Merle West Medical Center
Klamath Falls, OR

"I wasn't always a proponent of the technology," recalls Chabner. "I knew that our Radiology department could be improved and that we were losing film and misplacing originals, but I also associated PACS with a high price tag."

While at the conference, Chabner listened to the success stories of other hospitals utilizing PACS and was impressed by the unanimous return-on-investment (ROI) that those hospitals were experiencing. Upon his return to Klamath Falls, he pushed his hospital board to invest in an imaging solution. "Although cost was an issue, PACS was essential to the further development of our EMR," says Chabner. "Initially, we had slated PACS for deployment at a later date, but due to the hard evidence of immediate ROI, we pushed it up to the front burner."

Merle West found the PACS solution provided by DR Systems and MEDITECH's PACS Interface Suite to be a perfect fit, and since going LIVE in 2002, Chabner says they've never looked back. Merle West's PACS has benefited the hospital, its providers, and its patients--as it allows the site to save money on film purchase and processing, while giving providers easy access to detailed on-line exam results so they can give their patients accurate diagnoses in less time.

Enhancing Efficiency for Providers
For care providers, having all of the most current information at their fingertips is essential for improving workflow and overall efficiency. MEDITECH's PACS Interface Suite has been designed to support a seamless, two-way flow of data between the hospital's information system and its PACS. As a result, providers can view up-to-date demographics and exam details whenever they need them, without having to hunt down paper records. In addition, providers are alerted through a status update the moment a requested image is available for viewing.

"Physicians are able to launch images directly from the electronic medical record application (PCI) with the simple click of a button," says Chabner. "It's very important for our referring physicians to be able to view images on-line, and furthermore we have entirely eliminated the problem of lost film and misplaced originals."

With the DR Systems/MEDITECH PACS solution, providers have a number of additional benefits, such as the ability for a referring physician or radiologist to actually view the exam before it's finalized. This saves a great deal of time for both the physician and the radiologist, as the physician can make sure that the image is clear and correct before it is finished. "This feature is great in trauma situations and while doing ultrasounds," says Chabner. "A physician can easily look at an image while the radiology technician is performing the test and then instruct the radiologist to go deeper with the ultrasound. This capability makes both the physician's and the radiologist's jobs much easier."

Physicians at Merle West also benefit from using a voice clip, which is a recording of the radiologist's report, attached to the image. "Our physicians love this technology, as reports used to lag behind the image and often were not ready as quickly as they were needed," says Chabner. The voice clip provides a way for the radiologist to immediately comment on an exam as it is being interpreted, which adds both value and efficiency to the exam, providing physicians with reports even more quickly.

Extending PACS Beyond the Hospital Walls
The imaging capabilities at Merle West serve the organization's multi-entity structure. For example, Merle West owns a medical office building located directly behind the hospital, which they lease to an orthopedic clinic. The clinic has access to the hospital's MEDITECH software, and can send images to the hospital's PACS. And since patient results are part of the electronic medical records, images automatically follow patients if they need to transfer to a different facility. The system's interoperability allows patients to choose a location for services, which is usually more convenient than traveling to the medical center.

The PACS system also benefits care providers at other facilities, working in conjunction with Merle West. This includes trauma reference facilities that provide Merle West with immediate neurosurgery access when needed. Through the PACS, the neurosurgeons are able to look at images taken at Merle West and determine whether or not a specific patient needs to be relocated for care. Merle West is also a campus for the Oregon Health Science Medical School in Portland, which conducts rural family practice residencies at Cascades East Family Practice Center. The Center is wired in every exam room with PACS and MEDITECH for seamless viewing of exams and patient information.

Even when working at home or travelling, physicians can have access to imaging technology, as remote access capabilities are available via CITRIX to keep physicians connected to the system at all times. Merle West is also in the process of acquiring the DR Systems PACS technology that will burn reports, voice clips, and images onto a CD, which will be beneficial for times when a patient needs to be transported out of the enterprise or when a physician doesn't have remote access.

Why DR Systems?
During its search process, Merle West narrowed down the initial selection of PACS vendors to Philips, Kodak, and DR Systems. Despite the fact that Philips and Kodak were already equipment providers for the hospital, it was DR Systems that ultimately won out. "Three factors stood out in the selection of DR Systems," says Chabner. "Ability to work with MEDITECH, a solid architecture, and a proven track record of success." A firm believer that PACS will not be successful unless radiologists are one-hundred percent on board with the effort to eliminate hardcopies, Chabner observed during site visits that the DR sites "had the other vendors hands down" in terms of being completely electronic.

A reliable system not only saves a hospital wasted time and frustration, but also affects the quality of care. Because images are often used during critical situations and are so vital to the care process, the PACS is designed to reside on its own Virtual LAN (VLAN), and is designed with sufficient redundancies as to create a high level of reliability. "PACS is a technology that absolutely cannot experience any downtime," says Chabner. "We built a new computer room last year, and our PACS was the only system that didn't go down."

Meeting Challeges Head-On
Implementing the new PACS technology required Merle West's staff to make some adjustments in their work methodologies, but as Chabner observed, they were well rewarded for their efforts. "To minimize the difficulties, I recommend that organizations give their radiologists a lot of planning time, as they will need to re-engineer their work processes. We also found it beneficial to select certain staff to train our physicians one-on-one and to follow them on their rounds showing them how to use the PACS," he says.

"Initiating any kind of change can be a challenge, but now, our staff wouldn't do without it." Chabner recommends, above all else, that organizations looking to implement PACS get their radiologists on board with the entire process, from vendor selection through implementation.

In view of their success, there is a very real chance that David Chabner could be on the other side of the podium at the next PACS conference he attends. "With the backing of a strong PACS solution provided by two reliable vendors, and the determination of our dedicated hospital staff, Merle West is no longer listening to success stories, but is one," he says.