Through both organic growth and merger-and-acquisition activity, the New Brunswick, NJ-based mega-practice University Radiology has increased in size from 61 to 96 radiologists in just six years. The task of technologically knitting all practice and service sites together into one integrated whole has fallen to practice CIO Alberto Goldszal, PhD.
It is a task Goldszal has managed with uncommon success, constructing not only an elastic infrastructure that accommodates multiples sites, but also one that provides the practice’s radiologists with access to priors, no matter where the study was generated in the coverage area. He attributes this achievement in part to good technology choices, but primarily to his understanding from the moment he was hired that the practice was bent on growth and any technology had to be scalable.
“I had the privilege to start the selection process knowing full well that I would have to scale up anything I was bringing in in 2007 and thereafter,” Goldszal explains. “The model that was delineated for me is the model we have been following since then.”
From a cost and contracting perspective, the good news for University Radiology and other large practices is that scaling up is easier than scaling down. “With all of the things you have to do today in radiology, when you have a small volume it can be very costly on a per-unit basis,” he says. “You want to have an understanding with your partners that as you do more volume, the unit cost must go down.”
Off the shelf
The tools he used to implement the plan were a series of well-chosen applications, including Synapse PACS from FUJIFILM, layered onto an off-the-shelf (OTS) hardware infrastructure that has since been virtualized and made available through a private cloud.
“Everything we did here in our organization was done using OTS equipment,” Goldszal says. “We didn’t customize anything, and that’s the reality. You would be surprised at how much custom workflow you can generate today with over-the-counter software and equipment.”
In fact, University Radiology doesn’t have a development branch, preferring instead to work with its vendors to add necessary features and functionality, which in turn become part of the standard application.
“One thing that we wanted to avoid—and that is perhaps the take-home message here—is to become so customized that we would be virtually impossible to be supported,” he explains. “The more customized we are, the further away we are from the core competence of the supporting organization.”
A practice is better off picking the partners that best fit its growth model, Goldszal advises. It’s an easier and less painful alternative than trying to fix issues with a mismatched system as the practice grows.
For the highly subspecialized University Radiology, which went from five to eight hospital contracts and eight to 15 imaging centers within six years, the IT infrastructure had to provide a workflow that was identical across all sites in order to leverage its subspecialized organization.
“Even though all of the hospitals we deal with have their own RIS and PACS, we provide a central place where all of the images come to, all orders are received and all results are generated,” he describes. “If you ask me what has been central to our success to integrate all of these hospitals and accommodate all of this growth rather quickly, it is that all of the reporting is done through a central location.”
Goldszal operated under the understanding that one of the greatest contributions he could make as CIO of a growing practice was to limit the number of information systems that the organization deploys. This requires both discipline and diplomacy.
“Over the long haul, you are probably better off constraining the number of information systems that you have to serve your enterprise, so you operate in a less costly manner with fewer systems,” he says.
Benefits of limiting applications range from economies of scale to simplifying support, enough to justify the approach from a financial perspective. The primary purpose, however is to leverage the aforementioned subspecialization across the organization.
University Radiology has several radiologists with pediatric skill sets, but a single hospital may not have enough cases to sustain a pediatric radiologist. “If that person is on the cloud, serving multiple hospitals, then the hospital benefits from the specialty care, and we can run the business efficiently by bringing enough