Executive Perspectives: Finding the Competitive Edge with Image Sharing

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Rob SumterBrian M. BarbeitoBrian M. Barbeito, MBA, MSHA, heads a radiology group that deals primarily with hospitals, but his Memphis-based company, Mid-South Imaging & Therapeutics, also covers numerous outside-read businesses, which offer outpatient imaging services. Getting the right images to the right radiologists has not been easy, but technology has helped. Rob Sumter, PhD, COO and CIO at the Tennessee-based Regional Medical Center at Memphis, also has explored the technical and economic models for image sharing.

Both agree that demand for image sharing capabilities will only increase, but what works best in which settings? What will the future hold?

For its inaugural issue, Executive IT Insight sat down with the two executives to discuss their perspectives on viable models for image sharing and distribution.

Executive IT Insight: How do processes differ between a radiology practice, a hospital, and a multispecialty group?

Barbeito: The biggest difference is scale. There is a difference between what you have to provide in an outpatient setting versus a hospital setting. Most of the outside-read business is single modality, such as one CT scanner or one MR scanner.

The hospital setting is going to be multi-modality—everything under the sun, from mammography to interventional radiology to CT and MR. In the outpatient setting, it is, in many cases, specific toward one type of imaging—cardiac, musculoskeletal, or neurological.

We read at a number of hospitals in the Baptist Memorial Health Care system, and it’s critical to be sure the right study goes to the right radiologist—and we must do that no matter what the setting. If you have a specialty image taken in hospital A, and the subspecialist is in hospital B 10 miles away, image sharing is very important. The ability to pull those images up and get them to the right radiologist can present networking challenges.

We are a radiology group, but if we are working with hospitals and multispecialty organizations that have different PACS solutions, we will use those systems. Our RIS is very flexible, and we have arrangements with many hospitals and multispecialty facilities that require this flexibility.

Sumter: A radiology practice group is likely to invest greatly in teleradiology, which helps them to read images of single modality quickly and to get them finished. When you send an image to our radiologists in the practice group, they don’t give a preliminary report; they simply give a final report.

In the hospital, where they are supporting trauma patients, the doctors' turnaround times for final reports are not as fast, due to the multiple modalities. To increase the speed of the clinical decision making process, many times a preliminary report is provided within minutes, with the final report coming hours later.

eITi: What is your economic model for image sharing/distribution?

Barbeito: We have been operating under a business model that is predominately hospital-based, but we also cover what we call outside-read businesses, which are traditionally outpatient imaging services, most often at physician offices—whether they be neurosurgeons, orthopedic surgeons, pulmonologists, or internal medicine physicians. They may have a CT scanner, MRI, ultrasound, or an x-ray unit.

Ten to 15 years ago, the physicians who incorporated imaging into their practices wanted Mid-South to provide interpretations for them because of our clinical quality. We are a subspecialized group, so if it was a neurological study, they knew a neuroradiologist would look at it. The same [is true] for a musculoskeletal read or for a cardiac read.

We discovered that a lot of these practices did not have an efficient method for image distribution, and they realized they did not need a full-blown PACS and all that IT equipment. They did not want to take on the responsibility of archiving the images. From that standpoint, there was a demand for these types of technological components, and we met that need with our tech solutions.

If a practice purchased and incorporated a CT scanner, we could link to their modality. There was a need for image distribution, and a RIS for patient histories. We met that need. We were able to have one radiologist in our corporate office, or to put a radiologist into their clinic.

We were much more efficient in our delivery model, and that allowed us to better manage our resources. Instead of having four different radiologists at four different facilities, one