How Much Is Your Practice Wasting on CDs?
It depends on how many different ways you want to measure it, says Daryl Eber, MD, co-founder and CMO of itMD. The Miami, Florida-area company specializes in the development of enterprise-class image-sharing software, and its products are taking hold in a health care environment struggling to address the portability and security issues of traditional media. The most obvious measure to calculate waste is cost. Many practices don’t know exactly how much they’ve sunk into keeping physical media throughout the whole of their infrastructure.
Daryl Eber"I would sit and watch the people standing in line in the radiology department to get a CD. Physicians would be there wasting their time, plus the department had to add an employee just to upload these CDs."
—Daryl Eber, MD
“If it’s $8 per CD,” Eber says—an intentionally low estimate—“and you do 10,000 CDs a year, that’s $80,000 a year.” When itMD delved into the total costs for an imaging center to rely on CDs for patient studies, they came up with a figure closer to $15.83 per CD. Multiply that figure by your average patient throughput, and it’s a staggering amount of money. As a raw number, however, it still doesn’t come close to communicating the myriad levels of waste in such a system. “I would sit and watch the people standing in line in the radiology department to get a CD,” Eber said. “Physicians would be there wasting their time, plus the department had to add an employee just to upload these CDs.” Then there’s the question of time—as in, how much is yours worth? From physicians to support staff to frustrated patients toting around CDs from appointment to appointment, nobody wants to have to think about where their “only copy” of a disc might have wandered. Especially when the next visit comes around and patients haven’t remembered to bring their CD, or expected that one would be there, which only leads to rescheduling everything. “About 30% of patients forget the CD,” Eber says. “If [a doctor] doesn’t have it, he can’t begin radiation treatment planning.” A Solution Is Born Barbara DeppmanitMD has brought together a management team from different backgrounds and complementary strengths to execute its vision. The team consists of physician users, medical software engineers, and image management experts giving itMD the in-house ability to identify, innovate and engineer the solutions that doctors want and need. Two of the three physician founders are practicing radiologists, and the third is a referring physician who extensively uses medical imaging (also known as an image intensivist). Their combined experience provides unique insight into customer needs. Likewise, their technical backgrounds informed product design, resulting in a solution that is functional, intuitive, and useful in everyday practice. In addition to the five founders, itMD’s management group is supplemented by its president, Barbara Deppman, FACHE. Deppman previously served as the director of imaging and therapeutic services at University of Miami/Jackson Memorial Hospital in Miami, Florida, the 3rd largest hospital-based imaging facility in the U.S. Deppman first met the three physician founders during their residencies at Jackson Memorial Hospital. Well versed in the costs of CD use, Deppman has been an active supporter of the itMD format concept since its early days. Time Eaters, Security Risks Consider the sacrifices in efficiency caused by the humble CD. Eber describes watching in disbelief as the front desk attendant at a colleague’s office had to wait 10 to 15 minutes to check in the next patient on her computer system because she had begun uploading a CD into PACS. “She couldn’t work in the scheduling software [and the PACS] at the same time!” says Eber. “Patients were piling up. From an institutional standpoint, everybody’s on a different network, but everybody needs access.” If the patient leaves the disc behind, then the department is vulnerable to a HIPAA violation—misplaced personally identifiable medical information can lead to fines, which can be significant. What about ROI? With any product of scale, a substantial cost savings can be realized based on the total number of patients seen; or, in this instance, the total number of CDs they burn. Switching over to a secure, portable distributed image-sharing solution can realize demonstrable results within the first year of implementation, Eber says. “When you start factoring in the real costs, it can spiral way out of control,” Eber notes. “There’s some education going on, and this is starting to hit the C-level executives. I’m sure that it extends beyond just medical imaging.” Patient Care Implications Even in larger institutions with multi-workstation film libraries, says Deppman, image-sharing on physical media can lead to other interruptions and hang-ups. In her previous life, Deppman learned first-hand about the snowball effect of physical media gumming up throughput in a hospital setting. “Where I used to work, trauma transfers from nearby community hospitals would be flown in with the CDs strapped on the chests,” she says. “If we were ready to upload the image but it couldn’t be opened for whatever reason, we’d have to do a second CT, for which the originating institution was already paid, plus you’re exposing the patient to more radiation.” Eber is a firm proponent of letting patients claim their studies online. For the obvious reasons of portability, always-on availability, and security, the idea has many advantages over traditional media. In fact, it is somewhat similar to the way music is distributed through downloadable file services like iTunes. 
“Providing an ecosystem where you can get access to your images like you could an MP3 file is something that patients are clamoring for,” Eber says, especially in the fields of pediatrics and geriatrics where patients are typically aided by proxy helpers. In all, Eber estimates that 45 minutes of total business time per patient may be saved on both sides of a study—image capture and image analysis—that is fully digital-only. “If those images can come in and that whole consultation workflow can be automated, you’re going to have a huge cost savings,” he says.” From a business perspective, Deppman says, digitally available studies can even be a revenue generator in teleradiology practices. “Physicians can charge for the second opinion, and they have a direct portal from the outside, internationally,” she says. The itMD solution to these problems is an image-sharing distributed network of technologies that allows for DICOM information, aggregated studies, mobile-device formatting, and secure patient access. More on itMD Matt Skoufalos is staff writer for imagingBiz, Tustin, California.