Introduction to the Paper by Eliot Siegel and Bruce Reiner, 'Work Flow Redesign: The Key to Success When Using PACS'

AS AN EARLY PICTURE ARCHIVING AND COMMUNICATION SYSTEM (PACS) adopter, I am often asked about “the most important lesson that I’ve learned about filmless radiology.” Although we have learned many things during the past decade, the most important lesson has undoubtedly been that the purchase of a PACS provides an opportunity to re-engineer and streamline the inefficient manual workflow found in most conventional imaging departments. In my experience, many imaging departments have used PACS as an electronic substitute for film, completely emulating all aspects of a conventional department. Such departments continue to push individual studies from a specific acquisition device (such as a CT scanner) to a specific workstation in a manner similar to hanging films from that modality on a specific film alternator. They continue to enter patient information either electronically or on paper multiple times on multiple information systems in a manner analogous to paper and index cards, rather than having these systems communicate with each other. It is therefore not surprising that there have been mixed results with regard to the impact of PACS on departmental productivity and cost savings. It has been my experience that departments that have concentrated on redesign of workflow using integrated systems that communicate with each other have been able to achieve the greatest gains in savings and efficiency. In 1991, when we purchased our PACS for the Baltimore VA Medical Center, we were required to create custom interfaces for each of these information systems in order to achieve interoperability. Today, customers can take advantage of the Integrating the Healthcare Enterprise (IHE) effort to minimize the need to reinvent this wheel and to optimize departmental and/or hospital workflow for imaging. This paper discusses our analysis which compared our workflow processes before and after implementation of an enterprise-wide PACS.