Maintaining continuity of clinical operations while implementing large-scale filmless operations

Area of Science:

• Medical Imaging Informatics
• Healthcare Operations Management
• Radiology Information Systems

Background:

• Texas Children's Hospital operates a large-scale, Digital Imaging and Communications in Medicine (DICOM)-compliant Picture Archival and Communications System (PACS).
• The PACS has evolved from a specialized ultrasound system to a comprehensive, multimodality operation.
• Maintaining continuity of clinical operations is the primary objective for the PACS staff.

Purpose of the Study:

• To outline strategies for ensuring uninterrupted clinical operations within a large-scale, multimodality PACS environment.
• To detail the essential components and procedures required for maintaining service continuity in a filmless radiology department.
• To address the challenges and solutions for managing a growing PACS installation in a pediatric tertiary care setting.

Main Methods:

• Implementing comprehensive redundancy across all PACS components, including acquisition, network, gateways, archive, and display.
• Establishing 24/7 service support with trained operators, users, and service personnel across three shifts, weekends, and holidays.
• Developing and rehearsing documented contingency plans for equipment failures, power outages, network disruptions, and Radiology Information System (RIS) interface interruptions.
• Implementing a structured problem reporting system, including a Trouble Call service and a RIS-based Maintenance Module for tracking service calls and actions.

Main Results:

• Successful transition to a full-scale, multimodality PACS operation with a focus on operational continuity.
• Established round-the-clock support and service, crucial for avoiding interruptions in clinical services.
• Developed and documented contingency procedures, alongside a robust problem reporting system.
• Defined clear responsibilities for imaging supervisors in a filmless environment to ensure accurate image delivery and verification.

Conclusions:

• Continuous clinical operations in a large-scale PACS depend on meticulous planning, redundancy, and trained personnel.
• Proactive management of PACS components, workflow, and potential disruptions is essential for reliable pediatric imaging services.
• Effective contingency planning and problem reporting mechanisms are vital for maintaining service integrity in filmless environments.