Driving standardization for a large health system

Promedica Health System, Toledo Hospital, Toledo, OH, USA

Like many hospitals today with legacy RIS products, ProMedica Health System found itself needing to replace its 15-year-old RIS, which was being sunset. It chose a RIS from existing PACS vendor, Sectra, to achieve both seamless integration between RIS and PACS and single-vendor convenience.

The size and scale alone of ProMedica Health System made this a very complex installation: each of the seven hospitals, 26 imaging centers and four radiology groups involved in ProMedica’s Sectra RIS deployment had their own workflows, nomenclature, and processes. Thus, a key objective in deploying the new RIS was to standardize everything across the sites in order to make workflow, management, communications, quality control and measurement much easier.

“Our prior RIS was put in at each facility in a vacuum, and we needed to standardize everything in order to put the new RIS in,” explains Sean McClure, clinical information systems administrator, ProMedica Health System. “This was highly complex from a lot of different avenues. Not only did we have to standardize all the exams and exam codes, order codes, preps and prompts throughout the health system, but we also had to standardize them in the ordering systems as well.”

ProMedica Health System background

ProMedica Health System was formed in 1986 and is a Toledo, Ohio-based, not-for-profit healthcare organization with nearly 15,000 employees, 2,900 physicians and more than 283 facilities in northwest Ohio and southeast Michi- gan. ProMedica serves more than 2.7 million patients

ProMedica Health System - Toledo Hospital, Toledo, OH, annually and includes ten hospitals; ProMedica Continuum Services with senior, hospice, rehabilitation, and integrative services; ProMedica Physician Group, a network of more than 300 primary care, obstetrics and specialist physicians; and Paramount Health Care, the largest HMO in north- west Ohio.

ProMedica has been named the nation’s second-most Inte- grated Healthcare Network (IHN), according to results of a 2011 survey conducted by SDI, the nation’s premier rat- ing system that evaluates IHNs based on performance level and degree of integration. ProMedica has ranked in the SDI’s top ten for the past nine years, earning the number- one ranking in both 2005 and 2007.

Goals for new RIS

Standardization of exams, preps, charge codes, order codes across ProMedica entities – to enable easier manage- ment and quality improvement
Integration – to connect a large and complex health system
Streamlining of radiology workflow – to provide faster report turnaround, increase staff efficiency and speed patient care
Scalability – to support 500,000 current annual radiology procedures as well as future procedure and site growth

In addition to single-desktop RIS/PACS/speech integration and single-vendor convenience, another reason for selecting Sectra RIS was an existing confidence ProMedica had in Sectra’s support and the Sectra PACS’ ability to utilize a master patient index (MPI) number. This MPI number is generated by another system within ProMedica; each hospital creates its own medical record number as a unique patient identifier, and the MPI links these medical record numbers together.

“When we went to replace the RIS we knew we needed a system that could also utilize the MPI,” explains McClure. “Because it worked with Sectra PACS, it was naturally assumed they could apply it to the RIS, and therefore our RIS and PACS would be in sync as to how they identify the patient.”

Needs analysis

ProMedica’s RIS selection and implementation team in- cluded IT staff, RIS super users, lead technologists, medical records and administration.

It took a lot of time and coordination by a variety of peo- ple to agree on several different components impacted by the RIS, as well as the items that required standardization.

For example, the ProMedica team had to agree about when, where and how reports were printed and delivered by site. As a standard component of its implementation process, Sectra also conducted a workflow analysis.

“It took us at least three or four months to get over our learning curve and understand exactly what was needed to do this implementation,” says McClure. “I almost think we were in denial for the first few months about needing to standardize all of our exams, preps, instructions and virtu- ally everything, and how we got to that was the key to the whole project.”

From Sectra’s standpoint, a key challenge was that each facility and radiology group had certain workflow requirements that it had to meet. For example, there were 25 different order classifications and priorities across the enterprise coming into the RIS, where typically a facility would have three (stat, routine and outpatient).

Implementation

The implementation process took a total of ten months, and ProMedica went live in April 2010. Sectra deployed its RIS with embedded speech recognition from Nuance Pow- erScribe® and single-desktop integration with its existing PACS. RIS and PACS can be installed on the same work- station, and in some cases ProMedica gained a workstation.

Additionally, Sectra developed 50 different interfaces to connect the RIS to other systems and modalities across the ProMedica Health System.

The data migration took seven out of the ten months to accomplish. There were several passes and different ver- sions to get the information exactly as ProMedica wanted to see it. Sectra worked with the previous RIS vendor to extract all the data and then import it into the RIS. A final step was to sync legacy medical record numbers to current numbers so historical reports were available in the new RIS and associated with the appropriate patient.

Approximately 35 ProMedica staff members were trained using a combination of onsite and “train-the-trainer” approach, and 65 radiologists were trained one-on-one twice, before go-live and then after as a follow up.

Sectra always had at least one representative on site for the eight weeks leading up to the go-live, and then sent 20 associates to assist with the go-live process for two weeks. All sites went live on the same day. After the go-live Sectra made several adjustments after users had time to experience the RIS, and Sectra continues to have calls with the radiol- ogy IT team to fine tune workflow.

“The Sectra team assigned to our implementation was extremely flexible,” says McClure. “They stepped up and made a lot of changes to the system, pretty much on the fly, to accommodate our needs.”

Some of the customizations Sectra made included adapt- ing the RIS to support seven different billing codes for each procedure and one single order code. Additionally, Sectra had to accommodate ProMedica’s need to continue hard copy report distribution, even though that is an older method of delivering the final radiology report.

Results

“The advantages of having one vendor and one system can’t be underestimated,” says McClure. “I now have four peo- ple on the radiology IT team who can effectively manage a highly complex system at multiple institutions.”

As a result of its Sectra RIS deployment with embedded speech recognition and single-desktop PACS integration, ProMedica Health System achieved the goals it had set while experiencing several additional benefits. The results of the implementation included:

Reduction of average report turnaround time from 24 hours to four hours, and immediately for ER cases
Improved access to exam and patient information with less clicks and easy navigation
Increased referring clinician satisfaction
Standardized exams, exam codes, charge codes, prep instructions, etc.
Improved workflow and integration
Establishment of a foundation for electronic medical records
Increased efficiency of radiologists and technologists
Improved real-time monitoring and ad-hoc reporting of key metrics
Reduction in the number of transcriptionists
Reduction in calls for report status and results
Greater convenience and easier staff management due to a single-vendor integrated solution

ProMedica Health System’s technologists have benefited significantly from the new RIS. They are able to take a more active role in running the department and managing workflow. RIS functionality enables them to filter by exams, sites, and radiologists, and adjust patient information as needed. Technologists have the ability to embed their notes into the radiology report using voice commands, and can conveniently access the RIS from virtually any PC or even work remotely, thus eliminating bottlenecks they experienced previously.

“We can navigate through searches and monitor what is outstanding, what needs to be verified, what needs to be read, what is missing, what didn’t get done, and how many exams are canceled for the day,” says Debbie Kluck, director of radiology, Bay Park Community Hospital. “We can now see live workflow processes in real-time.”

Tracking turnaround time and other key metrics is now a breeze for the staff. Where before they had to pull data from three different vendors’ systems (RIS, PACS and dictation), making it nearly impossible to do on a routine basis. The integrated solution from Sectra enables ProMedica to track exams from the moment the order is placed to the moment the report goes out, and to have a full account of all the steps in between and how long each took. Reporting functions in the Sectra RIS enable ProMedica to track referring physician volume trends, exam volume trends, modality utilization, report turnaround times and many other stats across all of their sites.

Words of wisdom

After undergoing a ten-month RIS implementation process, the ProMedica staff has the following pearls of wisdom to share with others:
Start looking for a new system immediately after your vendor tells you they are ending support for your exist- ing system.
Get buy-in from management up front – not only for decision-making purposes, but also for human resources.
Work towards standardizing your nomenclature before you start the implementation process.
Test all the different scenarios before you go live – order entry, order modified, grouping, accessing docu- ments, etc.
Ensure your diagnostic report includes the format and information that referring clinicians want and need.
Continue to meet after go-live to work out any kinks and further refine and improve your workflow, because you cannot expect to flip the switch and be done.

ProMedica Health System’s staff also share the following key reasons for hospitals and imaging centers to invest in a replacement RIS:

The entire radiology department works more efficiently;
Integration with PACS, other systems and modalities is tighter; and
The RIS helps lay the foundation for electronic distribution of images, information and patient records across the healthcare enterprise.

“I think that we are ahead of the game, because of the selection we made, and the dedication from our vendor,” says McClure. “People are adjusting to the RIS quite well, and there is a lot that we will be able to do in the future by virtue of the fact that we have an integrated RIS/PACS/ speech solution.”

ProMedica Health System video: See ProMedica Health System staff share their experience of implementing Sectra RIS/PACS