New Radiology-department Solution Opens New Doors
Integration has been a buzzword in the radiology community for some time, and the team at Valhalla, New York-based Westchester Medical Center (WMC) knows why. “We used to have PACS, RIS, and voice recognition all working separately from one another,” Mike Seiler, director of radiology IT at WMC, explains. “Today, they’re all tightly integrated. We had disparate systems, and now we have one.” imageWMC implemented its first IT tool for radiology, a RIS, in the dark ages of health IT: 1996. Originally manufactured by a small, Texas-based company that subsequently went out of business, the platform was acquired by a second vendor in 2002; that vendor eventually determined that the product would sunset in late 2009. Zvi Lefkovitz, MD, director of the department of radiology at WMC, says, “The system was archaic. It really stopped being useful in 2002, and since it was set to sunset last year, we were in a good position to go shopping for a more integrated system.” Solution Advantages Lefkovitz’s primary motivation for seeking an integrated, single-vendor radiology department (RIS and PACS) solution will sound familiar to anyone who has ever tried to work toward one goal with two vendors. “We felt that having a single vendor would be advantageous, in both the short and long term, because as issues occur—when you have two vendors sharing a technology in this way—there’s the potential for difficulties in solving problems,” he observes. “There’s a gray zone of responsibility where each vendor may be uncomfortable taking responsibility for the issue. I was very uncomfortable with the idea of using two vendors.” WMC uses the Synapse® PACS from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut, so the Synapse RIS was a natural choice for consideration by the center. Lefkovitz notes, however, that this was not WMC’s only requirement. The center’s experience with its legacy RIS meant that the team wanted a product with a long life cycle ahead of it. Just because a vendor offers both a PACS and a RIS, he adds, doesn’t mean that a client facility will reap the benefits of working with a single company. “What’s interesting with some of these large vendors is that even if you have only one, it’s like working with two,” Lefkovitz says. “The PACS and RIS groups may be very different.” In the end, WMC’s team selected the Synapse RIS both for its synergies with the Synapse PACS and for the ability of the vendor to provide features the organization needed to improve its radiology workflow, critical-results reporting, and peer review. “We were impressed with their RIS product, and we felt the vendor had the skill and the drive to customize the functionality for our needs,” Lefkovitz says. Seiler adds, “Now that our entire system is integrated, all the information flows to everybody, wherever each person is.” A Two-pronged Approach Although PACS is critical to radiology workflow, the complementary role played by an integrated RIS is equally important. Seiler notes, “The scheduling piece in our old RIS wasn’t even used because it was virtually unusable. A number of doors have opened up to us with this new RIS: information sharing, dashboards, statistics, and all kinds of things that people have grown to expect—and we just didn’t have.” WMC needed specific features from its RIS, including multiple account numbers, custom fields and reporting, and the ability to engage referring physicians through access to the system. “We can reach out to a referring physician and enable him or her to come in and schedule cases in time blocks,” Seiler says. “We have new report-routing capabilities where we can send a notification to the referring physician via email, and he or she can log in and see the report right then and there.” Lefkovitz adds that even with a robust PACS, WMC could not become truly paperless until the RIS piece was in place. “The RIS allows us to become paperless,” he says. “In the outpatient setting, it’s critical. Now, we can protocol cases in advance in an electronic, systematic way, whereas before, we were doing it on paper, which is less than optimal. In many ways, having that interface allows us to become more organized and systematic in the way we operate.” As chair, Lefkovitz also sees benefits in terms of data mining and oversight. “I can now have a dashboard view of what’s going on in my department at any given time,” he says. “Without a RIS, that simply wasn’t doable. Having this integrated system takes us to a whole new level of information management and technology.” Implementation and Training Though WMC is only a few weeks into the implementation of its integrated radiology environment, the organization began the data-migration process in December 2009. “With every data migration, you have to scrutinize every piece of information to make sure it gets where it needs to be,” Lefkovitz notes. “It’s a long, intensive process, and we have data going back to 1990. With the help of Fujifilm and our legacy RIS vendor, over a period of six months, we migrated all of it.” The organization has also commenced the process of training around 125 employees (including physicians, senior faculty, nurses, technologists, physician assistants, clerical staff, administrators, and receptionists) on the new integrated environment—a testament to how far-reaching its effects will be. Once on-site vendor training is finished, WMC will identify superusers who can help bring less–technology-savvy physicians and staff into the fold. “Depending on their levels of skill and knowledge, people are adapting to the new system at their own pace,” Lefkovitz says. “Our goal has been to make everyone understand that progress of this kind is inexorable—and that this is a tremendous advance on the part of our department.” Cat Vasko is editor of and associate editor of Radiology Business Journal.