Appl Clin Inform 2015; 06(03): 443-453
DOI: 10.4338/ACI-2015-01-RA-0014
Research Article
Schattauer GmbH

The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times

A mixed method study
A. Georgiou
1   Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australi
,
M. Prgomet
1   Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australi
,
S. Lymer
2   NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
,
A. Hordern
3   National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
,
L. Ridley
4   Medical Imaging Department, Concord Hospital, Sydney, Australia
,
J. Westbrook
1   Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australi
› Author Affiliations
Further Information

Correspondence to:

Dr Mirela Prgomet
Australian Institute of Health Innovation
Level 6, 75 Talavera Road,
Macquarie University, NSW, 2109, Australia
Phone: +612 9850 2421   

Publication History

received: 02 February 2015

accepted in revised form: 18 May 2015

Publication Date:
19 December 2017 (online)

 

Summary

Objectives: To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes; and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED).

Methods: We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff; and (ii) retrospectively extracted ED data before (March/ April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report).

Results: Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS; from a median of 76 hours to 38 hours per order (p<.0001) for patients discharged from the ED, and from 84 hours to 35 hours (p<.0001) for patients admitted to hospital. Medical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers).

Conclusions: The introduction of new health IT can be a “double-edged sword” providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department.

Citation: Georgiou A, Prgomet M, Lymer S, Hordern A, Ridley4 L, Westbrook J.The impact of a health IT changeover on Medical Imaging Department work processes and turnaround times: a mixed method study. Appl Clin Inform 2015; 6: 443–453

http://dx.doi.org/10.4338/ACI-2015-01-RA-0014


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Conflicts of Interest

The authors declare that they have no conflicts of interest in the research.

  • References

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  • 2 Mackinnon AD, Billington RA, Adam EJ, Dundas DD, Patel U. Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clin Radiol 2008; 63 (07) 796-804.
  • 3 van de Wetering R, Batenburg R, Versendaal J, Lederman R, Firth L. A balanced evaluation perspective: picture archiving and communication system impacts on hospital workflow. J Digit Imaging 2006; 19 (01) 10-17.
  • 4 Hains IM, Georgiou A, Westbrook JI. The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature. J Am Med Inform Assoc 2012; 19 (04) 506-513.
  • 5 Faggioni L, Neri E, Castellana C, Caramella D, Bartolozzi C. The future of PACS in healthcare enterprises. Eur J Radiol 2011; 78 (02) 253-258.
  • 6 Arenson RL, Andriole KP, Avrin DE, Gould RG. Computers in imaging and health care: now and in the future. J Digit Imaging 2000; 13 (04) 145-156.
  • 7 Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc 2011; 18 (03) 335-340.
  • 8 Institute of Medicine.. Health IT and patient safety: building a safer system for better care. Washington DC: The National Academies Press,; 2012
  • 9 Georgiou A, Westbrook JI, Braithwaite J. An empirically-derived approach for investigating health information technology: the elementally entangled organisational communication (EEOC) framework. BMC Med Informatics Decis Mak 2012; 12: 68.
  • 10 Tzeng WS, Kuo KM, Lin HW, Chen TY. A socio-technical assessment of the success of picture archiving and communication systems: the radiology technologist’s perspective. BMC Med Informatics Decis Mak 2013; 13 (01) 109.
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  • 16 Bowling A. Research Methods in Health (Third Edition). Berkshire, England: Open University Press; 2009
  • 17 Callen J, Paoloni R, Georgiou A, Prgomet M, Westbrook JI. The rate of missed test results in an emergency department: an evaluation using an electronic test order and results viewing system. Method Inform Med 2010; 49 (01) 37-43.
  • 18 Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf 2011; 20 (02) 194-199.
  • 19 Georgiou A, Lymer S, Forster M, Strachan M, Graham S, Hirst G, Callen J, Westbrook JI. Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers’ hospital. J Am Med Inform Assoc 2014; 21: 1104-1108.
  • 20 Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006; 27 (02) 237-246.
  • 21 Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 1998; 52 (02) 119-126.
  • 22 Krishnaraj A, Lee JKT, Laws SA, Crawford TJ. Voice recognition software: effect on radiology report turnaround time at an academic medical center. Am J Roentgenol 2010; 195 (01) 194-197.
  • 23 Berlin JW. The Four S’s: A Response to Market Forces Influencing Imaging. Am J Roentgenol. 2009: 565-567.
  • 24 Kennedy RL, Seibert JA. Error component analysis for PACS: operational sources of data error in real world PACS for DICOM series, study, and patient level identifiers. Med Imag 2002; 4685: 206-216.
  • 25 Ingebrigtsen T, Georgiou A, Clay-Williams R, Magrabi F, Hordern A, Prgomet M, Li J, Westbrook JI, Braithwaite J. The impact of clinical leadership on health information technology adoption: systematic review. Int J Med Inform 2014; 83: 393-405.
  • 26 Toouli G, Georgiou A, Westbrook JI. Changes, disruption and innovation: an investigation of the introduction of new health information technology in a microbiology laboratory. J Pathol Inform 2012; 3: 16.
  • 27 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care –an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 (05) 542-549.

Correspondence to:

Dr Mirela Prgomet
Australian Institute of Health Innovation
Level 6, 75 Talavera Road,
Macquarie University, NSW, 2109, Australia
Phone: +612 9850 2421   

  • References

  • 1 Siegel EL, Reiner BI. Filmless radiology at the Baltimore VA Medical Center: a 9 year retrospective. Comput Med Imaging Graph 2003; 27 (02) 101-109.
  • 2 Mackinnon AD, Billington RA, Adam EJ, Dundas DD, Patel U. Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clin Radiol 2008; 63 (07) 796-804.
  • 3 van de Wetering R, Batenburg R, Versendaal J, Lederman R, Firth L. A balanced evaluation perspective: picture archiving and communication system impacts on hospital workflow. J Digit Imaging 2006; 19 (01) 10-17.
  • 4 Hains IM, Georgiou A, Westbrook JI. The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature. J Am Med Inform Assoc 2012; 19 (04) 506-513.
  • 5 Faggioni L, Neri E, Castellana C, Caramella D, Bartolozzi C. The future of PACS in healthcare enterprises. Eur J Radiol 2011; 78 (02) 253-258.
  • 6 Arenson RL, Andriole KP, Avrin DE, Gould RG. Computers in imaging and health care: now and in the future. J Digit Imaging 2000; 13 (04) 145-156.
  • 7 Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc 2011; 18 (03) 335-340.
  • 8 Institute of Medicine.. Health IT and patient safety: building a safer system for better care. Washington DC: The National Academies Press,; 2012
  • 9 Georgiou A, Westbrook JI, Braithwaite J. An empirically-derived approach for investigating health information technology: the elementally entangled organisational communication (EEOC) framework. BMC Med Informatics Decis Mak 2012; 12: 68.
  • 10 Tzeng WS, Kuo KM, Lin HW, Chen TY. A socio-technical assessment of the success of picture archiving and communication systems: the radiology technologist’s perspective. BMC Med Informatics Decis Mak 2013; 13 (01) 109.
  • 11 Jorritsma W, Cnossen F, van Ooijen PMA. Merits of usability testing for PACS selection. Int J Med Inform 2014; 83 (01) 27-36.
  • 12 Hurlen P, Østbye T, Borthne A, Gulbrandsen P. Introducing PACS to the late majority. A longitudinal study. J Digit Imaging 2010; 23 (01) 87-94.
  • 13 Mekhjian HS, Kumar RR, Kuehn L, Bentley TD, Teater P, Thomas A, Payne B, Ahmad A. Immediate benefits realized following implementation of physician order entry at an academic medical center. J Am Med Inform Assoc. 2002; 9 (05) 529-539.
  • 14 Sittig DF, Singh H. A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care. 2010; 19 (03) i68-i74.
  • 15 Stoop A, Heathfield H, de Mul M, Berg M. Evaluation of patient care information systems. In: Berg M. editor. Health Information Management. London: Routledge; 2004: 206-229.
  • 16 Bowling A. Research Methods in Health (Third Edition). Berkshire, England: Open University Press; 2009
  • 17 Callen J, Paoloni R, Georgiou A, Prgomet M, Westbrook JI. The rate of missed test results in an emergency department: an evaluation using an electronic test order and results viewing system. Method Inform Med 2010; 49 (01) 37-43.
  • 18 Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf 2011; 20 (02) 194-199.
  • 19 Georgiou A, Lymer S, Forster M, Strachan M, Graham S, Hirst G, Callen J, Westbrook JI. Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers’ hospital. J Am Med Inform Assoc 2014; 21: 1104-1108.
  • 20 Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006; 27 (02) 237-246.
  • 21 Agresti A, Coull BA. Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 1998; 52 (02) 119-126.
  • 22 Krishnaraj A, Lee JKT, Laws SA, Crawford TJ. Voice recognition software: effect on radiology report turnaround time at an academic medical center. Am J Roentgenol 2010; 195 (01) 194-197.
  • 23 Berlin JW. The Four S’s: A Response to Market Forces Influencing Imaging. Am J Roentgenol. 2009: 565-567.
  • 24 Kennedy RL, Seibert JA. Error component analysis for PACS: operational sources of data error in real world PACS for DICOM series, study, and patient level identifiers. Med Imag 2002; 4685: 206-216.
  • 25 Ingebrigtsen T, Georgiou A, Clay-Williams R, Magrabi F, Hordern A, Prgomet M, Li J, Westbrook JI, Braithwaite J. The impact of clinical leadership on health information technology adoption: systematic review. Int J Med Inform 2014; 83: 393-405.
  • 26 Toouli G, Georgiou A, Westbrook JI. Changes, disruption and innovation: an investigation of the introduction of new health information technology in a microbiology laboratory. J Pathol Inform 2012; 3: 16.
  • 27 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care –an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 (05) 542-549.