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Electronic Clinical Image Management Lowers LOS.

With enterprise-wide, real-time information sharing, the CIMS has an impact on entire system.

Cape Fear Valley Health System (CFVHS) has experienced many obstacles common to the managed care environment, such as heightened competition for patients and physicians, demand to decrease operating costs, and pressure to increase efficiency.

We knew that information systems technology could address these issues at CFVHS. Dr. George Binder, chief of Radiology Services, and I began to research Clinical Image Management Systems (CIMS), also known as PACS. We agreed upon the over-all solution our prospective system needed to provide, and by collaborating on the research, we ensured that clinical and IS requirements would be addressed.

Our goal was to identify a CIMS that would provide two basic benefits to CFVHS. First, we wanted a system that could provide superior access to clinical images and corresponding diagnostic information on an enterprise-wide level. We decided that to have a tangible impact on the efficiency of the entire enterprise, our prospective CIMS must extend well beyond the borders of the radiology department and allow information sharing throughout the organization.

Second, we wanted to reduce film and film-related expenses within the radiology department. We associated a significant savings with the reduction of these expenses, although our primary concern was the efficiency of the overall enterprise.

Given these criteria, and our research of the market, we chose ImageACCESS[R], a Windows NT[R]-based CIMS from StorCOMM, Inc., a Jacksonville, FL, company.

Satisfies Several Needs

Their system captures, stores, retrieves, distributes and displays clinical images. It is able to satisfy the clinical requirements of the radiology group, Carolina Regional Radiology (CRR), and the information services requirements of the IS group.

A major justification of any information system is an increase in the efficiency of an organization via faster and more far-reaching access to information. The CIMS achieves this in three ways.

First, with enterprise-wide, real-time information sharing, the CIMS has an impact on our entire system. A majority of the PACS vendors we researched had strong radiology-centric products, but StorCOMM also met our qualifications in other areas of our organization. There are several clinical areas that have a critical need for medical imaging.

At the very least, an effective CIMS needs to benefit radiology, emergency medicine, the operating room, and intensive care. We connected these areas in the first phase of our implementation. By connecting critical areas, we are able to provide better service to patients and physicians,and improve the workflow of the health system.

Second, the CIMS seamlessly integrates with our existing information systems. To be useful to clinicians, images have to be merged with corresponding diagnostic and patient information. Our CIMS automatically retrieves data from several sources, allowing us to manage all of our clinical image data using one system.

Third, because of the dynamics of the healthcare industry, a highly scalable system is a must. System scalability is advantageous because it allows us to implement a turnkey solution in phases and also gives us the ability to expand the CIMS to match the growth of the health system. We have already begun to experience expansion into additional areas within the medical center and also into Highsmith-Rainey Memorial Hospital, recently acquired by the health system.

Maintains Image Quality

Another feature that influenced our selection of this system is its ability to maintain high image quality while allowing speedy access to exams. Access speed is not only a function of bandwidth and processor speed, but also the ease-of-use of the interface. The viewstation software, MedVIEW[TM], is a Windows[R]-based module that is easily mastered by the majority of users.

"Our review stations have a very friendly interface," says Dr. Richard Falter, a radiologist with CRR. "I felt comfortable using the software after only one day of use. It contains exam formatting options for multi-image exams like CT and MR that help ease the interpretation of long exams, and image manipulation tools that are handy and easy to use. More importantly, the system maintains very high image quality. I am confident in making diagnoses based on the electronic images."

Dr. Binder also observes: "During a recent multiple trauma situation at our facility, I was able to quickly access and diagnose all of the clinical CT images online using the system. I estimate this saved me 45 minutes over traditional hard copy reads."

An additional factor that has influenced our physicians' acceptance of the system is our Applications Specialist. StorCOMM provides a full-time, onsite employee to provide support and ongoing training.

Implemented Easily

Soon after implementation, all connected areas, specifically the intensive care units, were benefiting from the new technology. It stands to reason that ICUs, with a critical demand for clinical images, would greatly benefit from a CIMS. One particular incident related to me by an R.N. on the surgical intensive care unit, demonstrates the tremendous benefit to patient care incurred by CIMS usage.

"While awaiting results from a head CT, a young male patient began to exhibit minor behavioral changes," says Tina Emberton, R.N. at Cape Fear Valley Medical Center. "I was able to quickly access the exam from our review workstation. The images showed a severe swelling of the boy's brain and I immediately called his neuro-surgeon. The fact that I was able to access those images from the workstation in SICU probably saved this boy a great deal of functional damage. This system is a tremendous asset to patient care."

I decided to measure the effectiveness of CIMS in the ICUs, designing a study to compare average patient length of stay before and after implementation of the system.

Audited LOS

I audited the length of stay (LOS) for more than 1,200 patients who had been admitted to the surgical, medical or coronary intensive care units during a pre-implementation span from December 1997 to February 1998, and a post-implementation span from December 1998 to February 1999.

After the results had been analyzed, we found that a decrease in LOS of more than one full at day had occurred. A previous study, conducted by ultrasound supervisor Carmen Perri, associates a dollar figure with the impact of CIMS. Her study projects that usage of CIMS will increase revenue in the ultrasound department by nearly $1.2 million per year.

We are actively expanding the reach and functionality of the system, installing new workstations in emergency medicine, our cancer center, radiology, the neurosurgery step-down unit and the post-surgical care unit. These new workstations will allow even more areas of the medical center to benefit from the technology.

We also are designing an implementation strategy for Highsmith-Rainey Memorial Hospital. Finally, StorCOMM is discussing plans with our wound care center to acquire their digital photographs and incorporate them into the CIMS.

High Internal Demand

The demand continues to rise. To date, I have received numerous other requests for acquisition interfaces and review workstations from physicians at CFVMC. One of the biggest supporters of this technology, Dr. Mark Hnilica, is a neurosurgeon who has had contact with the system in SICU and the OR.

"The CIMS has been an enormous benefit to me," Dr. Hnilica says. "As a neurosurgeon, I am consistently required to review clinical images. Often, I am called to consult on cases while performing an OR procedure. Before, I would have to race down to the radiology department to review the film. Now, with the CIMS, I bring up the images on a monitor in the OR. In neurology cases where every second counts, the on-demand access to images has contributed significantly to my ability to provide quality patient care.

"On-demand electronic access to clinical images holds such an advantage in speed and access over traditional analog film that I believe systems such as this will soon be standard tools in the practice of medicine. Imagine a business operating today without computerization -- it's inconceivable! I am certain that CIMS will soon be just as indispensable."

Electronic clinical image management has been a great benefit to Cape Fear Valley Health System. First, by expanding the impact of image management past the Radiology Department, we have been able to benefit the entire organization. Second, the system is able to seamlessly integrate with our existing information systems, and with standards-compliant and non-standards compliant imaging devices. Third, the easy-to-use interface, fast access and high image quality contribute to a high rate of physician acceptance. Fourth, the system is highly scalable, accommodating the expansion of the health system.

These four factors, along with a number of others, have allowed us to share information on-demand throughout the health system; improve workflow and increase our efficiency; decrease our operating costs and increase our revenue enhancement opportunities; and enable us to compete for physicians and provide the highest caliber of patient care. There is no question that information systems are a necessity in the modern healthcare industry. CIMS is the next generation of technology, allowing healthcare organizations to apply the benefits of information systems to clinical images.

For more information circle 175

RELATED ARTICLE: CIMS Success in the Cape Fear Valley Health System Ultrasound Department

Cape Fear Valley Health System (CFVHS), Fayetteville, NC is comprised of Cape Fear Valley Medical Center, Highsmith-Rainey Memorial Hospital, and Southeastern Regional Rehabilitation Center and Behavioral Health Center. The facilities have a staff of 17 primary care physician practices and six specialty physician practices, with a total of 800 beds. Annual outpatients visits total 418,047 with 22,282 annual admissions. Twenty MedVIEW telemedicine home review workstations are distributed throughout the system.

Carmen Perri, ultrasound supervisor at CFVHS, conducted a study to analyze the impact of electronic Clinical Image Management (CIMS) in the ultrasound department. The study was designed to measure efficiencies obtained by using CIMS over traditional film-based procedures and to quantify their impact on revenue enhancement opportunities and cost savings.

Auditing the health system records, Perri found that, after implementation of StorCOMM's CIMS, ImageACCESS[R], the average amount of time spent on an ultrasound exam dropped from 48 minutes to 40 minutes. The decrease in examination time means that the department can schedule more exams per week without increasing fixed costs, a significant contribution to revenue enhancement. In fact, by projecting the increase in efficiency across a one-year time span, CFVHS could potentially increase departmental revenue by more than $1 million per year. She also estimates that the department will save approximately $30,000 per year in film and film-related expenses.

The successes of electronic clinical image management in the ultrasound department illustrate just one of many departmental increases in efficiency that have resulted from the implementation of the CIMS. Each success story is a building block in the overall success of the system at CFVHS. This is the hallmark of a true CIMS - the ability to not only individually impact the departments of an organization, but also to connect each department, resulting in enterprise-wide benefits to the entire health system.

For the complete version of Carmen Perri's ultrasound study, please visit http:\\

David B. Dillehunt is the CIO for Cape Fear Valley Health System, Fayetteville, NC.
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Title Annotation:Product Information
Author:Dillehunt, David B.
Publication:Health Management Technology
Date:Jan 1, 2000
Previous Article:Best of the Best: IT Solutions of 1999.
Next Article:Courting Disaster.

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