Examine | PACS: Case Study: Bloomington Hospital’s Unifier

Bloomington Hospital, headquartered in Bloomington, Ind., is a regional referral center serving a 10-county area in the south-central part of the state.

The outpatient imaging center employs 14 radiologists, who provide a full range of imaging services to the 355-bed main hospital, two immediate care centers, and a critical access center. Our radiology team reads an average of 20,000 CT scans and 4,000 MRI scans each year.

Despite large distances between the enterprise facilities of Bloomington Hospital, we all share the same patients. However, sharing patients’ medical images and health information used to be challenging. Radiologists would have to travel between three facilities to provide exam interpretations.

As a result, radiology report turnaround time took more than a day, delaying patient treatments. Report turnaround time in the emergency department (ED) took more than an hour. With no way to access patient images or reports from other locations, providers had to fax a patient list to the imaging center prior to visits to determine if there was existing patient information.

Even after patients arrived, office staff had to call to track down information, slowing patient throughput and reducing patient and physician satisfaction. In addition, the lack of timeliness was affecting care. Bloomington Hospital administrators and clinicians recognized that they could provide better patient care if they had the right tools in place.

Instead, patient exams were often repeated, and radiologists had to compare studies after the first read. Bloomington Hospital needed to provide simpler access to images and information for specialists, ED consults, radiologists, and referring physicians, so that all patient information was available, regardless of where the patient was seen.

Simply put, we needed a better, faster, and cheaper way of doing things in radiology. The path to accomplishing these goals was to facilitate the digital transfer of images as well as a centralized order management solution. 

An Integrated Approach

Bloomington Hospital had already identified a vendor of choice for a medical imaging system when our new chief information officer arrived. During his analysis of the hospital, he noted that the organization followed a patient-centric approach in all areas, with the exception of technology, which was department-centric.

As a result, all departments were struggling with access to a complete view of the patient’s condition and medical record. He put a halt to the purchase of the pending imaging system and asked the team to embark on a new selection process that would help it meet the needs of the entire enterprise, not just the radiology department.

Our enterprise selection team quickly narrowed the field of vendors, based on integration, and then made the final decision based on functionality, service, and support. San Francisco-based McKesson won the business because it had the most solutions for the problems Bloomington Hospital was trying to solve.

We chose to implement the Horizon Medical Imaging™ PACS and radiology information system (RIS) to better manage the patient experience, from ordering through report distribution. Functionality was the primary factor in the selection. Radiologists wanted access to digital technology to improve the quality, efficiency, and coordination of care.

Additionally, the team felt the robust systems would meet the needs of the radiology department in delivering timely reports to attending physicians so that patients could begin treatment as quickly as possible. The depth and breadth of McKesson’s other offerings was another big factor.

In our move away from silos of technology, Bloomington Hospital planned to integrate the enterprise and felt that another vendor could not meet both the needs of the radiology department and the enterprise.

Bloomington Hospital was able to quickly and effectively deploy radiology, scheduling, and order management solutions, and then connect them to McKesson’s clinical repository and physician portal. McKesson also had the solutions Bloomington Hospital needed for cardiology imaging, the ED, and nursing.

Time mattered, and McKesson was able to meet Bloomington Hospital’s timeframe with a strong and rapid implementation methodology. Our selection committee was also impressed after a site visit to the Vancouver support center.

The Horizon Medical Imaging Package

One of the keys to our medical imaging success was a disruption-free implementation strategy and an extremely well-trained and knowledgeable team who completed a tiered implementation of the PACS and RIS at the main hospital, smaller hospital, and the outpatient imaging center.

That included system pre-staging, integration with other systems, conversion of 10 years of data, and going live with the system 30 days ahead of schedule. To enhance user adoption, training included pre-installation, onsite support for super users, and dedicated one-on-one radiologist training.

Reengineering processes played a part in the implementation as well. For example, employees and departments all used different abbreviations for radiology procedures. So, we formed a committee of employees from radiology, billing, and scheduling to determine unified names for all exams.

With the integrated RIS-PACS, our team of 15 radiologists can now quickly see prior reports and images, enabling them to complete side-by-side comparisons on first read, and get results back to the ordering physician by the end of the day, viewable through the physician portal.

Radiologists note that the quality of the images in the PACS gives them a safer read, and the dictation feature in the RIS – which auto-launches and allows them to immediately begin dictation – is a favorite. A true testament to the importance of the system is that, when we schedule downtime of the system, the radiologists walk away from the station.

In essence, they now happily rely on the medical imaging system to help them deliver safe and effective care. At Bloomington Hospital, we recently extended our medical imaging success with the go-live of Horizon Cardiology™, reducing the turnaround time of cardiology images to help ensure a low “door to balloon time.”

Before implementing the system, cardiologists rarely had the time to locate prior images on CD in time to affect patient outcomes. Now, they can view prior images before they get onsite to determine where previous arterial blocks were. They can also see the targets while performing the procedure in the operating room.

Unifying Patient Care

Bloomington Hospital has unified patient care by enabling providers to immediately access and share patients’ digital images and information from any location – in the ED, OR, physician’s office, even at home. Costs are down, revenues are up, and faster treatment times have led to better patient outcomes.

The hospital’s radiology report turnaround times to referring physicians also have dropped drastically, from more than a day to often just minutes. Report turnaround in the ED has been reduced from 64 minutes to nearly real-time readings. These faster report times not only meet national standards, but also save lives.

Additionally, Bloomington Hospital has increased revenue 15 percent, or $1.6 million, by standardizing billing procedure names, and recouped another $600,000 because of the system’s ability to capture vital billing details. Film costs were slashed 90 percent – $200,000 – in the first quarter alone, and the film room and related full-time employees were eliminated.

As expected with an integrated solution, our medical imaging success has affected other areas of the hospital as well. For instance, Bloomington Hospital has experienced an 80-percent increase in physician portal usage now that it is image-enabled and physicians can view a patient’s full, image-enabled medical record.

In summary, enterprise-wide medical imaging solutions are the necessary building blocks for an integrated care delivery system at Bloomington Hospital. Most important, there are fewer errors and faster treatment times, which ultimately produce better outcomes for our patients. 

— Becky Patton, BSBA, PMP, is the imaging project manager at Bloomington Hospital in Indiana. Direct all questions and comments to editorial@rt-image.com.