Enterprise Workflow: Imaging’s Next Frontier?

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Steven HoriiThree hospitals using two separate PACS are a recipe for headaches, and Steven C. Horii, MD, is determined to find relief. As clinical director in the Medical Informatics Group at Philadelphia’s University of Pennsylvania Medical Center, Horii wants his enterprise imaging platform to boost crucial connectivity, while maintaining most of the capabilities of the “full blown” workstation.

The transformation is ongoing, but Horii is successfully leveraging his department’s already strong enterprise workflow to boost organizational growth, all while driving quality and efficiency. The University of Pennsylvania Hospital, Presbyterian Hospital, and Pennsylvania Hospital have all benefited from the new enterprise imaging capabilities—with patients and professionals alike appreciating better communication.

With patients often going back and forth between the facilities, the process of moving images around must be smooth. “With two different PACS, we could move the images, but it was not trivial,” Horii explains. “The only way we could do it was to use the electronic medical record (EMR) system that our hospital web applications group had put together. I give a lot of credit to the hospital IT developers, along with the folks from radiology IT. They built a lot of what we could not reasonably buy."

The EMR setup worked, but not perfectly. One problem was that different departments had their own databases and information systems. “Even though there is a medical record number that is uniform across a given facility, it is not uniform between hospitals,” Horii notes. “We are just now converting to an enterprise identifier that will be uniform across all three facilities—including our outpatient facilities.”

It’s a challenge, but the main objective is to get everyone on the same PACS, to facilitate the same capabilities wherever radiologists in the health system may find themselves. Cross-coverage will improve, in addition to the efficiency of processes and the familiarity of viewing tools. “We have had to scale up to do that,” Horii says. “We are putting all these images into a storage system, and that must be increased in size to meet our needs.”

The viewing tools are Web-based, requiring that radiologists load the active controls; the same is true of the enterprise viewer, which can be utilized anywhere with Internet access. Those outside of the enterprise, either at home or at a different facility, can access images via a virtual private network.

As the imaging platform evolves, Horii favors a “thin client” system akin to a Web viewer that is easy to install, but not as memory-intensive. “The Web viewer works fine, but just does not have as many options for how you display things,” he explains. “It’s designed as a single screen system, whereas our principal PACS workstation software will run on a single monitor, and up to four.”

Enterprise Workflow: Scaling Up Reuven ShreiberIn January, the implementation of the Carestream Vue PACS system at Clalit Health Services in Israel was named one of the country’s best IT projects by People and Computers Group magazine. Clalit is the world’s second-largest HMO, with 14 hospitals and 39 imaging centers serving over four million patients. Executive IT Insight sat down with Reuven Shreiber, MD, senior neuroradiologist at Clalit’s Rambam Health Care Campus in Haifa, to discuss his organization’s large-scale approach to imaging workflow.

Executive IT Insight: What motivated your organization to select the Vue PACS?

Shreiber: Carestream PACS incorporates the features of the regular PACS with the functionality of advanced 3D workstations. It also provides us with accessibility over the Web. These capabilities are crucial since the Rambam hospital is a major trauma center here, serving the entire northern part of Israel.

We have the Carestream PACS and the Sectra PACS working together in the hospital. The Sectra is used inside the hospital, while the Carestream PACS is used by the radiologists mainly for connection from outside the hospital.

eITi: Can you describe a case where enterprise workflow improved patient care?  

Shreiber: One of the on-call senior radiologists was called by the resident, who had a problematic and urgent case. The radiologist, who was on the road at the time of the call (but not driving), used an iPad to view the patient’s radiological images using the Vue Motion software package from Carestream. This application allows radiologists to connect to