Making PACS the present, not the future

Why haven't you moved forward with PACS? Have you just procrastinated or does your facility have legitimate reasons? Some say the technology is too confusing or too new, while others say the cost of PACS is too high. Many facilities say they haven't found a satisfactory way to deal with the conflicting opinions of their radiologists, IS department, administration, referring physicians and staff. Take time to compare the technology you do understand with something familiar such as your own PC or perhaps the current networks inside your facility. You'll soon begin to see that PACS is not a new technology, but rather a new methodology. To handle the perceived high cost of PACS, remember that every facility has different needs. Look at your work flow and then the many byproducts of PACS, such as marketing. If you are the first in your area to implement this new technology, you'll gain a marketing advantage in competing for referring physicians and managed care referral business. Follow the process you use to purchase other products, such as CT or MRI, as you investigate the vendors. Finally, make a plan! Determine departmental goals and gather information from vendors. Create a timeline, a financial plan and your marketing strategy. Together, these steps will help move PACS into the present for you.     

Demystifying radiology information systems

Selecting the right radiology information system (RIS) can be a difficult and tedious task for radiology managers. Sometimes the information systems department ends up selecting the RIS. As a radiology manager, you can help yourself and your department greatly by becoming more educated concerning the technology and terminology of radiology information systems. You can then participate in one of the most important decisions that will ever be made regarding your department. There is much confusion about the meanings of the terms interfaced and integrated. Two applications are generally considered integrated if they freely access and update each other's databases. Two applications are generally considered interfaced if they pass data to each other but don't directly access nor update the other's databases. Two more terms are centralized and decentralized. Centralized is the concept of "putting all of your eggs in one basket." Decentralization means you spread your resources out. The main difference between centralized and decentralized is that all components of a centralized system share the same fate (good or bad), while decentralized components operate independently and aren't affected directly by failures in another system. Another significant term relevant to RIS systems is HL7, which is a standardized data format that allows one application to pass data to another application in a format that the receiving application understands. RIS vendors generally fall in three categories: single-source vendors, multiproduct vendors and single-product vendors. Single-product vendors include best-of-breed vendors. No one approach is necessarily better than the others; which you choose will depend on your needs. When considering the purchase of an RIS system, there are important questions to ask yourself, the vendor and the vendors' customers as you gather information and prepare to make a decision.     

All you need to know about a PACS RFP, you learned in kindergarten

Key to purchasing any picture archiving and communications system (PACS) is the generation of a request for proposal (RFP), which defines the system's requirements. An RFP is not difficult to create and, in fact, one can follow simple rules such as outlined in Robert Fulghum's book, All I Really Need to Know, I Learned in Kindergarten. "Take time to look" is the first rule--don't jump into new adventures. Instead, start with a mission statement and clear objectives. Define the stakeholders and assemble the team. "Share everything" is the second rule to follow. This includes information, objectives and definitions of the problem. You'll want to define your specifications. What are the component requirements? How will you integrate information systems at your facility? What about performance--how is it defined and what is expected? Warm cookies and cold milk--or common sense--is another rule, particularly around issues that may seem obvious such as training and service. Who is going to do it, and what is required? "Watch out for traffic and hold hands." This rule, as applied to PACS and an RFP, means stick together. Create a partnership with your vendors. Talk to as many vendors and other users as possible. Last, "be aware of wonder." Fulghum's Rule, as applied here, means performance will speak for itself, particularly when there is significant improvement in the service you provide to your users.     

A case study in developing a radiology information technology (RIT) specialist position for supporting digital imaging

Support services in providing PACS to healthcare facilities are becoming more complex. Imaginative staffing models are imperative to provide a successful PACS program to customers. Choosing the right staffing grid of support staff can be assisted by locations with like volumes or geographic areas. The RIT (radiology information technology) specialist is an excellent asset in a growing PACS environment. RITs can be the crucial liaison between the radiology department and the customer. RITs with different backgrounds can be recruited based on what type of support services your customers need. RITs are a great resource for one-on-one training from physicians to nursing staff. This mobile PACS spokesperson can take the concerns of the customers to the PACS administrator to open dialogue and communication that will win customer loyalty in this ever changing world of technology.     

Evaluation of radiological workstations and web-browser-based image distribution clients for a PACS project in hands-on workshops

The methodology and outcome of a hands-on workshop for the evaluation of PACS (picture archiving and communication system) software for a multihospital PACS project are described. The following radiological workstations and web-browser-based image distribution software clients were evaluated as part of a multistep evaluation of PACS vendors in March 2001: Impax DS 3000 V 4.1/Impax Web1000 (Agfa-Gevaert, Mortsel, Belgium); PathSpeed V 8.0/PathSpeed Web (GE Medical Systems, Milwaukee, Wis., USA); ID Report/ID Web (Image Devices, Idstein, Germany); EasyVision DX/EasyWeb (Philips Medical Systems, Eindhoven, Netherlands); and MagicView 1000 VB33a/MagicWeb (Siemens Medical Systems, Erlangen, Germany). A set of anonymized DICOM test data was provided to enable direct image comparison. Radiologists (n=44) evaluated the radiological workstations and nonradiologists (n=53) evaluated the image distribution software clients using different questionnaires. One vendor was not able to import the provided DICOM data set. Another vendor had problems in displaying imported cross-sectional studies in the correct stack order. Three vendors (Agfa-Gevaert, GE, Philips) presented server-client solutions with web access. Two (Siemens, Image Devices) presented stand-alone solutions. The highest scores in the class of radiological workstations were achieved by ID Report from Image Devices (p<0.005). In the class of image distribution clients, the differences were statistically not significant. Questionnaire-based evaluation was shown to be useful for guaranteeing systematic assessment. The workshop was a great success in raising interest in the PACS project in a large group of future clinical users. The methodology used in the present study may be useful for other hospitals evaluating PACS.     

Employee retention: a customer service approach

Employee retention is a huge problem. There are staff shortages in radiology because not enough people are entering the profession; too many people are leaving the profession for retirement, higher-paying jobs or jobs with less stress; and there are not enough opportunities for career advancement. Staff shortages are exacerbated by difficulty in retaining people who enter the profession. While much work has been focused on recruitment and getting more people "in the front door," I suggest that the bulk of future efforts be focused on employee retention and "closing the back door." Employee retention must be an ongoing process, not a program. Approaches to employee retention that focus on external things, i.e., things that the company can do to or for the employee, generally are not successful. The truth is that employee retention processes must focus on what the employee gets out of the job. The process must be a benefits-based approach that helps employees answer the question, "What's in it for me?" The retention processes must be ongoing and integrated into the daily culture of the company. The best way to keep your employees is to treat them like customers. Customer service works for external customers. We treat them nicely. We work to satisfy them. We help them achieve their goals. Why not do the same for our employees? If positive customer service policies and practices can satisfy and keep external customers, why not adapt these policies and practices for employees? And, there is a service/satisfaction link between employee retention and higher levels of customer satisfaction. Customers prefer dealing with the same employees over and over again. Employee turnover destroys a customer's confidence in the company. Just like a customer does not want to have to "train and educate" a new provider, they do not want to do the same for your "revolving door" employees. So, the key is to keep employees so they in turn will help you keep your customers. Because the techniques of this process mirror the activities of customer service and customer relationship management, I call the combined process C/ERM for customer/employee relationship management. Both activities must be going on simultaneously to create a loyalty link that ensures customer satisfaction and retention through employee service, satisfaction and retention.     

Integrating digital systems: commitment and collaboration

One year ago, the radiology department at Ball Memorial Hospital, a 350-bed facility in Muncie, IN, was completely film-based. The need to support a new all-digital, 35-room emergency department (ED) hastened the facility's transition to a digital environment. Today, with the exception of mammography, the hospital's imaging services are now digital. To develop and implement the project, the hospital formed an internal implementation team. An independent consultant was also hired to evaluate the impact of these new technologies and to provide an estimated cost payback. After research, site visits, and vendor demonstrations, the hospital selected a single vendor for its picture archiving and communication system (PACS), digital radiography (DR), computed radiography (CR), and overall project management. The DR system was installed in the ED to provide digital image capture for a full range of trauma exams. The ED also initially began utilizing a Web-based PACS distribution originally implemented for after-hours teleradiology. The majority of the hospital's imaging studies are captured with 2 multi-cassette CR systems that serve 7 exam rooms in the radiology department. The hospital also installed remote operations panels to expedite entry of patient and exam information. Technologists readily embraced both CR and DR systems. The Web distribution system now transmits images to hospital-based computers and to 150 remote referring physicians. The PACS platform automatically e-mails key images and radiology reports to referring physicians. Authorized physicians can also request reports and images on an as-needed basis. The PACS vendor had previously performed multiple integrations with the radiology information system (RIS) vendor; the integration of PACS and RIS was extremely smooth. One of the critical components of a successful conversion is experienced, dedicated management. The hospital retained professional project management services to facilitate implementation and to ensure adequate training for all users.     

Strong branding creates a competitive edge

This article encompasses the basics of branding and how it relates to radiology organizations. It also provides tools to help develop your brand. To effectively use branding as a component of your marketing strategy, it is important to follow 3 basic principles: focus on where you excel, understand the existing markets, and be consistent. You do not need to be a large hospital, imaging center, or department to create a brand identity.     

PACS需求方案的设计方法和原则

目的结合我们的ＰＡＣＳ设计实践探讨ＰＡＣＳ系统需求方案的设计方法和原则。材料与方法搜集和分析各类ＰＡＣＳ有关的信息和数据,建立对ＰＡＣＳ发展技术和动向的深入理解,基于此确立将构建的ＰＡＣＳ系统的规模、结构和功能方面的实际需求。结果ＰＡＣＳ的ＲＦＰ中主要的组成包括：放射科以及医院状况的概述和对ＰＡＣＳ的一般需求;对新建ＰＡＣＳ及其亚系统的结构和功能需求的细节描述;对ＰＡＣＳ集成／提供商的能力和产品支持的具体要求的描述和说明。结论建立基于放射科和医院实际需求的ＲＦＰ,是完成适用并具较高性价比ＰＡＣＳ设计方案的可靠保证。     

When time matters

The most important organizational resource is energy. The most important resource in time management is energy. Managing energy, not time, can help create encouraging time management skills and appropriate work life balance. Once a leader understands that time should be spent on things that are important instead of everything that is urgent, you can begin to develop a balance that will support your values, your family, and your organization. When leaders find meaningful ways to add a sense of purpose to their work they can personally improve themselves and their organizations. If your personal values do not align with the values of your organization you will never work with a true sense of purpose. Make the time to manage your energy. You will be surprised how much free time you find.     

应用IHE集成PACS/HIS,构建数字化医院之基础——新楼医院经验介绍

新楼医院在PACS的构建和PACS与HIS/RIS的集成中遵循I HE的技术框架,应用I HE的集成模式。结果显示I HE的参照应用不仅可以评估PACS厂商的集成能力,提高院内医疗人员素质外,也可以缩短PACS构建的进程,降低构建成本,并保证未来系统的扩充性。而医疗机构高层的充分支持和对标准应用的肯定,以及相关的完整教育训练和配套措施,是提高系统成功的关键因素。本文的实践证明采用标准规范的好处及分享个案医院应用I HE的经验,并再次验证标准规范对于医院不同信息系统集成的重要性,供其他医院在构建PACS时参考。     

Does your equipment maintenance management program measure up?

Identifying a clear maintenance philosophy is the first step toward choosing the right program for your healthcare organization. The second step is gaining a clear understanding of how proposed savings and improvements will be delivered. The third and last step is requiring that the proposed company or manager have specific tools in place for measuring and analyzing program performance. There are three primary philosophies underlying current equipment management options. These include risk-transfer philosophy (e.g., maintenance insurance, service contracts, multi-vendor and outsource programs), asset management philosophy (e.g., programs delivering a management system based on managed time-and-materials), and internal management (in-house managed programs). The last step in selecting the right program is insisting that proper performance measurements be built into the proposed management program. A well-managed program provides results in three general areas: financial outcomes, operational improvements and process improvements. Financial outcomes are the easiest to measure. Operational and process improvements are more challenging to assess but equally important to the program's overall success. To accurately identify results in these three areas, the overall management program should measure the following eight separate components: procedures and support for department staff; equipment inventory, benchmark costs, and budget guidelines; experienced equipment support team; objective, independent analysis of maintenance events; repair documentation and reporting; vendor relations; equipment acquisition analysis; and recommendations for improvement. Do everything you reasonably can to assure that the selected company can work side-by-side with you, providing objective, measurable advice that is ultimately in your best interest. You will then know that you have been thorough in your marketplace selection and can confidently move into implementation, expecting tangible and successful results.     

New emphasis on strategic planning

Increasingly, administrators will need to rely on aggressive and ongoing planning processes to stay abreast of changes in healthcare. Mr. Bouchard asserts that "strategic planning can help us manage inevitable change" and describes various approaches to planning. He includes a list of questions to help you examine your current practices and supplies a sample strategic plan to prompt ideas and get you started with your plan.     

Creating a successful relationship with customers

In 1997, several employers commissioned an inpatient survey for a group of businesses that included hospitals in southeast Michigan. Its results indicated that the University of Michigan Health System (UMHS) needed to become more customer-focused. To meet this challenge, UMHS mandated that customer service to its patients and their families should be its first priority. A pilot project in the radiology department's pediatric division was established to recognize and reward employees for outstanding service to customers. The program is now used to reward employees throughout the radiology department, on the assumption that when employees feel special, so will their customers. Management's focus is on employees--they are the health system. The department also invested in employee development, a continuous training program that centers on customer service and teaches tools and skills for better communication. The goal of the development program at UMHS is to exceed the needs of its customers.     

Effective management starts with self management

Each manager is his or her own best resource. As with any resource, managers should put effort into the development and improvement of that resource. A conscious effort to continuously improve personal resources will increase a manager's ability to effectively manage the efforts of others. These personal resources include initiative, integrity, organization of time and resources, and coping strategies. An individual's ability to practice initiative in their profession is only limited by their attitude. How do you answer the following questions: How much do I like my job? Do I have the desire to improve the skills and the abilities that will allow me to perform my duties more efficiently? How can I best achieve the goals expected of my department and me? In short, you will never improve your ability to manage unless you get moving! Don't wait for occasional pushes from above. Become an active and enthusiastic contributor to the development of plans and goals. Integrity is essential in establishing trust and loyalty between managers and their staff. Integrity is displayed to the department through honesty, consistency and fairness when dealing with operational problems. Most managers have an honest desire to learn how to manage their time, but don't have the time for it. In other words, we are so busy working inefficiently that we don't have time to become efficient. By organizing your space, you begin to organize the effective use of the time you spend in that space. Remember that your office is space, and space is a resource; demonstrate that you as a manager are concerned with the effective utilization of all organizational resources. Management is not for everybody. Some individuals may be better off realizing this early in the process. If an individual feels that management is their field, they should establish as much control over themselves and over the work place as they can if they hope to perform effectively for the long run. Some stress can be a positive motivator, but if the stress is unrelenting, if managers finds that they are chronically on the verge of anxiety, depression or panic, stress can also lead to personal ineffectiveness or eventually even physical or emotional illness.     

Delivering radiology supplies just-in-time.

The radiology department at Dartmouth Hitchcock Medical Center (DHMC) adopted a just-in-time (JIT) inventory management system in 1992, reducing the volume of its in-house inventory of radiology supplies from a value of $400,000 to $16,000, just enough for four to five days of activity. An asset manager, the only person authorized to order supplies, was given responsibility for maintaining the department's supply of fixed and consumable assets. The first step in implementing the new system was to identify the supplies needed, standardize them and determine how often deliveries would be made. The JIT implementation team developed a request for proposal (RFP) that incorporated the standardized list of supplies. Three radiology supply vendors were invited to respond to the RFP. The team later determined that only one vendor was capable of implementing the JIT program. A three-year contract was awarded to that vendor. As that three-year contract reached completion, DHMC offered the JIT program to its eight affiliate hospitals and four outpatient clinics. The team decided to re-bid the contract for the entire network, which collectively performed 700,000 radiology exams annually. The new RFP encompassed 90 percent of the network's consumable supplies and offered customized delivery for each facility. The team identified eight criteria necessary for the evaluation of each vendor response to the RFP, rather than use price as the only consideration. The company that won the three-year contract furnished 90 percent of the radiology supplies for the DHMC network, allowing even further savings by the network, particularly for the smaller facilities and clinics. The program is continually monitored, adjusted and enhanced in order to incorporate changing departmental needs.     

Prepare for an SpR interview

By the time you attend an interview for a military SpR number you should have no real problems but it pays to be prepared. Begin preparations early, reading widely and talk to as many people as possible. Your consultants will have a useful viewpoint on the proceedings and may be able to help you refine your answers to the common questions. Arrive at your interview in a smart and timely fashion and answer questions with confidence and common sense. Avoid confrontation and bluff and be courteous at all times, whatever you may be feeling inside and thank the interview panel as you leave.     

The challenge of PACS in a small hospital

Memorial Hospital is located in-North Conway, New Hampshire. Year round, the 35-bed hospital serves mainly tourists and retirees to the area. The imaging department wanted to integrate its services within an existing community network, meet the needs of a transient population and resolve staff utilization and storage problems. Conversion from film to digital in the radiology department took advantage of digital x-ray and PACS. Since the hospital was already using digital technology for CT, MR, ultrasound and fluoroscopy, it made sense to include plain film imaging in the digitization process Memorial Hospital faced a number of challenges. Those in decision-making positions lacked a general knowledge about PACS, and, in particular, about PACS in similarly sized facilities. The hospital also lacked experience working with vendors. A timeline was critical as Memorial Hospital prepared for winter, its busiest season. The facility decided on a phased-in project with no immediate HIS/RIS interface, and computerized radiography with hard-copy films was implemented immediately. The facility has made the transition from a conventional imaging department to a PACS environment. It attributes its success to the way it involved those who would be affected by any future changes in the planning and decision-making processes. Memorial Hospital expects to expand its services and streamline its archival capabilities in the near future.