When Parkland Health and Hospital System began plans to construct a new facility, the administration decided it was time to rebuild from the inside out. At the time, the Dallas-based county hospital had five different picture archiving and communications systems (PACS) in place and a particularly outdated one in the radiology department.
In August 2009, Parkland began implementing McKesson’s Horizon Medical Imaging enterprise PACS for a consolidated, open imaging platform that integrates with Parkland’s third-party electronic medical record (EMR), third-party viewing applications and various teaching and conferencing applications. As a result, Parkland’s system uptime is constant, image retrieval has dropped from minutes to seconds and radiologists have increased reporting volume while improving report turnaround time for accelerated decision making.
Challenges
Parkland Health and Hospital System is a 990-bed county hospital for Dallas and one of four teaching hospitals for the University of Texas (UT). Prior to opening a new facility, Parkland took a closer look at its internal processes and operations. The imaging department was quickly targeted for an overhaul because of its many challenges.
While PACS technology had been deployed, there were five different systems for obstetrics, cath lab, echo lab, ultrasound and radiology, which required multiple system sign-ons and made scalability extremely difficult. Additionally, the radiology department’s aged PACS was burdened with many workflow and stability limitations.
“System uptime hovered around 60 percent, and we had trouble adding end users,” explains Maviea Easter, manager of diagnostic imaging and informatics at Parkland. “The system was so clunky, in fact, that radiologists sometimes just went back to doing things manually or were forced to create workarounds in their workflow.”
When Parkland added an EMR, radiology’s PACS simply couldn’t keep up. The radiology information system (RIS) workflow made it hard to find cases, compare priors and launch dictation. Radiologist and support staff frustration levels were high.
“Opening prior reports was laborious,” recalls Travis Browning, M.D., Parkland’s director of radiology informatics and assistant professor at UT Southwestern. “The load time was very slow for larger studies, making you cringe if you had to close and reopen the exam. Often you had to wait while prior studies were retrieved manually from the archive. The whole process was just inefficient.”
Answers
When Parkland decided to consolidate to one PACS, the county facility evaluated its existing in-house PACS vendors. McKesson, at that time, supplied PACS for Parkland’s obstetrics unit. After multiple demos and site visits, the committee comprising radiology, obstetrics, surgeons, referring physicians and ER physicians chose to upgrade to McKesson’s Horizon Medical Imaging PACS because of its stability, scalability and flexibility.
“As an academic institution, we have a diverse workflow that encompasses multiple patient care provider levels,” says Easter. “Horizon Medical Imaging has a flexible workflow, its disaster recovery ranked high and the neutral platform allows us to integrate with third parties and to easily add imaging to other ‘ologies' in the future.”
Implementation speed was also a factor, adds Easter, noting McKesson installed the PACS in only one year. The implementation included migrating 1.6 million studies from the previous systems and converting from a RIS driven workflow to a PACS driven workflow. “The timeframe was incredible. The norm to accomplish all of that for a hospital this size is two and a half years.”
Browning and his peers are more productive with single sign-on and a PACS workstation capable of launching a variety of applications including the study worklist, dictation system, peer review, RIS and EMR. Studies sent from the scanner are immediately seen and available on the worklist.
Opening a study displays the images automatically using user-specific hanging protocols. Prior reports and comparison exams are displayed and easily browsable, thus streamlining the process for the radiologist to interpret the study, dictate and electronically sign the report. Moments after signing, the report is available in the EMR, which helps Parkland comply with the meaningful use requirements of federal stimulus funding.
Results
Since implementing Horizon Medical Imaging, image retrieval time dropped from 11 minutes to 21 seconds — a 97 percent improvement. Image transfer time for studies with more than 1,000 images decreased from eight minutes to 3.5 minutes — a 56 percent improvement. There have been no imaging system outages and report turnaround time decreased by 34 percent.
“With the McKesson PACS, we can see more, better and faster,” says Browning. “Study loading is quicker. Finding cases is easier. Integration of digital dictation, electronic peer review and EMR software is smoother, and, most importantly, interpretation and diagnosis is accelerated.”
For more information: www.mckesson.com
This case study was supplied by McKesson.
May 01, 2024 
