Have RIS/PACS, Will Travel
For over thirty years, Radiation Physics Inc (Beltsville, Maryland) has been providing mobile imaging services to the Baltimore and Washington, DC, metropolitan areas, serving long-term–care and assisted-living clients, as well as prisons and private residences. “We started doing this in 1976, and the business model has been pretty much the same ever since,” Lou Rubin, president of Radiation Physics, explains. “The technology is really the only thing that’s changed.” The first technological transition that Radiation Physics underwent was moving from analog to digital radiography, which the company did with the purchase and installation of CR technology from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut. “We have two vans with CR processing units in them, and 20 radiography machines out on the road that use digital cassettes instead of film cassettes,” Rubin says. “The technicians can either come into the office or meet one of the CR vans to process the cassettes. From there, wireless routers on the vans transmit the studies back to the office to be read by our radiologists.” Radiation Physics, which performs around 60,000 studies annually, made the digital switch two years ago; the next step was implementing a PACS and RIS. Rubin explains that he selected the Fujifilm Synapse PACS and RIS products to avoid having to integrate multiple vendors’ systems: “We liked the one-stop shopping for a fully integrated system. In the mobile environment, integration is particularly critical—everything needs to work, because if the computer goes down, the whole business goes down.” Mobile Workflow Radiation Physics employs four radiologists; Rubin observes that the transition to digital operations has yielded major workflow benefits for them. This, in turn, enables the business, as a whole, to provide faster turnaround times. The Synapse PACS allows radiologists to read from home (a capability that they take advantage of around a quarter of the time), and it offers image enhancement tools that enable the radiologists to perform better and faster reading. Once patients’ images are in the Synapse system, all of their prior studies are automatically ready for radiologists to view when they sit down to read new studies from those patients. “They like being able to magnify and zoom in, and there’s a feature where they can reverse the image, making black white or white black, to make bone and soft tissue detail stand out,” Rubin says. “They can level the image, making it darker or lighter, which is helpful.” The addition of the Synapse RIS further optimized radiologist efficiency, Rubin says. “The built-in dictation and transcription of the RIS are nice features,” he notes; prior to implementing the Synapse RIS, Radiation Physics had been using transcription software from another vendor. “It’s all one system now, and bringing everything under one vendor umbrella really improved workflow and made interacting with the system much easier.” The digital transition has also made life easier for the technologists, who can connect with a CR processing unit on the road to view and upload their images instead of returning to the office to process film. In the area that the business serves, Rubin notes, that’s no small advantage: “We’re the traffic capital of the world,” he says. “We’re serving a big, congested area. Without the CR vans’ ability to process and transmit the images, the technologists would have to keep coming back to the office; now, we keep them out on the road and close to the clients.” He adds, “Our workflow for actually taking the images didn’t change much when we transitioned from film to digital, but turnaround time has improved drastically, and that’s a big advantage for us.” Growing Into Digital Imaging The Synapse system is easily scalable; Radiation Physics initially signed on for four terabytes of storage, which Rubin estimates will last the business around four years. “All you need is to add more storage space when you’re ready for it, which is not an issue for us yet,” he explains. “We have a huge storage bank, and all images are accessible to our clients online, which is much easier and faster than sharing them via film. When physicians want to see the images, they can log on and look at them. We’ve been able to eliminate film almost completely. If they want to see the actual image, we send them CDs.” The digital equipment has performed well in the mobile environment, “especially considering how complex it is,” Rubin says. “Fuji gives you a mounting kit to secure the equipment in the vehicle, and the laptop they provide is rugged, so we haven’t faced any hardware issues in-house or on the road.” Radiation Physics employs an on-site IT consultant, but Rubin says that Fujifilm handled most of the hard work of the implementation: “They did the integration and the setup, and our IT consultant did the networking,” he says. “The advantage, from my perspective, was that once we were up and running, the hardware would know the software, and we’d only have to work with one service team. We wanted one package.” Mobile Imaging’s Future The regulatory and business environment surrounding imaging continues to change, and Rubin’s slice of the market is no exception; in fact, he notes, the long-term–care market has been particularly vulnerable to the shifting whims of payors. “There’s always that discrepancy of what the insurance companies want to pay for versus what the physicians need or want, and even more so in long-term care,” he observes. “The bottom line is that they want to cut the amount of money they’re spending, and everyone’s under the same double-edged sword. But the patient comes first.” That makes maintaining high image quality and rapid turnaround time particularly important, Rubin notes. “The CR image quality has been much better than plain film, and it gives the radiologists the viewing capabilities they need,” he says. “Responsiveness and quality are the key benefits our customers are looking for, and going from film to CR to the full integrated Synapse system has definitely improved our service.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.