One of the biggest challenges that both acute and ambulatory facilities face when installing a PACS is tailoring the system to meet their needs.  A properly integrated workflow is critical for a PACS to be truly efficient and is the key to minimizing cost. 

In order to deal with the unique challenges each facility presents, PowerServer has been outfitted with a powerful workflow engine.  This allows it to work in hospitals, outpatient clinics, teleradiology facilities, mobile x-ray companies, as well as a large number of hybrid scenarios.  On top of that, full compliance with the DICOM and HL7 standards as well as a large number of IHE profiles, allows the software to easily interact with the numerous other systems found in healthcare facilities.

The following segment outlines an existing RamSoft installation to showcase the adaptability of the PowerServer PACS.

West Lincoln Memorial Hospital
This Canadian health care facility uses RamSoft PowerServer PACS in conjunction with the Meditech Hospital Information System / EMR.  The PowerServer software is being used by the radiology department, the ER, and numerous hospital physicians.

Radiology orders are entered into the Meditech system.  The patient information along with the scheduled study information is transferred into PowerServer via HL7.  In turn, PowerServer makes the scheduled study information available to the modality via the DICOM Modality Work List service.  This level of integration ensures that the patient and study data is only entered once, removing the possibility of errors due to multiple entry.

The technologist brings the patient into the exam room, chooses the ordered procedure from the worklist and performs the exam.  Once the imaging is complete, the images are automatically sent to PowerServer.  At that point, the completed exam automatically appears on the tech’s worklist.  The tech scans in the paper requisition, verifies the images and demographics, and adds any required notes.  As soon as the tech completes this work, the exam moves off of their worklist and is ready for interpretation.    

The unread exams are now available to the on-call radiologist as well as the ER doctors.  Based on the department/location that is typed into Meditech, PowerServer automatically assigns priorities.  This allows the reading doctor to determine the urgency of the cases on their worklist.  When a radiologist is not present, the ER physicians view the images and leave a short voice note in PowerServer with their preliminary interpretation. 

When a radiologist logs into PowerServer, they automatically see all unread exams.  For cases that have been interpreted by an ER physician the night before, the radiologist can play back the voice clip to review the preliminary interpretation.  The radiologists dictate their findings directly into PowerServer.  A radiologist can link up related exams, so that they may be dictated with a single report, eliminating a common problem with many PACS interfaces. As cases are read, they disappear from the unread worklist and immediately become available to transcription.

Transcriptionists play back the dictation using PowerServer and type reports directly into the Meditech system.  The reports are then sent back into PowerServer via HL7 and are automatically associated with the images, allowing them to be easily accessible for prior study comparison.

Throughout the various stages of workflow, updates are sent back to Meditech from PowerServer along with a study reference URL.  This allows hospital physicians to use the EMR to determine the status of a radiology study and to launch RamSoft PowerReader with a single mouse click to view images and burn patient CDs containing images and reports.