Parsing Health IT for the Radiology Practice
After consulting for the practice for several years, two years ago, Robert Cannistra joined Radiologic Associates PC (Middletown, New York) as its director of IT. Like many in the informatics field, Cannistra says, he was surprised by the unique challenges that health-care providers face when he first began consulting for hospitals and health-care practices. “I was flabbergasted when I walked into one of the first hospitals I consulted for,” he says. “I was amazed at how many vendors they were contracting with to handle just a single piece of the technology puzzle. Informatics in health care is still very proprietary, and we need to break away from that.” For that reason, Cannistra says, interoperability must be one of a radiology practice’s key considerations when evaluating a potential purchase of new technology. His technology-assessment process takes a multitude of factors into account, however. “Years ago, one or possibly two individuals may have made a decision about a new-technology purchase,” he says. “Today, I aim for a more multifaceted approach, in which people from different backgrounds come together to provide vision and perspective on workflow and overall functional use of the technology. If one person solves (or attempts to solve) a problem on his or her own, that is not in the best interest of the business as a whole, and is actually doing a disservice to the practice.” Collaborative Approach With that imperative in mind, Cannistra takes a collaborative approach to parsing health IT solutions for the practice, which has 21 radiologists reading approximately 450,000 studies a year. He explains that he, the CEO, and the CFO all come from different backgrounds, and when a new solution is needed, the three come together to narrow the field of options to a small number of front runners. “The three of us sit down and balance what we need for the business to succeed against the problem we are trying to solve with whatever technology we are considering,” he says. “We always have to weigh cost versus benefit.” Though the factors being weighed depend on the technology in question, Cannistra says that the balance that the three evaluators try to strike remains the same. “This is a radiology company; however, it’s a technology-focused business: Without the technology, the business simply wouldn’t exist,” he says, “so the business focus and vision have to correlate with the technology.” Once three to five candidates have been identified by the executive team, Cannistra invites end users and IT staff to evaluate the finalists. “We’ll bring in the IT team to pick these products apart and tell us what is good and bad, from a technical perspective,” he says. “We’ll do the same thing with the partner physicians, and we will go to the board of directors, as well, for their input and perspective. The last thing I want to do is make the final decision for someone else if they are going to be the one using the product. We all need to be a collaborative team when making these purchasing decisions.” Global Mindset Radiologic Associates is a growing business with eight different divisions, and this makes preparing for future expansion particularly important, from Cannistra’s perspective. By way of illustration, he says, “With the director of one of our outpatient sites, I met with a potential new modality vendor; while the director had the perspective of needing a solution for his specific site, I needed to know what the vendor could do for our other sites as well. I need solutions that are going to streamline the business. We have to come at our decision making with a global mindset, keeping the future in mind.” Managing the informatics side of the business is already sufficiently burdensome for Cannistra to require a support staff that includes a network engineer, a server administrator, a desktop administrator, an interface engineer, a database administrator, and others. For that reason, he says, he focuses on informatics vendors able to act as partners of the practice. “We try to establish good partnerships that will help us grow our business without taking on 10 extra staff members,” Cannistra says. “Establishing those key relationships, as we move forward, really helps us.” Cannistra offers, as an example, the relationship of Radiologic Associates and its revenue cycle management provider, Integrated Medical Partners. “When it comes to business analytics, we have some key personnel on staff, but not the depth of expertise we would like,” he notes. “We are constantly being asked to provide more data, critical values, measures for meaningful use, information on how long it takes our physicians to read studies, and so on; we need to better mine the data for all of those measures, going forward.” He adds, “Business intelligence has been around for a long time, but it’s coming to life now in radiology. To make this type of business succeed and prosper, there are many diverse systems that have to work in a collective manner. Within each system, there is typically a database of its own. Now, you need a database that is able to query and store metrics for all of the diverse systems and present these metrics in an easy-to-read format. It will increasingly become common practice to provide that data in real time to whoever is asking for it.” Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.