Clinicians find PACS transition challenging

Massachusetts General Hospital clinicians faced a bumpy road to PACS implementation, but the road was made smoother for orthopedic physicians by the development of a joint radiology and orthopedics task force.

The committee, consisting of orthopedic surgeons, radiologists, administrators, and technical staff, helped eliminate the silos that had been erected between the radiology and orthopedic departments, according to Dr. Francis J. Hornicek, who spoke at the Radiology into the 21st Century congress in Boston last month.

Prior to soft-copy implementation, the radiology and orthopedic departments provided effective patient care separately, but neither had focused on patients' experiences in the other department.

Bottlenecks in the radiology department often led to a bunching up of appointments in the orthopedic department by mid-day. The implementation of PACS and a soft-copy workflow has helped reduce transit time through both departments.

"We wanted to look at the patient experience as a whole," said Hornicek, chief of orthopedic oncology and director of the Center for Sarcoma and Connective Tissue Oncology at MGH.

The first monitors provided to clinicians during the initial stages of the PACS implementation were only 15 inches across and had poor resolution. They also had a timeout feature that could lead to serious problems in the operating room.

Orthopedic physicians, who were used to viewing many images at once, found the single images provided by the monitors challenging. Neurosurgeons, orthopedic surgeons, and other surgeons also had different image viewing needs.

But once the kinks were ironed out, the benefits were many, Hornicek said. The physicians found that PACS offered a much better method for storing film, provided better patient throughput, and improved inpatient care.

While consultations are still done with films, Hornicek said that he is seeing the use of more and more CDs. Soft copy has been a significant advantage at conferences, where it has eliminated the once-towering stacks of films and film jackets needed for presentations.

"The goal was to reduce patient throughput and to improve their experience coming to see me, and that has been done," Hornicek said.

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