The Logistics of PACS for the Practice

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Now that radiology practices have discovered the benefits of PACS, they are investing in the IT support to leverage the technology for its maximum potential

At one point during his enrollment in business school, Randy Hicks, MD, MBA was assigned a paper detailing how he might go about reorganizing his Flint, Mich, radiology group to make it a more efficient, prosperous practice. Very quickly, Hicks concluded that Regional Medical Imaging (RMI) needed to embrace a distributed model for reading so that the practice could provide subspecialty interpretation to multiple clients without having radiologists present at every RMI site. This, he envisioned, could best be accomplished by outfitting his practice with a PACS.

Having to perform this academic exercise inspired Hicks to explore the possibility of actually acquiring such technology for RMI. Unfortunately, at the time (about 10 years ago), PACS was not a particularly practical investment at the practice level. These were systems intended for hospital applications, to judge by their price tags alone.

Still, Hicks knew that one day PACS would migrate from the hospital to the practice. For his group of nine radiologists, that day arrived about three years ago. Things have not been the same since. “We have greatly benefited from having our own PACS, and so have the customers we serve,” he says.

IT Support

RMI is one of a growing number of radiology practices around the nation acquiring PACS. A driver of this, just as Hicks noted in his own situation, is the need to provide distributed image reading. There can be no question, though, that another equally important driver is the attractiveness of the costs associated with PACS acquisition and, especially, ownership: in a well-run, medium-sized practice, PACS typically accounts for a mere 1% to 3% of total practice expenses.

IT-department costs make up a significant share of that outlay, according to James List, director of informatics and advanced applications support at Consulting Radiologists Ltd in Minneapolis. The organization of about 70 radiologists covers 30 hospitals in Minnesota and Wisconsin and provides services to 53 other clients (and those services include after-hours, weekend, and subspecialty reading). “In our group, we have a team of seven IT people who all contribute to support our PACS operations,” he says.

There is, of course, a PACS administrator on this team, but Consulting Radiologists takes an interesting approach by designating eight FTEs to act as radiologist service specialists. Among their assigned duties is the chore of checking PACS images received from remote locations to make sure that all sequences have arrived safely and that the images and associated clinical data are accurate.
“This way, when the radiologist selects that image for viewing, we have assurance that all information needed is, in fact, there,” List explains. “We are preventing the situation wherein the radiologist makes it halfway through the read and only then discovers there is a sequence missing. That sort of gaffe is a time waster. We want our radiologists to be as productive as possible, which is why PACS is here in the first place.”

Other members of the IT team at Consulting Radiologists function as teleradiology coordinators. One of their tasks involves helping readers start their days by hitting the ground running. “In the early morning hours, the teleradiology coordinators prepopulate the PACS workstations,” List says. “This way, as soon as the radiologist logs into the workstation, the data are already resident locally. This spares the radiologist from having to experience any latency during data transfer. The radiologist is thus able to work at an optimal pace.”

Teleradiology coordinators also free radiologists from having to attend to much of the daily minutiae that normally act as a drag on productivity. “For example,” List says, “if the radiologist needs to consult with the ordering physician, one of our coordinators makes the phone call and puts the two parties together. The radiologist does not spend minutes on hold while the ordering physician is located.”

List credits a creative radiologist with developing an enterprise worklist that denotes who is reading which study. “One of our radiologists developed a homegrown product because he wanted to eliminate the dependence on faxing and didn’t want multiple radiologists querying the same data (a waste of bandwidth). We want radiologists who submit a