OIA: Tackling a Complex, Distributed Workflow

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Imagine owning or operating a business in which your best customers pretty much dictate your prices. In that same business, you face an organized effort to tell you when and how you can practice your trade, and those guidelines are often contrary to what you have been trained to do. Imagine, too, that your business also experiences skyrocketing costs for acquiring and maintaining needed technology to remain relevant in the market. Finally, imagine that your business is confronted with unprecedented competitive issues which, if not properly addressed, threaten to ruin what you have worked so hard to create. In almost any other profession, businesses facing these challenges would collapse. Not so, however, in outpatient medical imaging, which faces these upheavals, and more. But instead of the typical retreat response, medical imaging has adopted a survival mode that has evolved into the pursuit of efficiency. Instead of hunkering down and trying ride out the latest storm, outpatient medical imaging providers are responding with a series of adaptations to help ensure their viability. One notable example of the pursuit of efficiency is Nashville-based Outpatient Imaging Affiliates (OIA), which has 24 imaging centers in the Midwest, South and East. Though the market challenges faced by OIA are the same as other medical imaging enterprises, their unique business model lends itself to efficiency achievement at a faster pace. In the process, there are multiple lessons to be learned from their evolution. Formed in 2000, OIA’s facilities include single and full-modality locations, several of which are owned in joint venture arrangements with local healthcare providers. “Our goal, our niche market, is to partner with academic medical centers to compete for outpatient imaging market share,” says Jeff Tumbleson, OIA’s Vice President of Information Technology. “We built our company around our ability to provide a menu of services and let our partners choose those services for the joint venture. That includes everything from new capital to space planning, to construction, to providing infrastructure, managing and billing and handling the day-to-day operations.” OIA’s wide range of modalities, their specialized business model and their geographic coverage have created an unprecedented number of logistical challenges, among the chief of which is tackling a substantial workflow and making the process seamless. “OIA doesn’t employ any radiologists,” says Tumbleson. “Our interpretive services are provided by independent radiology practices so that typically comes with a preference for a PACS. All of our teaching institutions already had an enterprise-wide PACS solution so rather than require them to use some other PACS to interpret studies for the imaging centers, we have provided for them to interpret those studies in their native PACS.” That was the challenge: To structure each facility’s IT configuration so the radiologists could remain in their operational comfort zone. The solution was provided by Compressus which provided the software solution to help overcome the hurdles associated with OIA’s medical imaging interoperability. “Our desire to allow the facilities to operate in their current systems drove the model that we use with Compressus, which allows us to build a master worklist,” says Tumbleson. “We can then populate it with information coming from our RIS and capture all of the workflow from our imaging centers. That allows the information to be read utilizing the PACS system of choice, and to the degree that they are using their own VR Compressus supports that as well. Or, if they don’t have VR, we can provide one. So, Compressus allowed us the flexibility to utilize multiple, disparate PACS and VR solutions to complete the professional read component.” In fact, VR proved to be a daunting challenge for Tumbleson and the OIA team and they realized that proper alignment of a VR system was a key to their efficiency targets. “One of our lessons learned in this process is that not all voice recognition systems are the same,” says Tumbleson. “We typically had radiologists using voice recognition in their practice but when we brought our VR solution to our practice here in Nashville, for example, the VR system was modeled differently and was a different program. Once we got over the initial learning curve, everyone has been pleased with our VR engine. It certainly was a learning experience in terms of workflows that have been built around the various solutions.” “In 2007, the Deficit Reduction Act shook up the market and set our growth projection on its head,” says Tumbleson. “So, from that point forward we had to focus on ‘same store’ growth, bolstering our positions in the markets we were in, and looking at the acquisition market. Since 2007, most of OIA’s growth has happened in that manner and we have completed 13 imaging center acquisitions.” One element of OIA’s original business model has not changed, even during the current changes in medical imaging: Efficiency is now more important than ever. “Like everyone else, we’re getting squeezed on a daily basis,” says Tumbleson, “and also like everyone else, we have to do more with less. As a result, our focus is on improving each center. We’re constantly trying to look at our protocols and see how we can get more people through the equipment that we have. “So the improved efficiency in the imaging center is the focus for us. We have to be competitive in the market and one of the things that Compressus allows us to do is stay on top of the sub-specialty reads that we have pushed to radiologists in offsite locations. It’s easy to go to the radiologist inside your facility and say ‘I need this study read’ but it’s more difficult when they are across the country or across town and not where you can readily see them. But with Compressus the process is set it up so that if the on-site radiologist needs assistance, exams can be transmitted to a radiologist in another location for timely interpretation, regardless of their location or their software.” OIA thrives today not only because of the technical solutions provided by Compressus, but also because their culture is such that progress through efficiency is the corporate watchword. Steve Smith is a contributing writer for imagingBiz, Tustin, California.