The PACS has come a long way since its inception, enabling communications among all imaging stakeholders in a hospital or health system. But what is the large radiology practice to do that works in a heterogeneous environment, with multiple information and dictation systems, and a centralized reading model?
Radia, a 75-physician radiology and vascular practice based in Everett, Wash, found itself in just such a predicament. Since launching its teleradiology operation—teleRadia—in 1998, the service has evolved from a way to provide nighttime emergency reads for client hospitals to a thriving service line that provides nighttime coverage, subspecialty reads, and supplemental reading for more than 30 hospitals, clinics, and radiology practices, all of which have their own information systems.
The practice’s information system—devised under the guidance of CIO Jack M. Jones and teleRadia medical director Jeffrey Robinson, MD—works remarkably well considering the number of PACS and information systems involved. But in order to broaden its service and meet demand in its marketplace, Radia knew it needed to exact more efficiency from both its information technology and its radiologists. After scouring the market for a product that could provide a single worklist and dictation system for its scores of clients in its dual-PACS environment, Radia earmarked up to $1 million, hired a software engineer to write the code, and designed a new front end for its two PACS.
The project, begun one year ago, is representative of the creative approaches radiology practices are taking to customize garden-variety information systems to their unique needs. ImagingBiz.com interviewed Jones and Robinson, to understand the steps taken to streamline Radia’s teleradiology workflow with a custom fix.
Radia’s core business comes from the nine hospitals for which it performs all professional services, supplemented by 4 outpatient joint ventures and a growing number of teleradiology clients. Currently, all images from Radia’s teleradiology clients arrive at a centralized reading room via DICOM. Orders come in via fax and are processed by imaging assistants who match the order with the image.
“The way we do it today is that each of the sites either sends us the image directly from their PACS or they will send to us directly from the modality,” Jones explained. “As long as it is in DICOM format, we can take images into our system here, read the cases, do the interpretations and get the results back out to them, and that is the tricky part. Today we are dealing with seven or eight different dictation systems, and that is the real problem we have today.”
Because Radia does not interface directly into its clients’ HIS or RIS, teleradiologists must dictate into the client’s dictation system, programmed directly into the client’s reporting system. Another obstruction to workflow is the need for teleradiologists to switch back and forth between the user interfaces of the two PACS used by the practice, one acquired for its teleradiology practice and the other more recently through a joint venture imaging center with a hospital, whose PACS was chosen by the community. That hospital provides a significant amount of Radia’s volume.
The dual systems present a significant productivity hurdle. “Right now we are running two independent PACS simultaneously on one workstation,” explained Robinson, a key advisor in the architecture of the new system. “We have AMICAS and Stentor, and as a radiologist, I have to flip back and forth constantly. It’s like reading from two different books at the same time. Getting everything on one worklist would be a dream in terms of efficiency.”
The impact on radiologist productivity should not be underestimated. Jones predicts that Radia will achieve a 5% to 10% improvement in radiologist productivity as a result of the project, which it calls Teleradia 2.0.
Ultimately, the new system will have one user interface and dictation system for the teleradiologists and, eventually, a paperless process. “The radiologist will have one worklist that will launch one or the other PACS depending on where the case comes from, the system will know that and launch the appropriate viewer,” Jones explained. “We will have one dictation system here, and it’ll be a voice recognition system. We haven’t made a selection on that yet, but it will be one of the big three. When Phase I of the new front end goes live later this month, orders