Clearly, the aim behind introducing a PACS is to install a system that optimizes modern radiology processes through its functionality and user-friendliness, and supports users to the greatest possible extent during their daily work. At Alexianer in Münster, however, the means was also the end. That is because the entire implementation phase in the Clemenshospital and in the Raphaelsklinik was anything but usual, and required finesse, flexibility and a great deal of specialist knowledge.
Rüdiger Kerkloh, who works in system communications at Alexianer DaKS GmbH, which is responsible for the IT infrastructure across the entire Alexianer Group, refers to it in terms of open-heart surgery. "The entire implementation ran on the fly - by which I mean that when commissioning it, we were not able to predict the precise scope and all the user requirements. The reason for that lay partly in the parallel introduction of a new HIS and a number of additional sub-systems. Naturally, before the start of the project we carried out an evaluation, but the actual scope only really became apparent in the weeks and months following the kick-off. So we needed a partner that not only offers excellent PACS, but is also flexible, creative and able to work in partnership for the implementation."
The fact that the starting-gun was fired at all in autumn 2017 for introduction of a new PACS in the two Münster hospitals was down to the maintenance contract on the old system coming to an end, combined with the fact that the system itself was aging. Based on the excellent experience that the Alexianer Maria-Hilf hospital in Krefeld had had using JiveX, it was an easy decision for DaKS to opt for that system. "Firstly, we were convinced by its functionality, but equally by the VISUS service. Excellent collaboration was the pre-requirement for the success of the overall project," says Kerkloh.
Fast, flexible and thorough
Despite all the imponderables, managers at DaKS and VISUS had just three months from the project start at the end of September 2017 to get JiveX up to speed for real-time operation. And JiveX needed to be fully deployable alongside introduction of the new HIS at the turn of the year.
"On the first day following kick-off, the customer made the hardware available and undertook the basic installation. Two days after that, we started on transferring the legacy data."
Projekt Manager, VISUS Health IT
At the start of the project, the questions of how many - and above all which - clients were needed where was bottomed out. Ultimately, what this showed was that, alongside the Diagnostic Advanced and Review Clients, Web Clients also played an important role – namely in ensuring hospital-wide image distribution. In addition, Mammography Client is also used. "It was certainly just as brave for VISUS as it was for us to get involved in a project whose scope only became apparent after it had started. Mammography Client, for example, was not planned beforehand," says Kerkloh. But with rapid introduction of the right clients in the right place, one obstacle to a seamless change to JiveX was already overcome early on: users were already able to work with the JiveX interface - even though far from having all modalities connected at that stage. In the transition phase, DaKS directed data forwarding from the legacy PACS into JiveX, which was why all data could be called up via the clients. Thus it was possible to integrate the modalities bit by bit in the background - with this process being imperceptible for the user. Integration into the HIS was also possible without issues, because the Web Viewer via which access is provided to the PACS studies from the HIS was already in use. With real-time operation of the new HIS on 1 January 2018, the new PACS was also running, which was then further adapted to user requirements whilst in operation - in effect, fine-tuned.
New routings for old data flows
It was not only the flexibility that VISUS showed over the number and set-up of clients that convinced the DaKS team. Unexpected obstacles, too, were mastered using straightforward and creative solutions. "For example, the fact that we could not easily change the patient IDs in Radiotherapy in the Clemenshospital. The patient's radiation dose is a cumulated total over the entire course, and with a change of ID for existing patients that would have created a break in continuity. VISUS considered a customized solution for this, and ensured that the old IDs are accessed automatically for existing patients," says Kerkloh. The IT experts at DaKS are also convinced by the transparent and simple ease of administration, for example the Worklist, which they rate as offering extremely adaptable parameterization.
But from the medical perspective, too, there have been some benefits since introducing JiveX. For example, currently a pilot project at the Clemenshospital is trialling feeding the ultrasound images directly into PACS too, so that these are now available hospital-wide, rather than only being viewable at the workstations for the special systems. And the image captures from endoscopy are also being fed directly into JiveX -
thanks to a bar-code principle used on the patient sheet, again with direct assignment to the patient.
As unusual as the whole circumstances were for the JiveX introduction process, ultimately it ran straightforwardly and successfully, as Kerkloh emphasizes in his summing-up: "The whole project was really a lot of fun, and the result precisely matches up with our requirements. I can imagine a comparable approach very readily for introducing JiveX at further Alexianer sites."
Alexianer is a company operating in the health and social care economy, employing around 16,000 staff around Germany. With a tradition extending over 800 years, Alexianer runs hospitals, retirement homes, integration support facilities, youth welfare facilities, health promotion and rehabilitation facilities, outpatient treatment and care facilities, along with workshops for the disabled and integration companies. The Foundation of the Alexian Brothers (Stiftung der Alexianerbrüder) is the sponsor of this corporate group. The Raphaelsklinik and the Clemenshospital in Münster were founded by the Sisters of Mercy (Clemensschwestern). They have been part of the Alexianer Group since 2016.