Impact of picture archiving communication systems on rates of duplicate imaging: a before-after study

<p>Abstract</p> <p>Background</p> <p>Electronic health information systems, such as picture archiving communication systems (PACS), are commonly believed to reduce the need for duplicate testing. However, empirical data to support this belief are not available.</p> <p>Methods</p> <p>Before-after study using administrative claims data from the Ontario Health Insurance Plan to determine whether the introduction of PACS at 10 hospitals in the Thames Valley region of southwestern Ontario, Canada between June 2004 and December 2005 reduced the frequency of duplicate imaging examinations. The imaging modalities studied were: chest and abdominal X-ray; computed tomography of the abdomen/pelvis, head, and chest. The frequency of duplicate testing was examined at 3 different time frames: 7 days, 30 days, and 60 days after a given index test.</p> <p>Results</p> <p>Overall frequencies of duplicate imaging were: 2.7% within 7 days of an index imaging test, 6.7% within 30 days, and 9.8% within 60 days. Comparing the 12 months before and 12 months after PACS, absolute reductions in the frequency of duplicate X-rays using 7-day, 30-day, and 60-day time frames were: 0.2% (P = 0.01), 0.6% (P < 0.001), and 0.9% (P < 0.001), respectively. In contrast, there were absolute <it>increases </it>in the frequency of duplicate CT scans after PACS of 0.0% (P = 0.92), 0.5% (P = 0.01), and 0.5% (P = 0.01), respectively.</p> <p>Conclusion</p> <p>The frequency of duplicate imaging is relatively low and we did not find large reductions in duplicate imaging after the introduction of PACS. Independent evaluation of electronic medical systems should be conducted to confirm widely held beliefs of their potential benefits.</p

Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

<p>Abstract</p> <p>Background</p> <p>One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS).</p> <p>Methods</p> <p>Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups.</p> <p>Results</p> <p>There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence.</p> <p>Conclusion</p> <p>Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.</p

Creation and Usability Testing of a Web-Based Pre-Scanning Radiology Patient Safety and History Questionnaire Set

Recent advances in technology have significantly changed radiology workflow. The main focus of these changes has been the transition from hard copy film to digital imaging. The next transition will be a “paperless” transformation. Web-based versions of the current paper-based patient safety and history questionnaires were created using PHP and MySQL. Two rounds of usability testing using volunteers were completed using tablet PCs. Volunteers were comprised of ten individuals. Ages of volunteers ranged from 27 to 60 years, and there were eight males and two females. The majority of users had at least a Master’s degree and was considered to have a computer experience level of a programmer. Eighty percent of the users agreed that the web-based questionnaires and tablet PCs were easy to use. Text input through the writing recognition window and scrolling proved to be the least usable sections of the questionnaires. The new web-based system was found to be a very usable system by our participants. The questionnaires were easy to use, easy to navigate, and easy to read. Individual elements such as radio buttons and checkboxes did not fair as well but were due to their small size. Difficulty with the writing recognition interface is an inherent issue with the Windows XP Tablet Edition operating system

From Traditional Reading Rooms to a Soft Copy Environment: Radiologist Satisfaction Survey

Academic radiologists are experiencing increased clinical workloads. New technology such as picture archiving and communication systems (PACS) are often justified on the premise of increased efficiency. The authors believe that efficiency can be influenced by the image interpretation environment, and thus they set out to establish baseline satisfaction levels with this environment. The authors surveyed 90 Indiana University (IU) faculty radiologists, fellows, and residents. Their survey was implemented with a questionnaire sent via e-mail. Questions focused on satisfaction with the current soft-copy reading environments and preferences regarding improvements. Of the 90 radiologists surveyed, 55 (61%) responded. Several key findings emerged: (1) Overall satisfaction with the soft-copy environment is low, with nearly half (46%) of respondents rating themselves as “very dissatisfied” or “dissatisfied.” (2) Faculty are least satisfied regarding work space ergonomics, room layout, and amount of work space. Appropriate lighting also emerged as an area with low satisfaction and high importance. (3) Ninety-eight percent of respondents indicated that an “ideal” soft-copy environment would have a positive effect on their efficiency. The dissatisfaction with the current soft-copy interpretation environments used by the IU radiologists indicates that this is an area that requires attention. Furthermore, there may be a direct relationship between radiologist efficiency and satisfaction with the image interpretation environment. Attention should be focused on this environment during a soft-copy technology implementation to ensure that planned efficiency gains are realized

Monitoring the PACS Implementation Process in a Large University Hospital—Discrepancies Between Radiologists and Physicians

Successfully introducing a new technology in a health-care setting is not a walk in the park. Many barriers need to be overcome, not only technical and financial but also human barriers. In this study, we focus on the human barriers to health-care information systems’ implementation. We monitored the acceptance of a Picture Archiving and Communication System (PACS) by radiologists and hospital physicians in a large Belgian university hospital. Hereto, questionnaires were taken pre-implementation (T1) and 1 year after the radiology department stopped printing film (T2). The framework we used to perform the study was the Unified Theory of Acceptance and Use of Technology. Main findings were that both groups were positive toward PACS prior to the introduction and that each group was even more positive at T2 with extensive PACS experience. In general, the ratings of the radiologists were higher than those of the physicians, as the radiologists experienced more of the benefits of PACS and had to use PACS throughout the day. Two factors were salient for predicting users’ intention to use PACS: the usefulness of PACS (performance expectancy) and the availability of support of any kind (facilitating conditions). The results show that our approach was successful. Both radiologists and physicians give evidence of an excellent level of user acceptance. We can conclude that the implementation of PACS into our hospital has succeeded