title: The Impact of a Health IT Changeover on Medical Imaging Department Work Processes and Turnaround Times: A mixed method study.
abstract: OBJECTIVE
  To assess the impact of introducing a new Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) on: (i) Medical Imaging work processes; and (ii) turnaround times (TATs) for x-ray and CT scan orders initiated in the Emergency Department (ED).
  
  
  METHODS
  We employed a mixed method study design comprising: (i) semi-structured interviews with Medical Imaging Department staff; and (ii) retrospectively extracted ED data before (March/April 2010) and after (March/April 2011 and 2012) the introduction of a new PACS/RIS. TATs were calculated as: processing TAT (median time from image ordering to examination) and reporting TAT (median time from examination to final report).
  
  
  RESULTS
  Reporting TAT for x-rays decreased significantly after introduction of the new PACS/RIS; from a median of 76 hours to 38 hours per order (p<.0001) for patients discharged from the ED, and from 84 hours to 35 hours (p<.0001) for patients admitted to hospital. Medical Imaging staff reported that the changeover to the new PACS/RIS led to gains in efficiency, particularly regarding the accessibility of images and patient-related information. Nevertheless, assimilation of the new PACS/RIS with existing Departmental work processes was considered inadequate and in some instances unsafe. Issues highlighted related to the synchronization of work tasks (e.g., porter arrangements) and the material set up of the work place (e.g., the number and location of computers).
  
  
  CONCLUSIONS
  The introduction of new health IT can be a "double-edged sword" providing improved efficiency but at the same time introducing potential hazards affecting the effectiveness of the Medical Imaging Department.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, Australi.
authors.forename: A
authors.initials: A
authors.lastname: Georgiou
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, Australi.
authors.forename: M
authors.initials: M
authors.lastname: Prgomet
authors.affiliation: NHMRC Clinical Trials Centre, The University of Sydney , Sydney, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Lymer
authors.affiliation: National Drug and Alcohol Research Centre , UNSW Australia, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Hordern
authors.affiliation: Medical Imaging Department, Concord Hospital , Sydney, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Ridley
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney, Australi.
authors.forename: J
authors.initials: J
authors.lastname: Westbrook
mesh_terms: D022126:Access to Information; D003952:Diagnostic Imaging; D006801:Humans; D008490:Medical Informatics / Q000458:organization & administration*; D011873:Radiology Information Systems; D012107:Research Design; D013997:Time Factors; D057188:Workflow
keywords: Evaluation; Health Informatics; Medical Imaging; Picture Archiving and Communication Systems; Radiology Information Systems