In my 25 years of information technology (IT) management in four completely different industries (distribution, agricultural biotechnology, process manufacturing, and now health care), I have found that if IT is considered a strategic resource, rather than a pure cost-savings resource, the systems efforts will be more likely to succeed. Many times over, investments in IT, which can be extremely expensive, fail because costs are cut in training, infrastructure, and follow-up support. IT projects often take longer and cost more than anticipated, but if executed well and completely without cutting corners can provide an exceptional payback while adding unforeseen strategic value.

In 1996 when I started working at Inland Imaging, we were a group of 12 radiologists based in Spokane. In that year, we created and debt financed a business services division with the insight to provide medical management, business, and IT related services to an assortment of medical groups and providers in our area.

With the growth of our business services division and our own radiology group in mind, we purchased systems and built infrastructure that could expand and scale. I knew that to grow efficiently, a company must have a common infrastructure and workflow. We made it a priority to license the software we purchased for “resell” under the agreed on limitations of our software vendors. We acquired application software with enterprise-class levels of sophistication in the user and data security models. This new software also utilized a highly developed worklist and work routing capability that could handle many times our current exam levels. In addition, we put in place the best networking infrastructure and hired the smartest people we could find. Though this high-end software, infrastructure, and other staff investments were not the cheapest, they have enabled us to grow extensively without starting over or adding limitations to our expansion options. The systems and IT services proved to be an enabler to our growth both as a radiology business and a medical services business.

The Next Level
Inland Imaging is on the cusp of expanding IT services and medical file-sharing capabilities to clients in order to continue offsetting the cost of our newest systems. Preliminary stages and planning have been put in place to begin developing new software that will better integrate communication between other medical networking platforms. We will also begin to expand server accessibility and management to those that wish to utilize our information storage space. We have the ability to provide external client-based medical services to balance IT expenses and maximize return in investments.

Here are some examples:

• As we became experts in our own RIS/PACS systems running in our Inland Imaging centers, local hospitals decided to outsource their RIS/PACS services to our company as opposed to doing it themselves. Two multi-specialty clinics in the Seattle area with their own radiology departments, for which Inland Imaging radiologists do the interpretations, also use our IT services for their RIS/PACS solutions. In fact, we currently have more than 20 different organizations sharing our PACS in an application service provider (ASP) model. We even archive for a nearby hospital where a competing radiology group performs the professional services. We currently archive more than 1,000,000 exams per year. Not only does this provide for a revenue stream to our business unit to offset our IT overhead, but the sharing of PACS images across organizations in our region in a single, secured database, actually provides for dramatically improved patient care and overall workflow.
• As we implemented our RIS/PACS systems, we became experts in systems integration. We now provide systems integration services for most EMR systems and many HIS/RIS/PACS and other health IT systems as well.
• We have introduced a web-based medical imaging viewer to referring clinician offices in which many have hired our IT field engineers to assist with other IT-related troubleshooting and functions.
• The list goes on and on with originally profitable opportunities that have emerged as we invested in IT.

Over the years, we have seen increased savings in expenses as a result of our IT investments. Today, Inland Imaging has almost 70 radiologists and six vascular surgeons, and we are running on the same software and infrastructure, albeit enhanced, that we were on when we were 12 radiologists. The exact numbers associated with not having to convert to entirely new systems over the past 10 years of rapid growth is an unknown, but is estimated to be substantial. Medical records and film distribution departments have been downsized from more than 30 FTEs to now five. Our general imaging center operations staffing levels are down, while film and other associated costs are basically nonexistent. The transcription department once employed more than 30 people and now less than 10, and it is dropping due to recent extensive investment in speech recognition systems, which we also are starting to ASP as a new service line. Our radiologist group is almost entirely subspecialized, which we believe makes recruiting easier. It should be noted that we have significantly more IT staff than we did 10 years ago, so the exact payback on our investment is very subject to processes associated with cost accounting.

We are still based in Spokane, but are expanding services to the Seattle and Phoenix markets. Our business unit and IT divisions are currently looking into other value-added services that we can provide. As our radiology groups, including Inland Imaging, get larger and their work more fragmented, there is increased need for improved integrated workflow and decision-support systems. We are currently building our own systems to assist in this area to include integration of multiple HIS/RIS/PACS systems into a single integrated radiologist workflow system. From this single point of workflow and data collection systems, we are developing quality assurance, utilization appropriateness, and other data analysis for various purposes. We are currently evaluating the market potential for this service.