ORGANISATIONAL CHANGES MADE POSSIBLE WITH VIBORG HYPERPACS
Finn E. Lindhardt
Department of Diagnostic Imaging,
Viborg Hospital, Denmark
HyperPACS: hospitalwide interconnected PACS at several sites with shared archive, RIS and HIS and various teleradiology systems.
Organisational changes may occur at three levels: at the radiological department, at the hospital and in a wider area: county or country.
The department: gets consistency of patient demografic data from HIS/RIS to PACS. Precise, intelligent booking and better scheduling of the patient’s visit to the department. Image data are of better quality than with film/screen systems and retrievable anywhere. Patient flow accelerates and the department’s out-put rises with the same amount of staff. Some0 may be dismissed, but new jobs arises: super-users and system managers. The radiologist have access to all relevant clinical data from RIS/HIS or the EPR (Electronic Patient Record) when reporting. His workstation can be installed anywhere. His can design his own workload, selected from the day’s production. His is to a great extent independent0 of the secretarial staff. Working hours are not necessarily confined to day hours. Real “on-line radiology” is possible with image distribution combined with a speech file or speech recognition programmes. The disadvantage of this scenario is a possible isolation and disconnection from the clinical setting, the staff and fellow radiologists. A combination of PACS work and other jobs is recommendable. Information tecnology is a major part of radiology today. Therefore radiologists will always be needed. Even if some modalities will spread to the wards.
The hospital: Booking directly in RIS is allowed. Fast image distribution accelerates clinical decision making, speeds up patient handling, and eventually the in-stay time. Less time spent on searching for images and reports. Always available images, later part of the EPR. Local print-outs are possible. Users are content with PACS, several enquiries confirm this, but show an unexpected uncertainty with digitally displayed examinations. There are more clinical conferences than 5 years ago. An unscheduled consultation is no problem anymore. Paradoxically PACS improves the relations between radiologists and clinicians. Better presentation of easily selected image material also facilitates communication. A disadvantage is that is has become difficult for the clinicians to handle tomographic examinations (CT/MR). This demands greater confidence in the radiologist’s report and more inter-departemental meetings and discussions than before.
County/country level: There is an improved service to the patient and his local GP with direct booking and images distributed to the patient record. Reference and QA programmes are shared throughout the area. This is mandatory if examinations are evaluated where not produced. Reporting is performed where there is a radiologist available. Specific examinations are send to and read by the same few specialists. A more consistent quality of better reports are to be expected. These measures can be taken any time of the day anywhere and even as a contract job. It may be more expensive to shift primary diagnosis from a clinician or a radiologist in training to the senior radiologist. But more precise diagnoses are the result, and one radiologst can handle the duty service for several 0sites. Much of the diagnostic work up can be done at home, saving time and travel expenses. There might be the fear that 3-level centers will get flooded by examinations from smaller institutions. Prizing and agreements must handle this problem. The university clinics could re-export ordinary examinations to smaller centers. Teleradiology and expert counselling save substantially amount of money. The non-referral of otherwise moveable patients to 3-level centers accounts for that. And there are decreased expenses for transportation services and staff given time off in lieu.
Oral presentation at EuroPACS'98, Barcelona, Spain