XRay Imaging: Fast, Accurate, Paper Free
Innovator: Matt Granger, PACS Administrator
Innovation: DocScan and PACS Reporting Tool
When we think about the types of innovations that might be conceived within the medical field, images of complex scientific research or high-tech equipment might readily come to mind. Yet there is a level of operations within any medical facility that is often overlooked and underrated, where the positive impact on both patients and doctors can be direct and quantifiable: At the administrative level, the way a hospital runs can be improved, enhanced and even transformed. For computer systems administrator such as Matt Granger, the opportunities for positive change are seemingly boundless.
A native of Woodland, California, Granger followed in his x-ray technologist father’s footsteps, becoming an x-ray tech and joining Woodland Healthcare on the night shift. Rather than sleeping during the day, Granger opted to continue his studies, earning several computer certifications and then even starting his own computer networking and repair business, all while working as an x-ray tech at Woodland. For five years, he worked at both careers but had always hoped he could somehow combine his dual interests. When the birth of his children necessitated a change from his grueling night-and-day schedule, he left Woodland Healthcare for a day job as a computer specialist for the Woodland Joint Unified School District.
But in 2005, Woodland Healthcare called him back. They were installing a new Picture Archive and Communication System (PACS) to manage their digital radiology images, and they hoped Granger might want to return to the hospital and serve as their PACS administrator. Granger jumped at the offer: “I finally had a chance to use both my computer and x-ray skills.”
Re-imagining the XRay image
Most of us generally recognize the x-ray as that crisp, crackly piece of celluloid hurled dramatically onto a light board for viewing and evaluation. But in today’s digital society, that incarnation of the x-ray may soon be a relic of the past. Thanks to PACS, hospitals are now moving from the cumbersome medium of film to a system of digital images. Through PACS, the images can all be stored and displayed electronically, making it possible for several physicians to look at the same image at the same time and for doctors to even view them remotely from home.
While shifting to a digital environment was highly beneficial, it still presented its own challenges, and Granger was determined to find the means to overcome them. One such obstacle was the paper trail that came with traditional x-ray images. When working with standard film, the delivery of images would also include paper documents such as requisition forms and patient consent forms, on which notes could be taken and passed onto reviewing physicians. But hospital staff would have to gather paper requisitions three times a day and have runners pick up the paperwork and sort it for the radiologists. It was time consuming, and there would often be hours that images sat idle with no one reading them.
Granger saw this paper trail as a stopgap that negatively impacted the hospital’s work flow. His creative, time-saving solution was the development of a DocScan document scanner program that would convert the paper documents into digital images that could be sent through the PACS system along with the x-ray image. It is now just a matter of minutes from the moment an x-ray tech does the exam to when the exam and paperwork are available for a radiologist to read. The results get to doctors quicker, saving them critical time in determining what type of cures or treatments their patients need. With all of the images and information now stored on computer servers, the system also frees up huge amounts of storage space in the hospital where all of the films and paperwork were once housed.
Ingenuity is free
But, as with any computer technology, Granger’s troubleshooting did not end there. The scanners were needed anywhere a tech was doing an exam, but the typical scanning systems available for PACS were not as flexible or affordable (usually costing almost $3000 apiece) as he wanted—and as the hospital needed. For example, there were many different paper forms associated with each x-ray, and he wanted each form to be identified by type. But those kinds of features just weren’t available on the standard PACS scanning application. Ever resourceful, Granger decided to build one himself. By combining his own programming code and a few open source products available online, he was able to develop new software that could now support any scanner bought off the shelf.
And Granger’s PACS enhancements continue on. Recognizing a need to create a better method for monitoring and reporting discrepancies in x-ray evaluations, he has also developed a robust PACS Reporting Tool that expedites the flow of communication between staff and departments. While emergency room doctors will give a preliminary read on what they think an x-ray image shows, doctors and radiologists may sometimes have differing opinions about the readings. In the past, they would have made notes about those discrepancies on paper, which are then faxed back to the ER. With Granger’s new tool, if a radiologist notices a discrepancy in an x-ray reading in the ER, they simply click a button in the PACS system, call up the patient information, note the discrepancy, and click “send.” The results then print out instantly on a network printer in the ER, a message displays on the main computer in the ER, and the report is emailed to a discrepancy resolution nurse who’s responsible for checking the patient’s chart against the report. For even further oversight, the report is also sent to an audit file for tracking doctors and processes over time.
Open source means patients everywhere win
But it is not just Woodland Healthcare or CHW hospitals that benefits from Granger’s innovative PACS software: He has made it available on his personal website and is encouraging other hospitals to download the applications, free of charge, to use with their own PACS. It is particularly gratifying to Granger when smaller, underfunded hospitals that could otherwise never afford specialized software benefit from his work. In addition to Woodland, at least a dozen hospitals around the country are currently using his software.
In just the three years since Granger became the PACS Administrator at Woodland, he has taken their PACS further than anyone thought possible, successfully adding extra value to the programs and changing the way the hospital’s imaging and information systems work. “It’s all about changing the technology to fit the work flow we want,” says Granger.
Improving technology to meet the community's needs
He is enormously grateful for the full support he received along the way from CHW in helping him navigate the process of getting his innovations patented and handling all of the daunting legal aspects that go along with it. With the backing of CHW, Granger remains focused on making a difference in his field and he is always looking to improve on his ideas. “I’d like to be able to use the Reporting Tool to send stat reports to referring physicians right away,” he says. His plan? Send doctors a link and a passcode to a website where they can access the data instantly, and where the entire process will be time stamped, making it possible to know exactly when a doctor reads a report. From computers to technology, there is perhaps no end to Matt Granger’s great ideas—or his ability to carry them out.
