Workflow benefits of PACS outweigh fear of change

McHenry County Orthopaedics in Crystal Lake, IL, adopted PACS in 2002, a year after moving into a new 35,000-square-foot facility. The new site offers state-of-the-art technology, including digital and computed radiography.

"Implementing PACS has not changed the way we practice medicine," said Dr. William D. Cox, Jr., a board-certified orthopedic surgeon at MCO. "In our view, PACS has enhanced the way my five partners and I operate our practice. Ultimately, PACS has enabled us to improve operational efficiencies, workflow, and our bottom line."

The orthopedic practice has fully embraced the latest advances in technology to enhance patient treatment and could thus lead the way for other orthopedists who might be hesitant to add PACS to their practices.

"Adopting new modalities such as PACS was all about changing the dynamics of running an efficient practice from a bottom-line business perspective," said Manette DeCremer, office administrator for the 11-year-old practice.

Physicians and practices that may be adverse to change could find this a daunting proposition. DeCremer faced the issue head on when MCO added PACS.

"We selected a vendor that understood our objectives and offered more than one solution to meet our long-range needs," she said.

The practice chose SourceOne Healthcare Technologies, a consultative distributor that has access to PACS, CR, and DR equipment from a number of vendors.

"Finding a consultative distributor that provided multiple options to meet our needs took the 'fear' out of adopting PACS," DeCremer said. "I do not believe a practice can find the 'customized' solution by going directly to a vendor that offers only one or two options. A good consultant will bring options and solutions that a single vendor cannot offer."

There are many PACS vendors and setups available on the market. Good vendors should map out a practice's existing workflow patterns before purchase to identify any problem areas and how they can be improved or redesigned. PACS should accommodate the orthopedic surgeon's workflow, not the other way around. Vendors with a background in orthopedics are in a better position to understand this.

MCO has reaped many workflow benefits from PACS.

"PACS has improved our surgeons' workflow, and they have benefited from the 'extras,' like being able to read radiographs on a monitor, thus making it possible to obtain more accurate diagnoses and determine improved treatment plans," DeCremer said.

PACS allows MCO's orthopedic surgeons to select related studies and simultaneously view previous images on a monitor for comparison, instead of waiting for radiographs or searching through the patient's x-ray folder for other images. They can review an examination at any workstation, at any time and location, even offsite.

The surgeons can access tools that allow them to electronically magnify, zoom, pan, or rotate images, as well as measure angles. Radiographs that are too light or dark no longer have to be reshot or taken over to a hot lamp for better viewing. The physician simply adjusts the contrast on the monitor.

With the addition of PACS, radiographers at MCO have eliminated time-consuming tasks inherent in an analog environment:

• running test films through the processor

• pulling, typing, and filing flash cards

• searching for film

• pulling and refiling x-ray folders

• reshooting images

PACS allows radiographers to move from one case to another after each study because the images are instantly available. The process is much more efficient and productive than running films through the processor and waiting to assure that they are acceptable before releasing the patient.

"At MCO, the productivity of our radiographers has improved by 50% since we installed PACS," DeCremer said. "We now have a 1:3 ratio of radiographers to physicians, rather than a 1:1 ratio before PACS. The numbers build a strong case for PACS."

Throughout the workflow chain, all of these changes streamline the process and improve patient flow, safety, and care. Patient satisfaction is increased: Less time is required for taking digital images, retakes are eliminated, dose exposure is decreased, errors are reduced, patients no longer have to pick up and transport their own films, and physicians have more time to consult with patients.

"Physicians should never change the way they interact with and treat their patients," DeCremer said. "Decisions on whether or not to add new digital modalities, like PACS, should always be based on whether the technology will deliver your primary goal - to provide the best care possible. If you accomplish this, then all of the bottom-line business goals and objectives will fall into place, including optimizing your workflow. We are never satisfied with the status quo. We will continue to add modalities when it makes sense for our practice and, most important, for our patients."