Riverside Radiology and Interventional Associates (RRIA), Columbus, Ohio, was an early pioneer in the transition from analog to digital radiology, and radiologist Peter Lafferty, MD, vivdly recalls his first encounter with the interpretation of digital images in the late ‘90s.
Riverside CIO Ron Hosenfeld, who was working for FUJIFILM at the time, showed Lafferty some CT images on a computer monitor for an ER turnaround time (TAT) improvement pilot project. “I remember thinking, ‘Holy cow, what have we been doing reading off film? I want everything on here!’” Lafferty exclaims.
Thus began the practice’s pioneering work to build and optimize a digital reading platform for the 86-radiologist private practice—small at the time with one hospital client—but today a highly complex and subspecialized reading environment involving multiple unrelated hospital campuses.
The building blocks
Not long after its first encounter with digital interpretation, the practice took the then-giant step of investing in its own PACS, Synapse from FUJIFILM, Stamford, Conn, and brought on Ron Hosenfeld.
“I saw this huge underserved patient population,” Hosenfeld says. “The large institutions, Beth Israel and Chicago, could afford to purchase and support PACS, but there was no way my grandmother in Smalltown, USA, could get that same quality of care. I said, ‘Let’s deliver that as a service,' and that is where I came together with the group.”
RRIA began to provide PACS to small community hospitals and imaging centers that couldn’t afford the technology. “That was a big deal,” recalls Hosenfeld.
During the next five years, the practice thrived in its digital incarnation, growing both in number of partners and clients of all sizes. “What really helped us, especially in the early days, is that Fuji was unique in its ability to present the same patient across unrelated databases,” Hosenfeld recalls.
“Provided that the radiologists had the appropriate credentials, they could see across different hospitals that were in fact unrelated business entities, and they could see that patient travel between them,” he continues. “That was something that was really unique, and to this day, remains very unique.”
As the practice grew, the ability to present a single view of patients across the practice’s service area enabled it to ramp up quality, extending subspecialized interpretations to its outlying hospital clients and limiting duplicative imaging and unnecessary exposure to radiation.
Workflow is the thing
By 2005, however, the practice was struggling with workflow.
“We used to have a very sophisticated workflow engine, and it was human beings in a file room,” Lafferty says. “They would take a lot of information and knowledge of what referring physicians wanted and even what patients wanted and make sure that the studies were routed appropriately and at the right time.”
The analog workflow, however, was “all very clunky,” rendering turnaround times (TATs) “on the order of days and sometimes even longer than that,” he recalls. PACS helped reduce TATs, but as the practice grew and covered increasingly more disparate hospitals, radiologists found themselves hopping from workstation to workstation, in order to read.
That was the genesis of the group’s workflow software, RadAssist, which solved the problem of getting the correct study to the right radiologist. “That’s the software that we built that allows a doctor to work in, as Dr. Lafferty says, their wheelhouse,” Hosenfeld explains. “We believe that someone who is an expert at a certain type of study can do more studies faster—and likely better—than if you try to spread that out amongst doctors who only get to see a couple of studies a month or so.”
It also enabled the practice to treat patients based on their criticality regardless of their location. Sophisticated workflow rules allow for everything from prioritizing a stroke patient to backing up the radiologist who is sitting at a small town community hospital and gets stuck in a procedure.
“There are still a lot of practices that are doing [that]: This set of docs has ten windows open and this set of docs has ten windows open and they are their own workflow engine,” Lafferty explains. “They figure out what they want to read, when they want to read it and, invariably, asymmetries develop. Certain facilities receive preferential treatment over others, meaning those patients receive preferential treatment in the timing and or the skill-set