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APRIL 26, 2011 • VOLUME 4 • NUMBER 2	SEND TO A FRIEND

clinical history

Hawaii Pacific Health: PACS Takes the EMR for a Drive

By Cheryl Proval

hawaii In the island state of Hawaii, there is a four-hospital system, based in Honolulu, called Hawaii Pacific Health (HPH), with outposts and imaging technology deployed throughout the Hawaiian archipelago. This system is served by four different radiology practices, reading approximately 300,000 studies annually.

About three years ago, a systemwide upgrade gave radiologists improved reading from all locations with unprecedented access to everything from physicians’ notes and laboratory reports to referrers’ phone numbers and emails with the click of a tab on their desktops. Effectively, from the radiologist’s perspective, PACS is now driving the electronic medical record (EMR).

It is unclear whether this access is speeding up or slowing down radiologists, according to Robert Lipman, MD, a member of the 10-radiologist group that covers Straub Clinic & Hospital (Honolulu) and seven satellite sites on the island of Oahu. There is, however, no doubt that desktop context sharing has provided radiologists with ready access to information that has resulted in greater clarity in reporting and improved patient care. “It makes us do a better job,” Lipman says.

Consider this: A radiologist reviewing a CT exam of the abdomen encounters a slight lucency in the femur. Is it or is it not a bone lesion? At HPH, the radiologist hits a button labeled problem list on the EMR (which the PACS has opened to the correct patient’s record) and discovers that the patient has lung cancer. “It would have been nice if the referring physician had put that in the history sent to me, but now that I know it, that bone lucency has significance,” Lipman says.

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RIS-driven Workflow: Enhanced Clinical History Through the EMR

By Cat Vasko

John Strain Access to clinical history is of utmost importance to the radiologists of The Children’s Hospital in Denver, Colorado. Because the hospital’s main campus and five satellite sites generate around 130,000 pediatric images a year, it’s critical for radiologists to be able to access a patient’s indications and background quickly, while maintaining the pace of their workflow.

John Strain, MD, chair of the department of radiology at The Children’s Hospital, says, “We’ve been very aggressive in requiring an indication for a study before we do an exam, but even when you do that, there are times when you’d like to know more. Being one click from a patient chart really is handy, especially with a more complex image.”

To support a workflow wherein its radiologists would have easy, one-click access to electronic patient charts, The Children’s Hospital underwent some fancy configuration footwork. Today, its radiologists read from worklists produced by the Synapse RIS (FUJIFILM Medical Systems USA, Stamford, Connecticut) in an electronic medical record (EMR) from Epic Systems (Verona, Wisconsin); they dictate and self-edit reports using systems from Nuance Communications (Burlington, Massachusetts); and they send reports to both the Synapse PACS and the EMR, so that the report within PACS is linked to the full case in the Epic EMR.

Tailored Workflow

Strain explains that this arrangement dates back to the hospital’s legacy PACS, which (although also integrated with Epic) lacked the capability to access charts rapidly from the EMR. When The Children’s Hospital replaced the legacy PACS with the Fujifilm Synapse platform, it made sense for the radiologists to continue reading through Epic’s worklists. “There was no training required of them,” Strain says. “We basically had no downtime turnover in switching from one PACS to another.”

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Legacy Health’s PACS-driven Workflow: The Imaging IT Perspective

By Julie Ritzer Ross

Over the past few years, health-care providers have recognized the potential of enhanced physician access to patient information to improve physician efficiencies and, in turn, patient care. For some, migrating to an integrated PACS/electronic medical record (EMR) configuration—instead of maintaining the legacy IT model in which PACS and the EMR exist as separate data silos—is the way to go.

Legacy Health ranks among players that have set off on the PACS/EMR integration path. Headquartered in Portland, Oregon, the not-for-profit health-care system operates five hospitals and eight clinics in the Portland metropolitan area, as well as an additional hospital in Vancouver, Washington. Each hospital works with its own contracted radiology group. Several clinics send exams to be read by radiologists at the nearest hospital, while others have specialists on staff to handle the task; in both cases, images are archived at the hospital in closest proximity to the facility.

The initiative now underway at Legacy Health entails integrating its Synapse® PACS (FUJIFILM Medical Systems USA, Stamford, Connecticut) with an EpicCare® EMR solution (Epic Systems, Verona, Wisconsin) currently being implemented to standardize the hospital system’s electronic charting platform.

The first hospital was integrated November 2010 when Epic went live at Salmon Creek Hospital in Vancouver, WA. The second hospital, Emanuel Medical Center, went live with Epic at the beginning of April. Emanuel Medical Center is a level one trauma center and includes the Children’s Hospital.

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States and Hospitals Leverage Direct Project Protocols for Health Information Exchange
Providers and public-health organizations have begun exchanging health information using specifications developed by the Direct Project, a private–public initiative that encourages collaboration between health-care organizations and the IT sector. The project supports information transfers of core elements of patient-care and public-health reporting (including standardized laboratory results, physician-to-physician summary patient records, and hospital discharge data) to physicians.