Filmless in 60 days: The impact of picture archiving and communications systems within a large urban hospital

Many large urban hospitals converting to filmless radiography use a phased approach for digital imaging implementation. In fact, this strategy often i s recommended by picture archival communication systems (PACS) experts and vendors alike for large, busy hospitals installing PACS in existing physica l facilities. The concern is that comprehensive conversion from film-based to digital imaging may be too overwhelming an adjustment in operations for a medical staff to effectively handle without serious disruption of workflo w for patient treatment and care. Elmhurst Hospital Center is a 543-bed hos pital located in the Borough of Queens in New York City. Owned by the New Y ork City Health and Hospitals Corporation, this municipal teaching hospital provides services to a patient mix that is 38% indigent with no insurance, 50% covered by Medicaid or Medicare, and 12% affiliated with HMOs. Most in patients are admitted through the emergency department. Forty-five percent of all radiology procedures conducted are for emergency patients. Historica lly, up to 25% of all diagnostic imaging examinations were never reported f ormally by radiologists. Report turnaround time for the remaining 75% was u nacceptable, with only 3% of all imaging examinations reported within a 12- hour period in 1996. Both situations existed in great part because physicia ns and residents who felt they needed access to films simply took them. Man y were never located or returned days after they were taken. In 1998, Elmhu rst Hospital Center replaced its RIS and added voice recognition dictation capabilities in January 1999. A hospitalwide PACS was deployed 10 months la ter. With the exception of mammography, the hospital converted to filmless radiography within 60 days. The critical objectives to maintain control of films and radically improve the reporting process were achieved immediately . Over 99% of all examinations now are formally reviewed and reported. Only 7% of all reports take 1 or more days to generate. This report describes E lmhurst Hospital's efforts to make improvements in the delivery of radiolog y services and the reasons attributed to its rapid conversion to becoming a filmless (mammography excluded) medical center. The impact of the PACS on radiology department operations and service is discussed. Copyright (C) 200 7 by W.B. Saunders Company.