Workflow analysis eases transition to digital world

Radiology departments switching from a film-based system to digital imaging should first undergo a thorough workflow assessment, according to experienced PACS users.

This type of analysis plays a central role in the integration of a radiology information system and PACS, especially in large hospitals with imaging facilities in different locations.

"The transition from the film environment to a digital world introduces a dramatic change in the radiology workflow management system," said Dr. Claudio Saccavini, a researcher at the Radiology Institute of the University of Padova in Italy. "Introducing a PACS today is not only a technical problem, it's a work organizational problem."

Saccavini outlined the approach used in a number of radiology departments in Italian hospitals. In each case, external consultants worked with radiologists, radiographers (technologists), nurses, IT personnel and engineers, and administrative staff.

"RIS/PACS implementation involves a large number of actors, and it is very important that clinicians and administrators work together in this analysis to get a consistent approach to this problem," he said.

External analysts first produced a workflow model for each film-based radiology department or unit. They collated details relating to micro-organizational structure, human and technical resources, and overall performance.

The model covered all steps from examination requests and scheduling to patient check-in, image acquisition, reporting, document distribution, and archiving.

"Some of these steps are outside the radiology department," Saccavini said. "Workflow is not only radiological workflow, but also clinical workflow."

The team examined existing relationships between the type of examination (inpatient, outpatient, or emergency case), the modalities involved (CT, MRI, plain-film radiography, and ultrasound), and the available human and technical resources.

They assessed how RIS/PACS implementation could either solve or increase any known weaknesses and estimated the time required to resolve these difficulties. They also highlighted key strengths in the current workflow.

This information was used to develop a new model, based on realistic performance targets and resources, that showed how RIS/PACS could best fit into the radiological workflow. A "gap analysis," which contrasted the present situation with the new scenario, helped identify new activities or additional roles that would have to be introduced.