Six months ago, Jesse Salen, vice president of sales and technology for Online Radiology Medical Group (ORMG), Riverside, Calif, found himself in a situation familiar to many radiology practices: upgrade ORMG’s RIS/PACS platform or face dissolution. ORMG had been in operation for nearly a decade, but the practice’s single-database PACS wasn’t sufficient to meet its needs. With an increasing number of radiologists reading from home, a single sign-on solution had gone from being a fantasy to a necessity.
“It’s not like we’re in a controlled environment, like a hospital,” Salen says. “We have no control over what our customers send us. In order to operate efficiently, we have to be able to adapt to whatever the customers need.”
Add to that the complicated infrastructure created by a staff of more than 30 radiologists, and you’ve got a daunting problem. It’s an issue faced increasingly by practices that want to expand their businesses in the era after implementation of the Deficit Reduction Act. How can you support efficient, distributed reading over a wide geographic spread?
The Dark Ages
ORMG began ten years ago, with a merger of three Inland Empire radiology practices that wanted to provide better patient service and to get more clout with payors. The staff of the resulting practice, Renaissance Radiology, decided to designate specific radiologists to handle night call. “They set up a little office in the basement of Riverside County Hospital,” Salen says, “where they would take nighttime calls for the whole group.”
When a deal is good, word gets around, and other radiology groups in the area were soon requesting that Renaissance’s night shift cover their nighttime readings as well. “We had multiple workstations set up, different viewing stations, and all kinds of crazy networking equipment,” Salen recalls. “The hospital got concerned because we were drawing way too much power. Eventually, they kind of kicked us out.”
Now formally incorporated as an independent business, ORMG moved its operations to a data center in Riverside and implemented a PACS. “The advantage to that system was that you could log on from anywhere, and that was important because, as we grew, we needed more than four doctors,” Salen says. “It started with them sleeping in a chair in the office between calls, but soon they were up all night, so we set them up to work from home.”
When the vendor couldn’t make the kinds of changes to its PACS that ORMG required, the company switched to a single-database solution from a smaller San Francisco-based vendor. “They were great as far as being flexible and adding all kinds of images, but they don’t scale well,” Salen says. It wasn’t long before ORMG was facing every practice’s worst nightmare: so much volume that its current RIS/PACS platform was a threat, not a boon, to the business.
“If we didn’t implement a new PACS, we were going to break,” Salen says.
It’s in the Architecture
Salen and team turned to GE Healthcare Dynamic Imaging Solutions for a more scalable PACS solution, the Centricity PACS-IW (formerly IntegradWeb PACS). “[IW’s] architecture allows us to scale,” Salen says. “As we grow, we can add more and more servers, and it runs off an SQL server database from Microsoft, so we can now handle the volume.” The results have been everything Salen hoped for, and more. “Since we switched four months ago, we’ve probably increased our volume by about 25%, as far as images,” he says. “As far as workflow’s concerned, the system hasn’t even shown a sign of slowing down.”
Another key factor in ORMG’s decision was its RIS, which for some time had been a highly customized solution developed in conjunction with ThinAir Data Corp, Los Angeles, at a time when the RIS was less common. “That relationship had been around since 1992,” Salen recalls. “ThinAir’s RIS code was designed for us.”
Like the new PACS, ThinAir’s TeleRIS product has the architecture and functionality that ORMG needs to remain efficient. “At the time we got onboard with ThinAir, any RIS that was being developed was for a hospital environment,” Salen says. “ThinAir custom programmed this product for us, and it developed over time. There hasn’t been any time that we haven’t had around fifteen outstanding change requests with them.”
One of ThinAir’s most crucial functions is the custom assignment engine, which enables ORMG’s doctors, who read in more than 20 states, to receive automatically assigned worklists. “Not all the radiologists