The United State of Imaging in Tacoma

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Located on the Puget Sound about 35 miles south of Seattle, Washington, the community of Tacoma and surrounding Pierce County benefit from a number of innovations that are linking local radiology providers in an uncommon collaboration. Through IT and service agreements across two competing hospital systems and two separate radiology groups, all parties report improvements in multiple areas of patient care.

It’s most notable that imaging-report turnaround times have dramatically improved in the emergency departments involved, where even small delays can mean the difference between life and death. Other quality indicators are being tracked and measured using specific metrics.

At MultiCare Health System (Tacoma), which operates four hospitals and several clinics in the region, radiologists’ average interpretation-turnaround times for imaging exams from the emergency department went from more than an hour, three years ago, to about 20 minutes today. Franciscan Health System (Tacoma), which runs one of Tacoma’s two level II trauma hospitals, also has experienced reduced emergency-department turnaround times in recent years. For standard imaging exams that previously took an average of more than a day to complete, referring physicians often receive results in less than an hour at both hospital systems.

These improvements were made possible through high-level software integration within the two health systems and through community-wide collaboration among the hospitals and the two competing radiology groups. The programs still exist within separate, distinct systems, but such collaboration aligns the disparate groups on the same platforms, allowing access to images—wherever they might be housed.

Unified PACS

In 2007, the two competing hospitals made a strategic decision to use the same PACS vendor. MultiCare Health System followed Franciscan Health System in buying and implementing a new system, along with mutually chosen voice-recognition software, in all but one of its four hospitals. The fourth hospital will be added to the system soon.

Two radiology groups that serve the hospitals are 52-member TRA Medical Imaging (Tacoma), which contracts with both hospital systems and operates its own freestanding centers, and Medical Imaging Northwest (Tacoma), a 25-member group that contracts with hospital systems and medical offices, in addition to operating joint-venture outpatient imaging centers. Medical Imaging Northwest and TRA Medical Imaging both have their own PACS, provided by the same vendor that serves the hospitals. Medical Imaging Northwest also uses a middleware product that streamlines workflow by consolidating RIS data, PACS images, and dictation from disparate sites into one worklist.

Use of the same PACS vendor makes a more seamless workflow possible among the various health-care providers in the community, according to Brian Knudsen, area supervisor in the IT department overseeing the PACS at Franciscan Health System. It also facilitates access to prior studies.

“It was a pretty easy decision because our primary focus is on patient care,” Knudsen says. “Whether patients have been seen at a different organization or at ours, they are our neighbors. They are a part of our community, and we want them to be treated as quickly as possible.”

Andre House, manager of diagnostic imaging services at Franciscan Health System, says, “It definitely streamlined patient care and made access to comparative studies on patients more optimal.” Sharing a PACS vendor also opened the door to greater collaboration between the hospitals. MultiCare Health System and Franciscan Health System alternate level II trauma response every 24 hours, and this switching has enjoyed greater coordination since they began using the same PACS vendor.

The two health systems (along with TRA Medical Imaging) also share a Tacoma joint venture called the Carol Milgard Breast Center. Each party owns a third of the facility.

The two radiology groups and both health systems also coordinate their software upgrades at the same time, saving resources for the hospitals and vendors because the PACS trainers might need to make a trip to Tacoma for only one round of upgrade training (instead of four). The organizations’ PACS administrators meet on a fairly regular basis and communicate almost daily about how they’ve solved problems or configured the system to be more effective. Knudsen says, “That collaboration is possible because we work from the