Arreola M et al. 2003 "Enterprise-wide CR implementation: the Shands Healthcare System experience."

Arreola M, Rill LN. Enterprise-wide CR implementation: the Shands Healthcare System experience. J Digit Imaging 2003;16(2):173-179.
"Major healthcare systems are comprised of hospitals and clinics of different sizes and locations. Many such enterprises are already using picture archiving and communication systems (PACS) and computed radiography (CR) in their main hospitals. The integration of other hospitals and clinics into PACS is a more complex problem. The introduction of CR in remote facilities presents problems, as patient populations, department sizes, and work flow patterns may differ among facilities, and inadequate implementation programs may lead to disruption of patient care services. Although the University of Florida has had an operating PACS for years, facilities affiliated with the Shands Healthcare System (SHS) had not been incorporated into PACS until recently. This article presents the 5-year process to convert all film-screen radiological services to CR in the main hospital, five affiliated community hospitals, and four clinics. The article shows the importance of leadership by the medical physicist from inception of the project through installation and clinical implementation."
To describe "the experience and the methodological approach followed by the Radiological Physics Division at [Shands Hospital at University of Florida (SUF)] in the specification, vendor selection, installation, and clinical implementation of" the conversion to computed radiography (CR) ... [at SUF and] in the five community hospitals affiliated with the Shands Healthcare System."
Type Clinic
Primary care and specialty care
Type Specific
Specialty: orthopedics
Urban and suburban
Other Information
The study took place at various locations in Florida. Facilities were all affilitated with the Shands Healthcare System (SHS).
Type of Health IT
Computed radiography (CR)
Picture archiving and communication system (PACS)
Type of Health IT Functions
The images are created electronically, read in electronic form, and stored in an electronic archive.
Context or other IT in place
The context varied across practices.
Workflow-Related Findings
"A significant number of mistakes and low-quality images were identified by radiologists and QC technologists from all four facilities. Although technologists had indeed been trained on proper use of the equipment, they were not very familiar with the use of computers and software interfaces before CR implementation took place... this lack of familiarity had caused them to focus their attention during initial training on learning and memorizing which actions to perform in order to get their work done, rather than on understanding the basics and the processes involved."
"Because of the significanlty large number of technologists and technologist assistants... It was clear that the one-on-one communication channel established with technologists at [another hospital] could not be replicated at [Shands at the University of Florida Hospital] SUF."
Super-users and training were both important factors "in the acceptance of soft copy CR reading by radiologists at [one hospital], whose concerns and questions were resolved through proactive interaction with physicists."
Study Design
Study Participants
The study participants included primarily imaging technologists and radiological physics staff.