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Title and Description
Digital Imaging Systems at John Paul II Hospital Cracow
Reviewed/ candidate case
Quality reviewed case
Short description
The implementation of a Picture Archiving and Communication System (PACS) as well as a Radiology Information System (RIS) was the most important part of the ICT strategy of John Paul II Hospital. It led to increased quality of care and cost reductions.
Objectives and purpose
Due to constantly decreasing public health care expenditures, the hospital's management began to look for ways improving its operational efficiency. The implementation of appropriate ICT applications was meant to facilitate both administrative and health operations. However, the core driver of ICT implementation in the hospital was not cost containment but a better fulfilment of its objectives: The hospital’s ICT strategy was established in 2002. Its aim was to become an “e-hospital”, which would utilise integrated digital networks in all departments and integrating the hospital's network with external institutions.
Detailed description
The John Paul II Hospital in Cracow is a public hospital specialising in treatment of heart and lung diseases. Established in 1917, it is today one of the most modern hospitals in Poland. It has about 520 beds, 40 specialised laboratories as well as a Diagnostics Centre for Heart and Lung disease. The Centre conducts about 100,000 tests and consultations yearly, including 60,000 imaging examinations.
Core information system elements Since 2002, all operational applications and systems have been modernised and integrated to create a digital platform for medical information exchange across the hospital. Most of the processes have been digitised through the following implementations: -- Picture Archive Communication System (PACS): A system for taking and processing digital diagnosis images. -- Network Radiology Acquisition, Access and Distribution (NetRAAD): A Radiology Information System (RIS). -- InfoMedica: An application whose primary use is detailed registry of health care services provision. -- Konsul: An application facilitating administrative tasks such as appointments and consultation management, an own development of the hospital. The PACS and the RIS play a crucial role in the process of providing health care services, the lnfoMedica and Konsul systems support the administrative and managerial activities. The NetRAAD and PACS systems were implemented between 2001 and 2005 and their initial cost was over 250,000 euros.
Digital imaging Similar to other health care institutions, John Paul II Hospital has until recently used film for producing radiographic images. Due to the high importance of diagnostic imaging in patient care, especially in the specialist clinics, the managing directors decided to replace the expensive, time-consuming, manual film-based system with digital technology. The PACS enables taking and processing digital images. It was deployed to provide a single tool for managing images and their associated data. It was supplied by University Health Care (UHC), a Polish specialist ICT provider for the health sector. Currently the system collects images from various devices including, among others, a Siemens Computed Tomography (CT) multi-row scanner, a General Electric (GE) Magnetic Resonance Imaging (MRI) scanner, and a GE rotational angiograph. Medical graphics workstations are provided by Siemens, GE, Marconi, and eFilm; thermal printers by Agfa. The RIS, which has been tailored to the hospital’s needs, links all specialised diagnostic imaging capabilities with the administrative systems and automates the daily operations of the radiology departments. It facilitates the document flow and patient records improving overall healthcare provision. The images and related information are stored in one repository. The RIS constitutes the backbone of the hospital’s operations. The RIS is used by radiology departments to store, manipulate and distribute patient radiological data and imagery. This enables medical personnel to conduct, for example, collaborative diagnosis in the clinic and via Internet with professionals outside the campus. The system consists of three core modules: NetARCH supports the storage of images, WebRAAD enables the distribution to multiple image repositories and viewing of the images and their descriptions, and NetRIS manages the workflow of the radiology department including patient tracking and scheduling.
Funding
The e-Hospital strategy was implemented from the hospital's own budget
Interoperability and standards
The integration of different systems within the clinic was a critical issue in order to enable a frictionless exchange of information. Common standards enabling system interoperability proved to be invaluable. The smooth connection of the PACS system with devices from different vendors, thus reducing implementation costs was facilitated by the DICOM standard for handling, storing, printing, and transmitting information in medical imaging. For instance, the CT scanner, the MRI scanner, and other machines of different vendors all communicate within the PACS via the DICOM protocol. The images from all modalities can be displayed and interpreted at the same PACS workstation and then sent to the same archives from where they can be distributed over the network or sent outside the clinic. Via HL-7 and DICOM protocols the RIS is operating in connection with the administrative systems, enabling the creation of digitised patient records and sharing of these files with satellite clinics. The connectivity and interoperability of the whole system was tested for one year to deliver an integrated system at the beginning of 2006.
Timescale
Start of planning
2002
1st milestone
2002: Definition of the e-Hosptial strategy
2nd milestone
The NetRAAD and PACS systems were implemented between 2001 and 2005
3rd milestone
Implementation of lnfoMedica and Konsul systems supporting the administrative and managerial activities.
Start of routine operation
2006
Evaluation
In the past
Characteristic of the application
Country
Poland
Part in the healthcare chain
Diagnosis
Therapy
Level of Implementation
Single site
Technology
Customised solution
Details on Technology
The hospital’s internal computer network is equipped with advanced anti-virus control management systems and identification of users. In order to deal with security issues and unauthorised access, the NetRAAD system provides multilevel protection of patient, examination and image data using passwords and access rights. Each access is recorded and can be tracked easily by a system administrator. User accounts and user groups are defined and maintained by the hospital’s system administrator. In general, all doctors in the hospital have full access that allows them to edit or view the data and images. Nurses and administrative personnel have limited access to the system with a view-only option. The program also provides a special educational user group setting, which allows access to medical information for instructional purposes, but restricts access to patients’ personal information. Until now there was no unauthorised access or grave records misuse incidents noted in the hospital.
Results
Outcomes
Digital imaging brought considerable cost benefits to the hospital. An X-ray picture is costly, demands a certain processing time and storage solutions. The results are less detailed and complicated for reviewing during consultations than on a digitally viewed high-resolution picture. PACS technology offers the hospital a nearly filmless process.It also removes all the costs associated with hard film. Furthermore, it takes only a few minutes to have a copy of the images burnt onto a CD or DVD while it may take up to two hours to have a hard copy on film. Apart from material costs, the hospital achieved sustained savings on imaging operations. Today, only two people are involved in conducting and delivering the tests on CD, i.e. a doctor or technician taking the tests and a person at the reception desk to burn and hand over a CD or DVD copy to a patient. Previously at least three departments and several people were involved. Furthermore, the storage space for radiology film processing, administration and archives was reduced and the space is now used for consultation purposes, which increased the capacity of the hospital.
Wider impact
The digital technology enables the integration of images into one care record, removing the inefficiency of keeping elaborations clipped to an X-ray picture and folded between the rest of patient health record written on paper. The electronic patient records provide a single source for on-demand clinical information. The hospital also achieved considerable efficiency improvements in diagnosis. PACS and NetRAAD systems have brought changes to all departments of the hospital where medical images are used. The main benefits of digital imaging include:Reduced delivery time: Faster delivery of medical images to the clinicians that evaluate and report on them. The reduced waiting time for results and diagnosis can be crucial in many heart diseases. Anytime access: Clinicians can access images at any time, they are not bound to archive opening hours. Better co-operation, as images can be viewed from multiple terminals and locations by a range of clinicians, thus facilitating discussion about diagnoses. This also results in improved communication between radiologists and referring clinicians and also with primary care institutions. Reduced number of lost or misplaced imagesImproved flexibility of handling imagesBetter information availabilityResearch and education supportMore efficient time management
Success factors
The deployment of ICT systems for digital imaging has improved quality of care and reduced cost. The greatest benefit for patients is that images are always readily available.
Failure factors
Among the main lessons learned during digital imaging implementation and system integration at John Paul II Hospital are the interoperability issues. According to Zbigniew Les from John Paul II Hospital, “only with closely integrated ICT systems throughout the hospital, the full image-enabled medical electronic patient record can become reality”. However, while extending the ICT network within the hospital and interconnecting it with the systems of other institutions, the hospital faced interoperability problems. Due to a lack of interoperability, John Paul II Hospital cannot take full advantage of the technology in place to extend its usage outside the campus: Lack of industry standards: On the one hand, “there are still too many versions of software that are not compatible within the sector causing difficulty to exchange data”, Mr. Les said.A lack of state regulation is a further reason: “The process of system integration within the hospital and with other institutions, for example the NHF, is hampered by a lack of clear state regulation about electronic data storage and exchange as well as a lack of standards for exchanging medical information.” Consequently, beside technical solutions, “the involvement of policy makers is equally important to bring clarity and impose some common solutions for the healthcare sector.”.
References
References and dissemination
Research for this case study was conducted by Aneta Herrenschmidt-Moller on behalf of e-Business W@tch. Sources and references used:Interview with Mr. Zbigniew Les, Manager of IT systems and Data Protection, and with his colleagues conducted in CracowHospital on 14 July 2006.JohnPaulIIHospital website: www.szpitaljp2.com.pl (May-July 2006), John Paul II Hospital annual reports, http://www.wrotamalopolski.pl/root_BIP/BIP_w_Malopolsce/root_UM/podmiotowe/Jednostki+organizacyjne/Zdrowie+i+pomoc+spoleczna/Szpital+Jana+Pawla/O+jednostce/default.htm. John Paul II Hospital press clippings, http://www.szpitaljp2.krakow.pl/onas.php.
Languages
English
Polish
Organisation implementing
Title
Mr.
Forename
Zbigniew
Surname
Les
Organisation
John Paul II
Department
Occupational background
CEO, CIO, CTO
Address of organisation
Krakowski Szpital Specjalistyczny im. Jana Pawła II ul. Prądnicka 80 31-202 KrakówPoland
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