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PACS and digital imaging help improve patient quality of care
Orthopedic practices that implemented PACS discover that the cost of going digital eventually pays off, but patience is necessary.
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Hospitals and orthopedic practices are slowly making the switch to a digital office. They evaluated the vendors, prepared their offices and trained their staffs for the grueling weeks of implementation.
In the end, they said, it was all worth it. They abandoned their paper records to cut costs, enhanced health care delivery and improved the most important part of the job: patient quality of care.
Many have implemented digital radiography or computed radiography along with a Picture Archiving and Communication System (PACS). PACS stores the images, dictates where and when they are available and provides tools to assess and manipulate them.
Why go digital?
Courtesy of Stryker Imaging |
Koco Eaton, MD, team physician for the Tampa Bay Devil Rays baseball team, said that he made the switch to digital imaging because his practice is still young.
“Being 44 years old and planning on practicing for the next 15 to 20 years, I don’t think I could afford not to go digital,” he told Orthopedics Today. “I made the decision … to improve the delivery of health care and to cut down on costs.”
Before starting his own practice in St. Petersburg, Fla., Eaton worked in a five-man practice with three employees who dealt solely with medical records – filing reports and charting notes. “Even with that, things did not make it on the charts on a timely basis,” he said. “So, going digital really was the only solution [for my practice].”
The Steadman Hawkins Clinic in Vail, Colo., implemented a digital imaging system and PACS about nine months ago.
“The X-rays or MRIs … are immediately accessible at all times, they can be accessible to the patients and they can be accessible to different physicians at the same time,” Peter J. Millett, MD, director of shoulder surgery at the Steadman Hawkins Clinic, told Orthopedics Today. “The access improves efficiency and improves quality of care for the patient.
Portability is also an enticement. “I took care of patients in multiple different locations and … I didn’t have to carry [X-rays] from one place to another,” he added.
Searching for X-rays
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“We don’t spend time looking for X-rays anymore. … There’s a lot less downtime waiting for X-rays to be processed for patients in the office,” William I. Sterett, MD, partner at the Steadman Hawkins Clinic, told Orthopedics Today. “We can bring the X-ray up in the patient exam room.”
Sterett explained that the digital system eliminates repeat X-rays from poor film quality.
“We have the ability to digitally alter X-rays if they were either under- or overexposed on the computer,” he said. “Digital X-rays virtually never require repeat pictures, repeat views or repeat films, which is very different than when we had hard-copy films.”
In addition, while the Steadman Hawkins Clinic used to have large rooms dedicated to X-ray storage, they now access all X-rays via hard drive, which eliminated file and lost image issues, Sterett said.
So, how do I go digital?
According to Gerald R. Kolb, a health care professional with Kolb & Associates in Bend, Ore., the first step to going digital is evaluating a center’s workflow and considering how eliminating film can streamline the patient visit and improve patient/physician interaction.
“As soon as the image is acquired, it becomes available on the PACS,” Kolb told Orthopedics Today. “Practices can develop standing orders for specific patient complaints that have the patient proceed directly to imaging and then on to the examination/consultation area.”
Kolb said that practices should also carefully outline their goals before purchasing a PACS system. “The underlying network architecture must be evaluated and brought up to specifications for PACS use,” Kolb said.
After evaluating workflow and setting goals, the practice should consider the capabilities offered by different PACS vendors. Eaton suggested that at this point the physician and his staff visit another orthopedic office with a digital system to see how effectively PACS works there.
Sterett also recommended that practices consider their preferred X-ray type, view and storage preferences. “Figure out which is the most user-friendly option for the way you like to do things,” he said.
An educated consumer
Courtesy of Peter J. Millett |
Knowing all preferences beforehand helps the practice to avoid later complications with systems that are not integrated.
“A lot of the [practices] I looked at initially that didn’t have digital imaging are now looking to digital imaging,” Eaton said. He said that attitude shift among practices occurred just in recent months, in many cases. “But now, you have to have a system that works with a medical records system that wasn’t designed for imaging.”
In fact, Eaton chose his PACS from one company that provided electronic medical records, a billing system and a PACS.
Millett said that a strong technical support backing is also important when it comes to choosing a vendor.
“Even if it’s the greatest software in the world, if you don’t know how to use it or you can’t get the necessary support to teach your staff how to use it, that’s a problem,” he said.
“The better PACS companies will spend as much or more time discussing their implementation, applications and service programs as they do the PACS itself.”
Not all smooth sailing
Like any major project, the digital switch presents its share of challenges. When Eaton spoke with Orthopedics Today, his office was halfway through the implementation process.
“The medical records part is up and running and the digital part is up and running,” he said. “What’s taking long now is the billing and scheduling component, so I would say [it takes] two weeks to be up and running.”
During the conversion process, Eaton’s office only scheduled a quarter of the patients seen on a typical day.
“The office must make allowances for converting and not [schedule] the first day you have gone digital to seeing your maximum number of patients,” Eaton said.
All three doctors agreed that the biggest challenge is leaving paper charts and adapting to life in a digital office.
“We’re so used to having paper that it’s a completely new way of thinking about and running your office,” Eaton said.
Sterett added, “It takes a month or two to really feel comfortable with … the X-rays and bringing them up on the computer, especially if you’re not used to working in a computer-based world or computer-based practice.”
Eventual cost savings
The associated costs of the software, training and technical support have deterred some orthopedic practices from switching to a digital office. However, “The cost of paper, the cost of charts, the cost of people putting those papers into charts and also the cost of storage and the cost of keeping the storage for seven years … add up all of those costs, and going digital far outweighs the costs,” Eaton said.
At Steadman Hawkins, two X-ray technicians devoted time to films, using two X-ray machines. However, after the digital switch, the clinic reduced processing time and cut back to just one X-ray machine and one X-ray technician – and still keeps up with the patient volume.
“Not going digital is the huge cost, and I think that’s what [physicians] need to ask themselves: How much is it going to cost me to stay and practice the way I’m doing right now?” Eaton said.
The Steadman Hawkins Clinic plans to expand their connectivity to satellite offices and the hospital PACS system through a Web-based server, so that physicians can view MRI and CT scans from the hospital through the office system and vice versa. Eaton’s practice has plans for a digital operating room.