Taking Care of Maine

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Maine is a sizable state geographically, but its extreme northeastern positioning takes it off the beaten path. It’s a place tailor-made for electronic transmission of radiological images, and Radiology Specialists of Maine (RSM) in Brunswick is turning to technology to expand coverage in ways that it hasn’t before. It may be something of a pioneering effort. The motive isn’t profit so much as improved patient care.

“One does not need to be a megagroup to perform good work or do good deeds,” according to Robert B. Finegold, MD, FACR, a radiologist who grew up in Maine and returned there to work for RSM. “It just requires a neighborly attitude and a mutual desire to do what one can to serve patients well.”

Finegold says that the group of seven radiologists is moving with deliberate goodwill as it broadens coverage, careful not to encroach on competing radiologists’ turf. It’s the way things are done in a state where radiologists are familiar with one another, Finegold says. He has served as Maine chapter president for the ACR and on numerous ACR state and national committees.

Maine, which has a population of about 1.3 million, is served by 39 hospitals, Finegold says. The majority of Maine’s population lives in the coastal third, he adds.

Like those in many places, Maine’s radiologists are growing older, Finegold says, but because Maine is off the beaten path, “Attracting quality people with both current and diverse work sets to meet local imaging needs is a challenge for much of the state.”

Add to that the fact that Maine’s telecommunications/informatics infrastructure is loosely put together with, as Finegold says, “different Internet service providers, clients in various stages of PACS/radiology information system (RIS) acquisition, and limitations in the time of client IT specialists in coordinating reliable interconnectivity,” and the backdrop against which RSM is trying to extend patient care becomes clear. There are no grand integrations of radiology data transmission in Maine.

Because of this, RSM has turned for technology to the one place where most of Maine’s radiology providers are at least on common ground: the service that they use for after-hours preliminary interpretations. RSM is using the technology of its after-hours vendor to pioneer integration between sites where integration otherwise doesn’t exist.

For now, this is a pilot project for RSM. It is limiting use of the technology to interpreting MRI for two radiologists at a hospital in Norway, a town of about 3,000 people 45 miles northeast of Brunswick, away from the populous coast.

Finegold says that RSM wants to see how well the technology works in Norway before it extends coverage to other entities. How the pilot project plays out will partly determine what happens next.

Major clients

To see the lack of systems integration in Maine, you only have to look at RSM’s client list. For 40 years, RSM and its predecessor entities have served two Brunswick hospitals, which are still the core of its business. Mid-Coast Hospital is midway between Brunswick and Bath, a smaller town 10 miles or so to the west. In addition to being a vice president of RSM, Finegold is chair of the radiology department at Mid-Coast. The hospital is licensed for 104 beds and has about 100 doctors on staff. RSM’s other hospital is Parkview Adventist Medical Center in Brunswick. Parkview is an acute care hospital with 55 beds, 28 of them assigned to acute care.

RSM has a third major client, the InterMed Group. InterMed is Maine and Brunswick’s largest multispecialty physician group, according to Finegold. InterMed has its own radiology clinic, which RSM helped it organize, including selecting a PACS and obtaining some staff.

For all three clients, RSM provides full services, administering the radiology departments as well as providing radiation-safety officers and other departmental staff. It does all the study interpretations and provides interventional radiology services to all three. InterMed is a daytime business, but for the two hospitals, the coverage by RSM is 24/7.

Neither the two hospitals nor InterMed are connected electronically to share images. Each has its own stand-alone PACS/RIS and supporting equipment, which it owns independently. RSM has no PACS of its own; indeed, it has no office as a corporate headquarters except for a post-office box. RSM dispatches its seven full-time radiologists to the locations assigned, where they make up the radiology staff.