Medford Group Ups Productivity Ante with PACS/RIS/VR Integration
Michael TroychakAs the largest radiology practice in a 150-mile radius, Medford Radiological Group (MRG), PC, in Oregon enjoys significant demand for its imaging services from referrers near and far. Michael Troychak, MD, MRG’s president, says that satisfying such demand and (most important) providing the caliber of patient care that fosters growth necessitate a degree of productivity bolstered heavily by a tightly integrated, technology-based radiologist-productivity platform. MRG currently has 20 radiologists, with one more slated to come aboard shortly and another arriving in July 2012. Its wide swath of coverage encompasses 26 sites—22 outpatient facilities and four nonprofit hospitals—spread across a 200-mile span. Most interpretations are executed remotely, with on-site visits scheduled where necessary; for example, one radiologist travels weekly to a very distant site on the Oregon coast to perform mammography and certain other procedures. The group itself uses just one teleradiology provider (and only between midnight and 7 am). Factors other than geography also render maximum radiologist productivity an imperative for the practice. “Of course, there is the issue of declining reimbursements, which is something all physicians face and about which we are always hearing warnings and predictions,” Troychak says. He continues, “Even more significant is that over the past five years, we have increased our practice size and scope, doubling the number of sites we cover and adding four radiologists. At the same time, demand for specialty interpretations is on the rise as neurosurgeons, orthopedists, and other physicians become increasingly familiar with imaging; we, in turn, must become more sophisticated in our interpretations.” For the past several years, MRG has had in place a suite of IT tools intended to support efficient workflow and overall radiologist productivity, in addition to facilitating close communication with referrers and, in turn, fulfilling its mission to provide exceptional diagnostic and interventional imaging services within and beyond the community. The Tool Kit These tools include Synapse™ Web-based PACS and Synapse Teleradiology RIS from FUJIFILM Medical Systems USA (Stamford, Connecticut), integrated via software. The RIS serves as an interface for a voice-recognition system deployed two years ago. The PACS is Web-based, allowing radiologists to use thin-client software to access images anywhere, using any computer. Most sites served by the practice send images to its radiologists through the Southern Oregon Medical Network, owned by Charter Communications (Town and Country, Missouri). For his purposes, Troychak deems this dedicated medical network preferable to the Internet and worth the additional cost, given its gigabit speed, enhanced security, and ability to perform instant image transfers by eliminating the precaching step necessary with traditional network connections. He reports that the Oregon Health Network (in Lake Oswego) also is developing a dedicated medical network intended to be usable statewide. “Everything in our setup is very seamless,” Troychak says. “We do have one hospital system that has a different PACS, and we are obligated to work around it, but our ultimate goal is to function entirely in a one-PACS, one-RIS model.” Single Platform and Multiple Clients The single integrated platform paves the way for heightened accuracy and efficiency, in part, because the RIS and PACS act in unison to meet the needs of the practice, taking referrers’ preferences into consideration when configuring worklists. Studies can be organized by organ system and urgency, rather than chronologically or by individual site. Radiologists also can take advantage of the single platform to compare current and prior studies, without wasting time attempting to locate prior studies—and with the assurance that there is no risk of overlooking potentially critical patient-history information. Each location for which MRG reads has its own PACS, and MRG pulls prior studies through interfacing Synapse PACS and RIS with most sites. The fact that the RIS also kick-starts the voice-recognition system, which uses pre-populated templates, packs considerable punch here as well. “Preloading the templates with, for example, patients’ names and details of the imaging techniques performed not only saves time, but eliminates error because it is impossible to mix up reports,” Troychak says. This feature lends crucial support to MRG’s distributed-reading model. “It has allowed us to dispense with preparing and sending out preliminary reports from transcription,” Troychak explains. “With voice recognition, we edit our own dictation and see our reports (in real time) on a monitor, as we create them. There is no chance that something is going to get lost between that preliminary interpretation and the final report, and the final report goes out right away—with no delays.” This seamless tool kit also ups productivity and workflow by serving as the technological anchor of a call center that operates in Medford from 8 am to midnight, Monday through Friday. A five-person IT and workflow team routes calls from referring physicians to radiologists (if they are not physically present at the hospital for consultation). “All in all,” Troychak points out, “what we are getting with this single desktop solution is the ability to migrate away from a site-specific setup to a transparent one in which our radiologists can work anywhere; reports are produced in timely, accurate fashion; and no one is driving many miles simply to look at a few studies.” A Boon to Business It’s not surprising that MRG is leveraging its integrated productivity platform to avail itself of new business opportunities. With the technology in place, Troychak notes, he and his colleagues can expand the practice’s reach by positioning it as satisfying demand for comprehensive imaging services at small sites. This includes remote general and subspecialty coverage, supplemented by limited on-site coverage. “We are able to say we have the best of both worlds in terms of quality coverage,” Troychak says. Moreover, the integrated platform serves to build the practice by bringing more radiologists into the fold—and new sites that it might not otherwise attract. For example, a physician who resides 170 miles from Medford in Bend, Oregon will soon become a member of MRG’s staff, without actually relocating to the area. “We want to bring him into the group, but he prefers to live in Bend, where he now works,” Troychak explains. “The systems will allow him to handle some of our subspecialty interpretations from Bend, and will also let us do some of his interpretations here in Medford. This is the first time we have made such an arrangement, but it probably will not be the last; the arrangement fits our model perfectly and is supported by the technology.” In fact, Troychak says, the PACS/RIS combination has already helped MRG to cultivate a client relationship with a site in Bend where imaging services had previously been provided by the radiology group with which the new physician had formerly been affiliated. He concludes, “There’s a lot of potential in this platform. We are going to maximize it as much as we can.” Julie Ritzer Ross is a contributing writer for