August 2003

Document Type


Degree Name



Dept. of Medical Informatics


Oregon Health & Science University


Introduction A member of the St. Joseph Health System of Orange, California, Covenant Health System (CHS) of Lubbock, Texas is the largest health care system in West Texas and Eastern New Mexico region. It consists of three main hospitals, Covenant Medical Center, Covenant Medical Center - Lakeside and Covenant Children's Hospital. These three facilities have a combined capacity of 1,338 beds. CHS is staffed by over 6,000 employees and has over 600 admitting physicians. CHS also has a number of affiliated and managed hospitals and clinics within the West Texas and Eastern New Mexico region. Last year, the administration of Covenant Health System decided to implement a picture archiving and communications system (PACS) at their main facilities. PACS is a computer hardware and software system that is designed to acquire, store and transmit and present digital radiographic images for interpretation and review. It is, in effect, 'filmless radiology'. All radiographic images, except mammograms, are acquired as digital data (virtual images), stored on a central server and made available on demand for viewing at computer workstations. At the workstations the images can be digitally manipulated in a number of ways in order to enhance their diagnostic value or to facilitate their viewing by the radiologist, clinician or nurse. The hospital administration initiated the plan to acquire a PACS and chose Fuji (FUJIFILM Medical Systems, Stamford, CT) as the vendor of choice. A PACS Committee was formed and consisted of the Vice President in charge of Radiology, the two chief radiological technologists, hospital information systems (IS) personnel and four radiologists. The mission of the PACS Committee is to oversee the PACS installation, make recommendations to best serve the needs of the hospital and the clinicians and to educate the end users of the PACS. The end users consist of the radiologists, the admitting and staff physicians, the nurses, the radiology technical staff and the hospital ancillary staff who may need to use the system. The evolution (revolution?) from film based radiology to a filmless system involves a paradigm shift for everyone who uses radiographic images. For PACS to be successful, it is of paramount importance to have as smooth a transition as possible. To this end, the education of the end user is critical. I am a member of the PACS Committee and one of my duties is to be the point of contact for PACS education of physicians and nurses. Of the twenty-five radiologists on staff at CHS, only myself and one other have had experience using PACS in an actual work environment. To the best of my knowledge, only a few of the over six hundred admitting physicians on staff have had personal experience with PACS and I would assume the same is true of the nursing staff. The hospital ran an article about PACS in the recent issue of the Medical Staff Newsletter. This publication is distributed to the admitting physicians of the hospital. The hospital also ran a special PACS edition of the Covenant Connection, the newsletter that is distributed to the employees of the hospital. These articles announced the hospital's decision to implement PACS this fall and described the advantages of PACS over hard copy film radiology. The articles were primarily public relations type news pieces, important for making the physicians and staff aware of the hospital's decision to implement PACS. They do not go into detail about how PACS will function, the changes that we will have to make in how we view radiographic images, and they don't address questions that the end users might have about PACS. In meetings with clinicians I learned that there is a wide range of opinion about the transition to PACS. Some groups (e.g., the emergency room physicians) are very enthusiastic about the change. Most of them are computer literate and they look forward to the efficiencies that PACS promises, studies performed more rapidly, more rapid interpretation of radiographic images, more rapid reporting of radiographic findings, electronic communication with the radiologists via PACS, all resulting in faster diagnosis and treatment of patients in the emergency room. On the other hand, some groups that I spoke with are more divided in their opinions. The orthopaedic surgeons had views of PACS that ranged from highly enthusiastic to hostile. Many of them admitted to being computer illiterate and they were very resistant to having to learn how to operate a workstation in order to view their 'films'. The hospital Vice President in charge of radiology plans to meet one on one with physicians in their offices to explain PACS, but this will be a time consuming and inefficient method of educating the clinicians. It also doesn't address the needs of the other end users such as the nursing staff. Clearly, an educational module is needed that can be used to address large audiences of end users. To this end I have undertaken the task of developing a PACS education module using PowerPoint. I chose PowerPoint because it is a well recognized application for education, it is transportable, it is compatible with various operating systems (it is cross-platform), it permits modification of the content of the presentation with relative ease as new information becomes available, and can be tailored to meet the needs of various audiences. My presentation is designed to be presented in formal or semi-formal settings. In it, I will review the history of PACS, its advantages and disadvantages and the necessity of changing the way we work with radiographic images. I will address the questions and issues of members of the audience and will provide them with a method (phone number and email address) by which they can have any other questions answered. In the two weeks prior to PACS implementation Fuji will be conducting small group training sessions in the use of the PACS workstation for the benefit of the end users. My educational program will be presented to larger groups of end users prior to this and will bridge the gap between the public relations announcements about PACS and the small group training sessions.




School of Medicine



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