Process reengineering for the filmless environment.

Facilities that are converting to filmless operations can learn from the University of Kentucky Chandler Medical Center's (UKMC) experience: that dramatic reengineering processes must take place before radiologists' productivity can increase. To convert a radiology department to soft copy interpretation, a piece-by-piece implementation of new systems or upgrades is customary. The first step may be to link each modality that is already digital into modality-specific mini-PACS, then to link the mini-PACS. Bringing other modalities on-line as new equipment is purchased and expanding the image information system (IIS) to the remainder of the healthcare facility rounds out the transition and may take several years. The downside of this kind of evolutionary approach is that the radiology department temporarily operates in two environments, the traditional film and the new filmless environments. To make the move from film to filmless, an administrator and the radiology staff must reengineer nearly every departmental process. Total quality management (TQM) techniques offer tools that are ideal for the task. Other recommendations include using a multidisciplinary team of staff members who are familiar with film-handling to create flow charts of all departmental processes. Each step should be validated to show its value to the overall process, the department or the institution. Next, flow charts of the expanded or new processes should be developed with input from the IIS manager, referring physicians and key IS personnel. Follow with estimates of staffing requirements that meet the needs of the completed flow charts and, finally, train staff members for the implementation of the new processes.