Maintaining continuity of clinical operations while implementing large-scale filmless operations

Abstract

Texas Children's Hospital is a pediatric tertiary care facility in the Texas Medical Center with a large-scale, Digital Imaging and Communications in Medicine (DICOM)-compliant picture archival and communications system (PACS) installation. As our PACS has grown from an ultrasound niche PACS into a full-scale, multimodality operation, assuring continuity of clinical operations has become the number one task of the PACS staff. As new equipment is acquired and incorporated into the PACS, workflow processes, responsibilities, and job descriptions must be revised to accommodate filmless operations. Round-the-clock clinical operations must be supported with round-the-clock service, including three shifts, weekends, and holidays. To avoid unnecessary interruptions in clinical service, this requirement includes properly trained operators and users, as well as service personnel. Redundancy is a cornerstone in assuring continuity of clinical operations. This includes all PACS components such as acquisition, network interfaces, gateways, archive, and display. Where redundancy is not feasible, spare parts must be readily available. The need for redundancy also includes trained personnel. Procedures for contingency operations in the event of equipment failures must be devised, documented, and rehearsed. Contingency operations might be required in the event of scheduled as well as unscheduled service events, power outages, network outages, or interruption of the radiology information system (RIS) interface. Methods must be developed and implemented for reporting and documenting problems. We have a Trouble Call service that records a voice message and automatically pages the PACS Console Operator on duty. We also have developed a Maintenance Module on our RIS system where service calls are recorded by technologists and service actions are recorded and monitored by PACS support personnel. In a filmless environment, responsibility for the delivery of images to the radiologist and referring physician must be accepted by each imaging supervisor. Thus, each supervisor must initiate processes to verify correct patient and examination identification and the correct count and routing of images with each examination.

IT services in a completely digitized radiological department: value and benefit of an in-house departmental IT group

“…However, besides its benefits like optimization of workflow, paperless medical records and electronic image distribution the digital techniques bring up new aspects for the administration and organization of radiological departments, since failure of one or more parts of the installation might lead to a breakdown of the whole department with dissatisfaction of the patients, clinicians and radiologists as well [6]. To avoid those troublesome situations a fast and reliable as well as cost efficient IT service provider is very important [25].…”

“…Due to the rising cost pressure, radiological departments have an urgent need for an efficient and reliable but still cost effective IT service [11,[20][21][22][23]. However, objective data to support recommendations for a satisfying solution in this subject can barely be found [24,25].…”

Budgeting for PACS

“…PACS has become mission critical in the filmless environment so it is important that adequate redundancy exists to support radiology business continuity in the event of hardware failure [10,11]. This scoping will require input from information technology specialists and will require answers to question such as:…”

“…The types, numbers and specifications of server hardware components will need to be scoped to deal with the projected workload and required levels of redundancy and resilience within the system. PACS has become mission critical in the filmless environment so it is important that adequate redundancy exists to support radiology business continuity in the event of hardware failure [ 10 , 11 ]. This scoping will require input from information technology specialists and will require answers to question such as:…”