Diagnostic Professionals Monitors Patient Care With Pulse
A decade after starting Diagnostic Professionals, Inc (DPI), Claude Hanuschak, its COO, still refuses to let federal payment policy thwart his success. When faced with a 35% reimbursement reduction due to implementation of the DRA, the 30-year radiology veteran and president/COO of the four-site Florida imaging-center chain responded with a resolve to become more efficient, largely through a reliance on appropriate technology. The ability to maintain outstanding overall quality with fewer dollars continues to serve Hanuschak well. In fact, it’s the main reason that his four state-of-the-art facilities (in Fort Lauderdale, Pembroke Pines, Plantation, and Coconut Creek)—co-owned with CEO Howard Dekkers—continue to thrive. “The ability to increase productivity has kept us in business,” he says. As a relatively early adopter of RIS, PACS, and voice recognition, Hanuschak has always believed that wise investments pay off down the road. When the Synapse® RIS (FUJIFILM Medical Systems USA, Inc) offered a new patient-tracking tool (officially named Pulse) about a year ago, it was another opportunity to improve efficiency and continue DPI’s commitment to patient-centered radiology. In particular, radiologists at DPI have come to rely on the tracking tool’s digital feed (which comes in the form of a tab that resides in a corner of the screen) to assist them in delivering critical-results notifications. The persistent tab can act as a reminder for radiologists who forget to call a difficult-to-find referring physician. “If the radiologist forgets to do the call and/or does not even send out the report, the critical finding goes unrelayed. With this patient-tracking tool, radiologists can click a button on the patient’s chart while they are dictating. The information goes into this feed, and it stays in that feed until the task is finalized. They can put the report in, finalize it, and it remains there—reminding them, later, that they need to follow up,” Hanuschak explains. If a VIP is coming in, a notice can be put into the feed and monitored during the day, as the visit progresses. “From a quality-assurance standpoint, I’m able to follow up with the referring physician’s office to ensure things were done quickly,” Hanuschak says. “You can actually track the patient, right from the scheduling point. The feed shows whatever position that patient is in within our system. If that patient cancelled, I can click on the tab, and it will take me to the comments section of the chart—where I can find out why that patient cancelled.” As a tool embedded in the Synapse RIS, Pulse uses the concepts of social media to provide real-time information to users about the patients and tasks they find most relevant. Reynold Yordy, Fujifilm’s medical informatics director for Marketing Information Systems, points out that Pulse does not presume to know the individual priorities of each administrator; instead, it opts for a malleable framework. “Pulse provides the flexibility so that every user can define different criteria of what matters to them and be notified in real time, without ever having to go somewhere else within the application to know there is something of importance,” Yordy explains. “This functionality has also recently been extended to mobile platforms as well.” At a time when it can be more difficult to get preauthorization for patients’ exams, Hanuschak’s staff uses Pulse for insurance verification and tracking for timely authorization. Once a patient is successfully in the system and a consultation is requested, radiologists can “push it over to their feeds,” Hanuschak says, “and when other radiologists are available, they will be able to bring up the image quickly.” A Dual Feed Pulse patient tracker has two tabs. One is a feed that shows desired charts, while the other is a dashboard—on which Hanuschak relies for several facets of administration. “Clicking that tab allows me to see the status of today’s activity,” he says. “It shows reports to be signed, dictated, and transcribed—plus any overdue urgent findings. We do not want our patients waiting more than 15 minutes. If that happens, we can interact quickly and find the reason for the delay.” Additional flagged items on the dashboard include overdue film jackets, claims to be filed, outstanding stat work, and failed faxes. “All of these elements are key for an administrator,” Hanuschak says. “If the electronic fax has failed, we can drill down to what number that was. Typically, the referring physician’s fax machine is out of paper, is out of memory, or is overused. We can catch it early, without waiting for a physician to call and ask, ‘Where’s my report?’ That dashboard is critical, and it just sits down there in the corner for you to tap into whenever you wish.” Issues of quality control and productivity usually fall to administrators, but Hanuschak points out that all practice executives and division heads can benefit from added convenience. Spreading information among department heads also makes it easier to manage the enterprise. “I make the dashboard available to the scheduling department, the verification area, the middle-manager level, and IT,” Hanuschak says. “It’s a very easy thing just to have on your screen, and when things are easy to get to, people get to them. It is simple. You move your cursor to the corner, it pops up, and all your data are there, right now.” Taking the Leap With lower reimbursement being a persistent fact of life, radiology practices have largely made up the shortfalls with increased productivity. In 2013, Hanuschak believes, this ethos will essentially remain the same. “To deal with today’s realities, take the time to reengineer the way you practice,” he says. “If you are considering a patient-tracking tool similar to the one I use, seek out vendors and make sure, without a doubt, to spend time going to the vendors’ other clients to see it perform. You must learn from people who have applied it successfully. We are a perfect example of what we, as an industry, need to become, and I invite anybody to come down and see what we are.” In practical terms, Hanuschak reveals that DPI is able to perform an MRI exam for a third less than many hospitals charge. DPI uses the same equipment and the same fellowship-trained radiologists. “We pay them extremely well—above national averages,” he says. “I challenge other people to produce and stay in business at those levels with no quality trade-offs.” It’s not an easy proposition, but Hanuschak is convinced that it is possible, if providers are willing to make investments to increase productivity. “The industry is going through a tough time—a Dark Ages, of sorts,” he says, but embracing tools such as Pulse can help. “You really must have a commitment to be in health care. We, as an industry, can go to work. We can figure it out, and we must.” Greg Thompson is a contributing writer for Radinformatics.com.