Transcript A Successful PACS Implementation - Dartmouth

A Successful PACS
Implementation
Monte Clinton, CRA
Dartmouth-Hitchcock Medical Center
Brian Phelan
IDX Corporation
Disclaimer
This presentation is about a PACS implementation at
one facility (DHMC) with one vendor (IDX) and is
being given as an example of a successful PACS
implementation
Other facilities and vendors can do a similar PACS
implementation using this partnering program and
methodology
DHMC does not endorse IDX or any other vendor’s
products and services
Why Install a PACS?
Save money – Increase reimbursement
Reduce medico-legal risk
• Eliminate Film and processing costs
• Reduce Film Library staff
• Improve billing collections
• Reduce medico-legal exposure
Why Install a PACS?
Improve staff and imaging room productivity
• Increased staff productivity
• Reduction in the number of staff
• Increased imaging room productivity
• Eliminate imaging rooms
Productivity Benefits of DR
Source: Philips Medical System
Patient
Positioning
13%
Tube Position
5%
Film Handling
43%
Patient Transport
11%
Exposure
4%
Other
16%
Cassette
Handling
8%
Why Install a PACS?
Improve service to your customers
• Single set of film images limits collaboration
• Minimize lost studies and revenue
• Minimize treatment delays
• Speed service to referring clinician and patient
DHMC’s Steps to Justify PACS
Internal justification – The major players
• Large capital or operating cost impact
requires multiple levels of approval – at
DHMC this was:
– Radiology
– Information Systems
DHMC’s Steps to Justify PACS
Internal justification – Institutional leadership
– Administrative leadership
– Finance Committee
– Board of Trustees – final go or no go
PACS: Getting Started
Outside experts – PACS consultants
Institutional experts
• Radiology
• Information Systems
PACS: Getting Started
Educate yourself about PACS
Ask your colleagues about their experiences
Attend meetings such as this one
Vendor discussions and demonstrations at
trade shows - AHRA, RSNA, SCAR
PACS: Getting Started
Request for Information (RFI)
• Invite selected vendors to respond to RFI
• Get a list of their customers to contact
• How would their system fit into your facility
• RIS and PACS compatibility
Interface or Integrate
The critical relationship between the RIS and
the PACS
Have the RIS and the PACS vendors worked
together before?
Which vendor has primary responsibility or are
you expected to do problem triage?
PACS: Getting Started
Request for proposal (RFP)
• Invite a limited number of vendors to bid
• Vendor clarification meetings
• RFP review and analysis
• Site visits at working clinical sites
• Final negotiation – Purchasing and Vendors
Paying for a PACS
Capital Purchase or Operating Expense
• Capital purchase
– Major capital expense – compete for funding
– Cost to upgrade and remain technologically
current
– Ongoing service and maintenance cost
• Application Service Provider (ASP)
– Costs are an operating expense
– Always kept technologically current
– All inclusive ASP charges fluctuate with revenue
The PACS Timeline
Develop a realistic implementation timeline
with buy-in from all affected stakeholders
Radiology – all levels
Information Systems
Institutional Leadership
Referring Clinicians
PACS Vendor
DHMC’s PACS Timeline
• Phase 1
• 1-2003
• 4-2003
Archiving started in CT, MR, US
Live in CT, MR and US – stop printing film
• Phase 2
• 9-2003
• 12-2003
Archiving started in DX
Live in DX – stop printing film
• Phase 3
• 4-2004
• 4-2004
• 4-2004
Archiving started in Angio and NM
Upgrade the RIS
Live in Angio and NM
Partnering with PACS Vendor
Agreement with the vendor on the timeline and
implementation phases
Appoint key staff from each stakeholder
This must be a win – win endeavor
Planning the Implementation
Weekly meetings of the
PACS Working Group
•
•
•
•
•
•
Radiology Director
Radiology PACS Administrator
Radiology Clinical Operations Manager
Radiology Asset Manager
IS Director
IS Liaison
Guiding the Implementation
PACS Implementation Team
bi-monthly meetings
• Chairman of Radiology
• Chief Information Officer
• Vice President of Clinical Operations
• The Six Working Group Members
Before and After Implementation
Ongoing follow-up
• Weekly calls - Radiology and vendor
• Updates to the clinical departments
• Regular updates to the Board of Trustees
• Monthly updates to the Radiology faculty
• Weekly updates to the Radiology staff
Selecting the Hardware
Involve the end user in equipment selection
• Radiologists given a choice of monitors
• Referring clinicians given a choice of monitors
Specialty sections given choice of monitors
• OR selected from 5 large flat panel monitors
• ED selected the best monitor for their use
Reading Room Design
Radiologists given a choice of layout
• DHMC rejected the modular systems
• Radiologists preferred two image monitors
• Room lighting critical
• Calculate room temperature requirements
• Gradual phase out of alternators
The Archive
DHMC’s PACS Archive
• In-house dual servers maintained and
remotely monitored 24/7 by vendor
• External archive backed up daily to
vendor’s San Diego archive facility
• DHMC’s failsafe back-up archive -- DVDs
burned daily and stored at DHMC
Dartmouth Hitchcock Medical Center
Imagecast™ RISv9.8/PACS
CT
Rad/Onc
CT/Body Read
Area (3)
Fiber
Image Archive
CT GE - 3
10/100 MB
Display
Stations
100MB
Imagecast
PACS database
Imaging Suite
Neuro Read
Area (3)
MR GE- 4
MR Mobile
RF Siemens
3
DR Philips –6
• Dual DICOM Processors (~3
weeks)
U/S Read
Area (2)
• netCache (~6 months)
• Persistent Store (scalable life)
CR Philips - 3
DX Read Area (5)
ConnectRv4.0
IDXRad
Offsite Disaster Recovery v9.8
ICU
US – 7 HDI Acuson
Film
Digitizer
2
Onsite Disaster Recovery
HC
5
DVD Server
10/100 MB
Speare – Plymouth NH
MR Mobile
T-1
US – HDI 2
CT
Picker
10 MB
U/S Kodak
MiniPACS
(priors only)
10/100 MB
Kodak
Drylaser
Printer - 5
T-1
Enterprise
Access via CIS
LAN-10/100 Lebanon DHMC
Campus
WAN/DSL/Cable
Any Image, Anywhere, Anytime
Dated 05/05/03
Training of the Radiologists
Vendor provided 1 to 2 hours of one on one
training 2 to 3 days before activation
• Return visits after activation for more
training if needed
• Give them all the time and training they want
• Ask radiologists and residents to offer
suggestions for enhancements
Keep Your Staff Informed
• Being upfront about what is happening and when it
will impact the lives of staff will head off rumors
• Publish a PACS phase in plan – DHMC 1 year
• Stop hiring permanent full time Film Library
\employees a year before implementation
• Work with HR to find jobs for displaced staff
Contingency Plans
• Referring clinicians demanding film
• Acceptance of CD copies by other facilities
• Urgent results reporting
• Special requests
• System failure – power failure, virus, etc.
Partner With Your Vendor
• Clear objectives spelled out in the contract
• Agree on timeline, payment and penalties
• Clearly define facility - vendor responsibilities
• Track progress with regular reports
Make the PACS implementation a win – win
program for both your facility and the vendor
What DHMC Did Right
• Developed and used a workflow analysis
• Piloted PACS with 15 referring clinicians
• Had a close relationship with the PACS vendor
• Integrated modalities in advance
• Integrated RIS/PACS with electronic medical
record
A Chairman’s Perspective
“ Never in my 29 years as a chairman
have I made a decision that has
received such universal acceptance
from both the radiologists and the
referring clinicians”
Peter Spiegel, MD
Chairman – Radiology
Contact Information
Monte Clinton, CRA
Dartmouth-Hitchcock Medical Center
[email protected]
www.dhmc.org/dept/radiology
Brian Phelan
IDX Corporation
[email protected]