are involved from the beginning to create a shared vision, the way it happened here, the decision is also shared.
Team members used a combination of live and Web-based demonstrations and interviews with vendors’ current customers to make the assessments as thorough as possible. While visits to existing customers were not logistically feasible, WebEx™ video technology was used to get a detailed perspective on one system that was thought to be an especially good fit.
The vendor facilitated a WebEx session wherein the team was able to view its system actively being used in 40 different specialties; stakeholders from Sharp HealthCare’s pathology, gastroenterology,