Who Goes Digital? Why Did They Do It? Does It Improve Patient Care?

Click on a hospital below to be directed to a comprehensive profile of their digital echo lab.

Children's Hospital of Michigan

Children’s National Medical Center

Danbury Health System

Sky Ridge Medical Center, Lone Tree, Colorado

Facility Name	Children’s Hospital of Michigan
Location (City, State)	Detroit, MI
Questionnaire completed by	Richard A. Humes, MD Professor, Pediatrics Wayne State University Director, Echocardiography Laboratory Children's Hospital of Michigan
DEMOGRAPHIC DATA
Number of Ultrasound Systems	5
Number of Reading Physicians	5
Number of Sonographers	3
Number of exams performed per year	6200
DIGITAL LAB
Why did your department decide to go digital?	Multiple reasons. Our old echo management system was not Y2K compatible. We had a large donation of money for echo upgrade and needed to spend it. Truthfully, I was not that sold on the concept of digital until after we got it. Great decision in retrospect.
How has a digital lab met your needs?	Much faster turnaround of reports. Much better review of old studies.
Do you believe quality is better?	No. Quality is the same. Quality as measured by speed of reporting is about the only parameter which has improved.
How many exams were read per day prior to going digital? And how many after the transition?	Prior –avg 14/day. After –avg 20/day. However, the increase is difficult to attribute to the digital lab. We are just busier. Some may be attributed to our faster turnaround, but that is difficult to get a handle on. I don’t know how we would have handled the paperwork and reading work without the digital lab. We did not increase any personnel in that time period despite a 30% increase in volume.
How often were you doing side-by-side exam comparisons before? After?	Very rare before. Now at least daily.
How is it improving patient care?	Much easier review. However, other than saving time, it really doesn’t improve patient care specifically. Much of the improvement in our lab was a result of the management system of EnConcert, not the digital acquisition.
What problems did you have prior to a digital lab? How did you solve them?	Getting reports out in a timely fashion. Too many steps in the review process, even though we had a computerized, structured text reporting system. The report turnaround was about 4 days on average.
What issues arose when migrating to a digital lab? How were these resolved?	There was a disagreement between the vendor and facilty about the level of expertise needed to manage the system on site. Caused quite a stir. Otherwise the transition was extremely smooth. Worries about switching from tape to digital from the sonographers was largely non-existent.
What happens when your hospital network goes down?	In almost 4 years we have had only 4 down times and one was planned for a software revision. When it happens we record digitally and save to MOD, downloading those studies onto the server when it is back up. We have never gone back to tape and do not use a tape back-up system, as some labs do. In each of the cases of unplanned down time the issue was the MOD jukebox, and was a hardware issue. That has not happened for about two years.

 

Facility Name	Children’s National Medical Center
Location (City, State)	Washington, DC
Questionnaire completed by	Craig A. Sable, MD Assistant Professor of Pediatrics Cardiology
DEMOGRAPHIC DATA
Number of Ultrasound Systems	13 (5500 x 10, 7500 x 1, Cypress x 2)
Number of Reading Physicians	6
Number of Sonographers	10 (6 total FTE)
Number of exams performed per year	8,000
DIGITAL LAB
Why did your department decide to go digital?	Efficiency (workflow, report generation, conferencing, database searches), image quality
How has a digital lab met your needs?	Yes with few limitations
Do you believe quality is better?	Yes
How many exams were read per day prior to going digital? And how many after the transition?	Increase from 20/day to 30/day
How often were you doing side-by-side exam comparisons before? After?	Before: 1 to 2 times per day After: every follow-up study
How is it improving patient care?	Side by side comparisons, tracking of quantitative data, easier retrieval of old studies
What problems did you have prior to a digital lab? How did you solve them?	Serial comparisons, retrieval of old studies, conferencing, off line measurements, limited reporting system, export of loops and images for lectures, sharing of data with outside labs all improved by digital lab
What issues arose when migrating to a digital lab? How were these resolved?	Significant resistance to using short loops in pediatrics. St rong recommendation is that new users should not try to do simultaneous digital and videotape archival…need to make clean switch.
What happens when your hospital network goes down?	We have separate local network that is not tied to our hospital network

 

Facility Name	Danbury Health System
Location (City, State)	Danbury CT
Questionnaire completed by	Rick Rigling, BS, RDCS, Technical Director, DHS Echocardiography Laboratory
Danbury Echo Lab Team
DEMOGRAPHIC DATA
Number of Ultrasound Systems	7
Number of Reading Physicians	7
Number of Sonographers	8
Number of exams performed per year	8000
DIGITAL LAB
Why did your department decide to go digital?	Total Health System Echocardiography related increased efficiency, and transfer of quality raw digital data to interpreting physicians.
How has a digital lab met your needs?	The digital system affects our efficiency in every aspect. Manual hunting and interruptive systems were replaced by automated study demographic cueing and status tracking of study progress. Complete loss of videotape recueing for interpreting physicians. Transfer of image data to any internal and external sources including MDs interpreting from alternate off site locations and referring consultative services. Ability for any staff members to search and use pt database for statistics, billing and clinical purposes.
Do you believe quality is better?	Yes, Physicians now see raw data previously seen only by sonographers directly at the point of aquisition. Sonographers quality acquisition has improved by becoming the “producer and editor”and not just the panning photographer.
How many exams were read per day prior to going digital? And how many after the transition?	Same volume of studies, yet the physician interpretation time was cut by approx 1/3.
How often were you doing side-by-side exam comparisons before? After?	Previously most studies had previous studies pulled for review, but true side by side was not possible. Studies were reviewed in a linear fashion, i.e one tape in one tape out, which lead to apathy in actually looking at each complete study. Now all studies are quickly reviewed side by side without added time and cueing.
How is it improving patient care?	Besides the passing on of direct pure raw diagnostic data to interpreting MDs instead of transferred Video Tape, the rapid turn around affects care timely pt care. Studies can be interpreted and results distributed to the primary care giver within seconds of acquisition. Physicians no longer have to be on campus to interpret.
What problems did you have prior to a digital lab? How did you solve them?	Time wasted manual tracking and preparing data for interpretation as well as delays in interpretation which held up care plans and even discharges. The digital system improved efficiency of all data transfer. In labor we figured a gain of ¾ of a staff FTE, and a 1/3 increased gain in physician time spent away from reading echos.
What issues arose when migrating to a digital lab? How were these resolved?	The migration was hardest on changing old mindsets and habits. We found staff champions who influenced other staff. There was also technical and operational hurdles which were accomplished by teaming with vendors and multidiscipline staff complement.
What happens when your hospital network goes down?	Extremely rare, and extremely brief. Studies are reviewed at the cart level as needed and transferred without issue.

Facility Name	Sky Ridge Medical Center
Location (City, State)	Lone Tree, CO
Information Submitted by:	Tim Masters R.T. (R) PACS Administrator CPCS Radiology Core Team Leader
Sky Ridge Medical Center is located in Lone Tree, Colorado (South of metro Denver). Sky Ridge initially opened on August 20th, 2003 with 106 beds. Longer term, the hospital is planned for up to 335 inpatient beds. The development of Sky Ridge Medical Center was, in significant part, the result of an outcry from both the community as well as elected officials in Douglas County, CO including the Douglas County Commissioners and Senator John Evans. Until the opening of this hospital, Douglas County has been without an acute care hospital to provide for the healthcare needs of the community. The hospital offers the following services: • Full-range surgical suites • Obstetrical services and Special Care Nursery • Sky Ridge Cancer Center, including radiation and chemotherapy • Sports Medicine and Rehabilitation Center • Helipad for Air Life • Orthopedics including spine, joints, sports medicine • Pediatrics, including Pediatric Unit, Pediatric Surgery, Pediatric Emergency Services • ICU/CCU • Sally Jobe Breast Center • Endoscopy/GI Lab • Complementary/Alternative Medicine In addition, Sky Ridge offers full imaging services to include diagnostic imaging, MRI, CT, Nuclear Medicine, US and NIVA, Echocardiography and Cardiac Cath Lab, and Interventional Radiography. Sky Ridge has integrated GE Centricity for our PACS solution. Full integration of Radiology and Cardiology services plus an imbedded API (application program interface) for the MUSE (GE’s EKG and Management System) server interface has allowed our physicians to view all of their patient’s diagnostic testing data our Web viewing stations. The Echo lab at Sky Ridge has two Vivid 7 Echo machines at its disposal, allowing for multiple exams to be performed simultaneously. This aids in performing the weekly workload of approximately 100 exams per week. The AI1000 (GE multi-modality image view) and EchoPAC workstations (GE Echo image analysis, measurements and reporting) allow our Cardiologists to be efficient in the care of their patients. Currently, our PACS workflow is designed to offer the most efficient patient care possible. Technologists will download patient modality work lists from any PACS network port, perform the exam (portably, if necessary), and then simply upload the image data back into PACS. We utilize a Meditech RIS (Radiology Information System) to input orders and track patient information. In the case where information needs to be forwarded to the Cardiologist or Radiologist, the technologist scans the paperwork via a desktop, sheet-fed scanner (Strobe XP 100) and sends the data into PACS with PacsGear PacsScan software. The paperwork is converted to DICOM and is stored as a separate series in then patient’s jacket in PACS. The PacsScan software is fully integrated into the PACS system and can perform a DICOM query to the PACS database to ensure the data is sent to the appropriate patient file. All Cardiology data is sent through a CVLink that routes the data to PACS, the EchoPAC workstation, the AI1000 workstation, and in the case of Cath Lab images, to the DDS workstation. All Cardiology data is stored for short-term storage on a separate logical partition of 4 Terabyte on a CX600 SAN (Storage Area Network), and then to a 1.4 Terabyte Centera (Content Addressable Storage unit) for long-term storage. A single PACS/RIS Administrator manages the PACS network with network assistance provided by the hospital Information Technology & Services Department. Before Digital: Cardiology-imaging administrators are searching for efficient ways to handle the steadily increasing workload. The management of physical, CD, video, and film libraries using most of the existing database packages involves a lot of manual work, and is a major cost center for cardiology departments. Cardiologists and technicians are becoming aware of the operational benefits of increased digitization. The PACS system is one of the ways in which end users are responding to the drive for greater efficiency. Sky Ridge Medical Center opened in a fully digital environment. The complications such as damaged videotapes or lost film were not experienced. After Digital: Among other benefits, Sky Ridge has found that the Cardiology incorporation into PACS has offered the following: • A tapeless and filmless environment significantly reducing facility operating costs (videotape, physical storage requirements, messaging service, multiple films, film and chemistry, staffing master jackets). • Increase quality and of patient Medical record keeping. • Increase patient care by: eliminating misfiled or lost videotapes and eliminating retrieval time for older studies in archives. • Reduced administrative costs. Moving from videotape to digital has also raised some issues with the referring physicians. Some physicians rely on the videotape provided by the Echo department. We have addressed this issue by providing CD-ROMs with the Echo data. After a short educational meeting with the referring physician, the CD has been accepted by many of the Cardiologists. Other Cardiologists have opted to have the PACS network brought into their office. They are provided with a direct connect to the hospital fiber Gigabit network and are able to access their patient’s data at full resolution and frame speed. Take away: The one message that I would like to share is to make absolutely sure that the facility has a training and education plan established prior to moving to a digital environment. Training your staff and referring physicians will make or break the project. In all, our digital solution of Echo/Cardiology has been a great success. We are able to provide immediate images to the physicians and allow them to streamline patient care. Our patient throughput and medical record keeping has vastly improved. The fact that images can no longer be lost or damaged is an important determining factor. Cost savings and workflow improvements are added benefits to your facility in the move to digital.