The drive for improved system integration and decreased turnaround time has led to a continuous analysis of procedures and a never-ending cycle of trying to get the work flow to work.
One of the most interesting problems with imaging system integration is the unique and peculiar work flows created to accommodate institutional idiosyncrasies. Some institutions rely on a PACS-driven work flow, while others try to command their work lists from a speech recognition system or the RIS.
And then there is the added twist: Private practice work flows vary from those at academic centers, which in turn can vary amongst themselves as well. The constant drive for improved system integration and decreased report turnaround time has led to a continuous analysis of procedures - a never-ending cycle of trying to get the work flow to work!
At the University of Utah Health Sciences Center (UUHSC), the only academic medical center in the Intermountain West, encompassing four hospitals and 10 neighborhood clinics with a referral base covering 10 percent of the continental U.S., we’re no stranger to unique and peculiar work flows and a handful of institutional idiosyncrasies. However, when your imaging department produces 300,000 studies a year you need to ensure you’re leveraging technologies that are significantly optimizing your time, data entry and work flow. For this reason, we hit the pavement looking for a process that supported our unique needs and the technology that integrated seamlessly into it.
Our work flow
While the RIS was first installed at UUHSC in 1991, with several updates and database migrations since that time, the PACS wasn’t brought on board until 1998, and has since undergone two major database migrations and vendor changes.
Additionally, four speech recognition (SR) systems have been installed over the past 15 years, with various levels of integration with PACS and RIS. Over this time, we have significantly decreased our film printing costs, report turnaround time, inpatient throughput, and the number of file room personnel - all while increasing both our technologists’ and radiologists’ productivity.
All of these systems have made the imaging process throughout the university system more effective and have allowed us to better incorporate and assist other imaging specialties, such as cardiology, vascular surgery and orthopedics, with their own custom processes.
The largest integration to this day has been with Nuance’s radiology reporting and transcription tool, PowerScribe 360 | Reporting. The UUHSC system is constantly striving for ways to improve efficiency with our various processes and this reporting platform offered that. In the radiology department alone, the attending work flow varies significantly from that of the resident and fellow in terms of the PACS, SR, and RIS utilization and how studies are opened and viewed, how reports are created and edited, and how the study status is changed in each system. Every new system and modality may change the overall process and how data is sent, exchanged, and incorporated between systems.
The installation and integration of the system has allowed the imaging department to operate various work flows at the same time, all while the imager is at a single workstation, with one mouse and one keyboard. This was an important capability because our academic system consists of reading rooms that are spread out throughout the Health Sciences Center so it is crucial that we’re able to produce an image at one site and be able to access it at any other site, at any time, even at sites outside the enterprise.
Putting the work flow to work
The most common work flow at UUHSC involves a single physician opening a study in PACS, which in turn opens the reporting software with the correct accession number and a speech template loaded based on body part and modality. Then, at this point in the PACS driven workflow, the physician is ready to dictate the unique case. The imager can dictate the study and immediately sign it off, leading to the subsequent changes in PACS and RIS, as well as the reporting system. This is important, as the study status need to be consistent between systems.
The imager can also easily and immediately switch to a SR-driven workflow wherein he/she is reviewing cases that have been dictated by a resident or fellow. In this workflow, the imager (radiologist, cardiologist, or vascular surgeon) can query PowerScribe’s SR engine to open a list of reports that are waiting for approval. Then, when opening one of the reports, the reporting tool will command the PACS to open the same study based on the unique accession number. In this work flow, the imager can review the case and report together, and edit and finalize the report, which then closes the study in PACS, returning to the list of reports to be reviewed next. This is unique from other systems which force the imager to use a single particular work flow or switch systems.
The methods and degree of integration between the complex imaging systems are always in flux. We are constantly looking for new ways to improve imaging work flow throughout the enterprise, and we have managed to improve the overall efficiency of imaging throughout the UUHSC by integrating the various systems.
Richard H Wiggins, III, MD, CIIP is the director of imaging informatics at the University of Utah Health Sciences Center.