Building a Distributed-reading Solution: Sunshine Radiology
Sunshine Radiology was facing a quandary familiar to many radiology groups. The busy 25-radiologist practice (based in Sebring, Florida) wanted to expand its hospital business, but knew that it needed to lower its costs in order to do so. “We needed to keep our radiologists as efficient as possible, and there wasn’t always enough volume to support having a radiologist on-site at each hospital,” Shawn Zimmerman says. Shawn ZimmermanZimmerman is an IT specialist for Sunshine Radiology and CEO of allRadiology Solutions LLC of Winter Haven, Florida, which provides IT support for Sunshine Radiology. He explains, “With Medicare reimbursement being lowered, there’s a lot more pressure to keep costs low. We’re trying to use technology to create the efficiencies we need to lower our costs and pass those on to our hospitals.” Sunshine Radiology currently reads for five Florida hospitals, and is in the process of bringing on an additional three hospital clients. The practice plans to accommodate the new volume using a distributed-reading solution that will enable its radiologists to read off-site for all of its hospital customers. “We can make better use of our radiologists this way,” Zimmerman notes. “Instead of paying five radiologists’ salaries to cover, for instance, the 11 pm–7 am timeframe, we can take one salary and split it.” Solution for the 21st Century The linchpin of Sunshine Radiology’s new approach is the Synapse teleradiology solution from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut. allRadiology Solutions went live with the turnkey Synapse solution for its five hospital clients on March 1. allRadiology Solutions established encrypted (secure) tunnels to each hospital and handled integration with each hospital information system (HIS), absorbing any vendor costs that the hospitals might have had to pay. “We have voice recognition, so when the radiologist dictates the report, we want it to integrate seamlessly with the HIS,” Zimmerman says. “If we can electronically deposit the report in the HIS, then all of the referring physicians will be able to access it.” allRadiology Solutions uses an HL7 integration engine called Cloverleaf to “take the report from Fuji and manipulate it to what the hospital needs, almost like translation,” Zimmerman says. Integration with each HIS was a critical component of Sunshine Radiology’s goal: providing final interpretations to more hospitals at a lower price. Because radiologists need access to prior studies to write a final report, Sunshine Radiology needed to be able to communicate with its hospital clients’ PACS. “It’s technically complex, and to do it professionally takes the right people to make sure that it’s seamless,” Zimmerman says. Distribution of Labor Zimmerman explains that he was drawn to the Fujifilm solution because of its ability to automatically create orders from the DICOM header without having to go through patient registration and/or scheduling. “When the hospital sends the images, the Fujifilm teleradiology solution takes the patient information from the image and creates an order in our system,” he notes. In so doing, it enables hospitals to send studies to Sunshine Radiology without HL7 integration, and it allows Sunshine Radiology to provide a faxed report to the hospital. “It eliminated the need for us actually to develop something like this ourselves,” Zimmerman says. The Synapse platform, coupled with support and maintenance by allRadiology Solutions, enables Sunshine’s radiologists to distribute the workload from its hospital clients more evenly; they read from a unified worklist, interpreting the oldest study first, and dictate final reports that are then transmitted to the hospital in question. “We’ve moved to a fee-per-report system for the hospitals, so it’s all volume based,” Zimmerman notes. “They’re not paying for what they’re not using.” Thanks to the new solution, Sunshine Radiology was recently able to bring on three new hospital clients—while hiring a smaller number of radiologists than would otherwise have been possible, and while continuing to provide 24/7 final interpretations for its entire clientele. “We’re working toward extending our service offering to other hospitals as well,” Zimmerman says. allRadiology Solutions was an exhibitor in Washington, DC, at the August meeting of the AHRA: The Association for Medical Imaging Management, and Zimmerman reports that the company received positive feedback: “There are definitely a lot of customers interested in this kind of service right now.” Scaling for Future Growth As Sunshine Radiology and allRadiology Solutions continue to expand their business, there are other aspects of the Fujifilm solution that Zimmerman is interested in exploring. These include a Synapse teleradiology module called Worklist Assignment Engine that automatically assigns unread studies, based on criteria such as credentialing, subspecialty, modality/body part, and more. “As we start growing, we’ll definitely want to look into using that,” Zimmerman says. “If we had more subspecialty interpretations coming in, it would be a very useful tool.” With the new IT platform up and running and the connections established between the data center and Sunshine Radiology’s hospital clients, Zimmerman says, the group is ready to handle whatever new business might come its way. While each hospital will still require the work of an integration engineer before Sunshine Radiology can perform final interpretations, “we can get them set up with preliminary reports almost immediately because we can utilize the auto-order functionality of the solution and provide faxed preliminary reports to the hospital,” Zimmerman says. “With what we’ve set up with Fujifilm, we have the platform to handle a diverse workflow; that’s why we chose them.” Both Sunshine Radiology and its hospital clients are already reaping the benefits of what Zimmerman calls the new baseline. “This is a new area we’ve grown into, and we’ve already seen a lot of improvements,” he says. “Having final reports 24/7 is a level of service you’d normally see at a large hospital because not all smaller hospitals can afford that type of coverage. We make it affordable for them. It increases the level of service to all of our hospitals, and they’re ecstatic.” Cat Vasko is editor of and associate editor of Radiology Business Journal.