Harvesting PACS audit data yields operational gains

PACS audit data can do more than just ensure HIPAA compliance; it can also be a gold mine for driving quality improvement, according to the experiences of two healthcare institutions.

"We can maximize the power of our PACS audit data," said Bill Gregg, a PACS administrator at Louisiana State University (LSU) Health Sciences Center in Shreveport. He discussed his institution's experience during a talk at the Society for Imaging Informatics in Medicine (SIIM) annual meeting in June.

Radiology data comes from many places today, including HIS/RIS systems and financial systems. These data are utilized to provide information such as patient visit statistics and for billing and collections, as well as tasks such radiology exam procedure workflow, Gregg said. Users are able to view these data in many ways, including static Web-based reports or digital dashboard applications.

Following the onset of HIPAA, LSU gained audit access in 2004 to its protected health information, and subsequently created the first iteration of its audit log application to utilize the XML audit log files from its PACS (GE Healthcare, Chalfont St. Giles, U.K.).

In 2006, LSU offered its PACS audit log as an open-source application to the GE user community. Workflow analysis capability was later added in 2007.

"Audit data has a lot of value today," Gregg said. "As more information is added to it, more value will be derived. You want to 'mine' this data to provide useful information."

A number of events are logged in these XML files, including exam changes (with status), exam viewed, exam printed, login/logout, and exam merge/patient merge, he said.

The audit logs' display of discrete exam status information opens the door for calculating time spans for metrics such as "ordered to arrived," "arrived to verified," "verified to dictated," "dictated to completed," and "ordered or arrived to completed," Gregg said.

These time spans show progress for an exam, and when taken in the aggregate workflow, statistics can be generated, he said. Reports can be developed broken down by date range, modality, and shift.

"Lengthy time spans can be focused on," Gregg said.

As a quality improvement initiative, the institution sought to reduce the number of exams taking more than one hour to verify. The radiographer staff was informed of the goal, and monthly reports were generated and utilized for user education and to track monthly percentages, he said.

Before the quality improvement process was initiated, between 15% and 30% of exams took more than an hour. The number of exams decreased rapidly during the first several months and has declined to a fairly stable plateau of less than 5%, according to Gregg.

"It's been very effective for us," he said. "We've demonstrated quality improvement based on this type of analysis."

Real-time data and radiologist locator tool

Staten Island University Hospital in New York City has also experienced success with utilizing PACS audit data, benefitting from real-time statistics and even a radiologist locator tool, said Dr. Jason DiPoce, who also spoke during the SIIM meeting.

"They're very useful for keeping long-term statistics, such as how many procedures were performed and turnaround times," he said. "Audits can also be used for exam and user audits."

After its PACS vendor initially generated PACS audit data only in a daily XML log file, the hospital sought a more real-time method of receiving data. In cooperation with the vendor, the institution employed socket connection technology and developed computer code in PHP to receive the real-time events, according to DiPoce.

A SQL server database was developed to store the information, with fields named exactly as the vendor described the event components. An "event listener," a PHP script that runs as a service, automatically enters the event information directly into the database. A disadvantage of this approach is the need for extensive programming, DiPoce said.

A Web page, also written in PHP, was created to allow for general queries of the database, DiPoce said.

"This is good for quick answers about all events associated with a given exam or user," he said.

A "Where are my radiologists?" feature has also become quite popular in the department, DiPoce said. Users can see where and when each radiologist last looked at a case, with their phone number.

"Radiologists at our institution have a lot of opinions of this," he said. "Some people like it, some people don't. But the bottom line is, everybody uses it, and it's [here] to stay at our institution."

By Erik L. Ridley
AuntMinnie.com staff writer
August 24, 2009

Related Reading

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Multitouch imaging displays, Wii remote show promise in PACS, July 8, 2009

Handheld devices show promise for patient education, June 8, 2009

Treadmill-based workstation gets radiologists moving, June 6, 2009

Ergonomic practices can decrease repetitive stress injuries, May 18, 2009

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