Restructuring to Accommodate the ICTs
Implementation of the new technologies at Wakefield Radiology has been incremental, with the build-up to PACS taking about three years. Teleradiology was first used at the Lambton Quay branch in 1996, digital imaging technology was then implemented from 1999 and finally PACS was implemented at the main campus in Newtown in 2000. Since then, the number of sites and the size of the system have been increasing steadily. Equipment and technology are upgraded on average about once a year.
Trevor estimates that the new technologies have contributed to about a 10 percent increase in staff training costs. Frequent upgrading requires constant staff training, but he sees it as worthwhile and has noticed a lot of overlap in training - staff can use the skills they learn in other aspects of their work. New staff need quite comprehensive training to become familiarised with the technology used at Wakefield Radiology. Trevor estimates that the technology is only used in about 10-15 percent of radiology firms in New Zealand, so the majority of new staff members are not familiar with the systems. The state of the art technology and the commitment of the practice to training staff in its use means that in a highly competitive and mobile international market for health professionals, Wakefield Radiology is a workplace that is able to attract high quality staff for all positions. This further reinforces the high quality image that the practice aims to convey to patients and referrers.
Since the implementation of the PACS in 2000 and the RIS in early 2003, staff numbers at Wakefield Radiology have increased by about 56 percent. Due to overall growth in the business, it is difficult to separate out the increase in staff numbers necessitated by the change in technology, but Trevor believes that at least some of the increase is due to the technology. The staff mix has definitely changed as a result of implementing the technology. A full time PACS administrator has been employed, and there is no longer a requirement for a filing clerk following the implementation of the new RIS. On the whole, there is an improvement in productivity, as overall there has been an increase in the number of patients seen relative to total staff employed.
Wakefield Radiology now has an in-house IT specialist. The creation of this position came about gradually, first with the specialist being on call, then becoming part-time when the need for IT support grew. The IT specialist is now employed full-time, and is imperative to the smooth running of the various technologies being used and to advise on new technologies as they evolve. Wakefield Radiology always has several prospects on the go at any one time in a very dynamic market.
To get the maximum efficiency from the technologies, Trevor says that the firm needs to have IT support from both the IT provider and their own IT specialist. As mentioned above, the service provisions offered by a vendor were an essential part of the decision to implement new technology, and currently the IT vendor has support staff carrying out remote monitoring of the computer system. This remote monitoring has at times detected and resolved problems with the system before the radiology staff have even noticed a problem. Thus, the IT support staff of the firm work in both a preventative and reactive role, helping to achieve maximum benefits from the ICTs.
Also, there has been a change in the responsibility of front-line staff at Wakefield Radiology following the implementation of the new technologies. Processes have been moved to the front, so that receptionists are now much more responsible for managing patient relationships and information, allowing radiographers to concentrate on image production. Reception staff have welcomed the increased responsibility as it makes their work more interesting.
The information process for a typical patient is outlined in Table 1 below, the left column showing the process under the old system, and the right column showing how things are done currently using the computer systems (also refer to information flow diagrams in Appendix).
The switch from the "blue folder" system to the use of the RIS and PACS at Wakefield Radiology has resulted in some changes to the information process and a markedly different focus. Previously the information flow was tied to the file (i.e. the blue folder), making procedures, consultations or even simply adding information, at multiple locations very difficult. This created bottlenecks in the process, where the transfer of the file to different locations was very time consuming and caused delays.
Table 1: Typical Process for a Patient at Wakefield Radiology| Process under Blue Folder System | Process under RIS and PACS |
| Referrer sends patient to radiology. | Referrer sends patient to radiology. |
| Patient gives details at reception; details are checked, logged in file. | Patient gives details at reception, details are checked, logged and referral form scanned into RIS. |
| The file and the patient go to radiographer, who checks tasks in file. Data is re-entered onto film. Image is taken and stored in PACS, radiographer's working notes are added to blue folder. | The patient goes to radiographer, who checks tasks on RIS. Patient information is electronically transferred to film.
Image is taken and stored in PACS, radiographer's working notes are scanned into RIS. |
| Patient receives the film. | Patient receives a film print out (or on CD etc) if desired. |
| Patient is invoiced at accounts desk, payment details entered into RIS. | Patient is invoiced at accounts desk, payment details entered into RIS. |
| File (now with patient details, radiographer's working notes) goes to courier and on to radiologist. Radiologist studies the file and dictates report, which is added to file. | Radiologist brings up file on RIS and image on PACS and dictates report in RIS. |
| File (patient details, radiographer's working notes, invoicing details, radiologist's report) is typed by typist and goes to file clerk to be reconciled and stored, while a copy of the radiologist's report goes to courier and on to referrer (and patient). | Report is typed in RIS by typist, electronically verified by radiologist and sent via Internet to Healthlink (or sent directly to referrer via fax, email, or courier). Healthlink transfers information to referrer (and patient). |
With the new technology, information has become the focus of the system, so that instead of being "job-centric" as before, the process is more "patient-centric" - the focus is on patients and their information, rather than on following the physical file through the system. The technology has enabled effortless reconciliation of multiple jobs for the same patient, and multiple locations (of procedures or consultations) have been made irrelevant. Central control of patient details allows simultaneous actions on a patient's file, and any actions performed can be tracked by the click of a button using the "audit trail" feature of the RIS software.
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