Information at the Surgeon’s Fingertips

Sept. 1, 2006

For one health system, a PACS implementation is but a single step in a journey toward improved efficiency and patient care.

Doctors and nurses are demanding customers—and for good reason, as lives are at stake on a daily basis. As a result, healthcare IT implementations often face more than purely technical challenges. Even if a solution is technically perfect, physician adoption can prove to be a fatal obstacle if care providers do not see the value in evolving established routines and procedures to incorporate technology-based solutions. The ability to overcome end-user resistance through better process understanding, smart planning and stakeholder engagement can mean the difference between a healthcare IT implementation’s success or its ultimate failure.

For one health system, a PACS implementation is but a single step in a journey toward improved efficiency and patient care.

Doctors and nurses are demanding customers—and for good reason, as lives are at stake on a daily basis. As a result, healthcare IT implementations often face more than purely technical challenges. Even if a solution is technically perfect, physician adoption can prove to be a fatal obstacle if care providers do not see the value in evolving established routines and procedures to incorporate technology-based solutions. The ability to overcome end-user resistance through better process understanding, smart planning and stakeholder engagement can mean the difference between a healthcare IT implementation’s success or its ultimate failure.

Bon Secours Hampton Roads Health System is a nonprofit organization located in Hampton Roads, Va. that provides patients with access to an array of wellness and recovery programs. Our staff, physicians, nurses and volunteers offer services from advanced diagnostics to urgent care to rehabilitation. As with most health systems,
Bon Secours Hampton Roads is perpetually focused on new ways to improve patient care while driving down the total cost of medical procedures.

Photo courtesy of Bon Secours Hampton Roads Health System.

Understand Before Acting

As part of our ongoing commitment to advancing patient care, in 2005 Bon Secours embarked on a four-part Picture Archiving and Communication System (PACS) implementation, which also encompasses mobile point-of-care (MPOC) components. The time had come to implement digital imaging at Bon Secours because film images were increasingly expensive and difficult to process and store. In addition, since film images rarely have backups, using them also opened the opportunity for patients to lose irreplaceable images, thereby eliminating a valuable data point.

As a first step, a multidisciplinary team consisting of IT professionals, PACS coordinators and radiology staff closely examined the medical processes in which images were used. We wanted to learn from our end-users how they currently handled—and more importantly, how they would prefer to handle—patient images and information. Once we understood the basic system requirements, we engaged with a partner to determine what technology options were available to meet the process requirements.

Plan for Performance and Plan for Change

During our initial planning stages, we agreed on a phased approach to implementation, enabling the IT organization the opportunity to secure feedback and improve the solution in one area before proceeding to the next. Phase one would include the development of a PACS for the emergency room, with follow-on phases including an operating room implementation, mammography component and a remote-access portal for physicians. As part of the planning process, we recognized that additional technology, however spectacular, would need to earn its place in our treatment facilities, where every inch of space is dedicated to life-saving equipment and personnel.

We also knew that any front-end functionality had to be married to an intelligently designed system. We needed a vendor that could understand both the critical healthcare mission and the IT foundations. We selected CDW Healthcare to provide the infrastructure solution for our PACS and associated MPOC implementation based on our past relationship with the organization, their understanding of our existing IT environment and culture, and the fact that they could offer a one-stop source for leading technology brands.

At CDW’s suggestion, we purchased Planar monitors and mobile work carts equipped with an enhanced HP computer to meet our video needs. Since our physicians would be using the mobile monitors for reference and not diagnosis, we required displays that provided high resolution, but not necessarily reading-station clarity. Planar PX212M monitors provided an optimal solution, delivering high resolution at an optimal price point. Since Planar also produces industry-leading Dome monitors, we knew the technology was solid.

Consistently Engage Caregivers

We were careful to keep the end-user at the forefront of our PACS initiative. With the process support and infrastructure in place, our next step was to identify the optimal interface for the medical staff. Even if the solution fit the procedural requirements and IT parameters, we needed strong provider support to turn an IT success into a healthcare success.

In the operating room, for example, we combined the PACS with an MPOC solution built on Ergotron carts and containing high-resolution Planar monitors to deliver up-to-date medical images and information directly to physicians in the operating room. By providing critical information to the physician, immediately and at the point-of-care, the system is in a position to help improve patient outcomes and reduce the amount of time needed to complete procedures.

To ensure surgeon acceptance, we involved them from the start of the initiative and worked with CDW to bring in a solution that met their needs. We surveyed surgeons about their fundamental requirements for an MPOC solution and discovered that ease-of-use, stability and space conservation were critical. The solution, in short, had to make their lives easier, not more complex. Based on this information, CDW proposed the combined Ergotron/Planar system. To provide hands-on experience with the proposed MPOC solution, CDW arranged product demos for our surgeons. This approach helped us to find the right solution for our organization and was critical to our initial and ongoing success.

Our surgeons can now pull down images from the company’s PACS, plan and template surgeries, and then have those high-resolution images at their fingertips during the surgery via monitors on a fleet of 23 mobile carts. Previously, the surgical team brought bulky film images and patient records into the operating room, where a surgical assistant would often physically hold them for the physician.

Building on Success

In an effort to increase the reach of the PACS solution, we are testing a remote portal based on an SSL/VPL (secure sockets layer/virtual private LAN) connection that allows physicians to access centrally stored images on their home or office PCs. Since most physicians lack access to diagnostic-quality monitors in these locations, this platform is designed primarily for self-reference or patient data sharing rather than official diagnosis.

Again, we are involving end users throughout our portal development and deployment cycles. We met with members of the medical team to determine key requirements as part of our planning process and rolled out a pilot portal to selected members of the staff to test the system and provide critical feedback. Staff input has been invaluable. After incorporating feedback from our radiologists and surgeons, we are fine-tuning the portal for a full-scale launch mid to late 2006.

The final PACS solution, which combines a secure network for data transmission, interactive workstations and long- to short-term digital archives, allows our staff, physicians and nurses to access critical images at stations throughout the facility, in some cases using mobile computing carts equipped with high-resolution monitors. Expensive and bulky film, which once constituted a sizable portion of our operating costs, is no longer a consideration. Additionally, our patients no longer worry about the possibility of losing vital film during trips from one of our diagnosticians to an external doctor, as the PACS solution provides for a complete digital record of all images recorded in our facility.

Successful healthcare technology programs ultimately require the IT team to have a solid understanding of the healthcare organization’s workflow. By understanding the medical processes, planning intelligently and consistently engaging our stakeholders, Bon Secours Hampton Roads successfully equipped its medical staff to deliver faster, better and more efficient patient care.

For more information on CDW Healthcare,
www.rsleads.com/609ht-201

Scott Lull is information services project manager at Bon Secours Hampton Roads Health System, Hampton Roads, Va. Contact him at [email protected].

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