PENRAD Imaging: Technology Propels Attestation

For Colorado Springs Radiologists/PENRAD Imaging (Colorado Springs, Colorado), state-of-the-art imaging equipment and IT solutions have long supported a mission to offer top-tier patient care while maintaining a high degree of efficiency overall. A recent move to support this mission by replacing its RIS and billing systems has led the practice to the brink of Stage 1 meaningful use Stage 1 attestation, slated to occur shortly after January 1, 2014.

Colorado Springs Radiologists/PENRAD Imaging operates four outpatient-imaging centers in a joint venture with the Centura Health (Englewood, Colorado) hospital system. The 20-radiologist practice also provides inpatient image-interpretation services to two local hospitals, Penrose Hospital and Penrose-St. Francis Hospital, according to Douglas L. Gibson, CEO.

In 2012, it became clear to Gibson and his colleagues that the group’s RIS and billing systems were no longer sufficiently functional to suit its needs. A decision to replace both of these with technology that had been fully qualified and certified for meaningful use was quickly made and subsequently vetted by the board of directors.

Douglas Gibson“We figured that if we were going to invest in state-of-the-art RIS and billing solutions, then why not choose options that would qualify us for meaningful use incentive funds we could use to offset the purchase price? We knew that attestation would take work, but the prospect of financial return from the incentives was very attractive.”

—Douglas L. Gibson, CEO

To simplify matters as much as possible, a request for proposal (RFP) issued in the late summer of 2012 included the requirement that systems be fully qualified and certified for meaningful use. Those with even a single module that had not been designated as such were eliminated from consideration, based on the belief that linking and interfacing various modules from different vendors to create a completely qualified configuration would be an excessively expensive, overly complex endeavor.

Toward the same end, a timetable for pursuing attestation was created and finalized. The schedule stipulated going live with the RIS and billing systems as of early September 2013, prior to beginning to collect data for attestation (October 1, 2013) and following site visits to evaluate the technology (Fall 2012), final system selection (November 2012), and the receipt of board signoff on the project (December 2012). Staff training on the systems was set for February through August 2013.

Allocating six months for training and approximately four months between going live with the technology and the date of attestation would, decision-makers believed, allow plenty of time to resolve glitches and change data collection courses if necessary.

Technology Is Key

Colorado Springs Radiology/PENRAD Imaging looked at four or five different systems that had been certified for meaningful use, eventually selecting Synapse® RIS from FUJIFILM Medical Systems USA. The system was chosen in large part for its compatibility with Synapse ® PACS, which had already been implemented by the practice and Centura Health alike. Synapse RIS is integrated with Synapse® Financials, a billing solution that incorporates IMAGINEradiology™ technology from Technology Partners Inc, Charlotte, NC.

Notes Gibson, “Compatibility with our PACS, in other words, how closely it integrated, rather than merely interfaced with, our RIS and Centura’s was a major selling point for us, as was FUJIFILM representation on Penrad’s board. Our attestation strategy was such that if we were going to go through with it, we didn’t want to replace our RIS and billing systems for the next 10 years. We saw the compatibility and integration as insurance that this wouldn’t happen.”

That the billing software had been specifically designed to work with Synapse RIS and to function as an outpatient billing system constituted another factor in its favor; a mere adaptation of an inpatient billing system to serve as an outpatient billing solution would have been inadequate for the group’s purposes and may have complicated its attempts at attestation, Gibson states. He adds, “We also found that Imagine was in use by a number of third-party outpatient billing companies and concluded that if it was good for them, it would be good for us.”

Planning and Collecting

Once the technology decision was finalized, a team led by Gibson and inclusive of several of the practice’s directors (IT, clinical, clerical, and finance) was formed to get the attestation preparation underway. Lineage Consulting, a Cary, North Carolina-based health-care consulting firm, was engaged to support the practice through the various steps, from physician registration and ensuring that the systems indeed qualified for meaningful use to determining to which measures the group should attest data and from which it should claim exemptions.

FUJIFILM lent support by demonstrating how the systems should be utilized for attestation purposes, as well as by assisting in the training of staff to properly collect data from the day the systems went live.

Examples of measures to which Colorado Springs Radiology/PENRAD Imaging will attest range from, but are not limited to, include such core set measures as the maintenance of up-to-date problem lists, medication and medication allergy lists, the recording of patient demographics, smoking status, and the implementation of a single clinical decision support rule. Among discretionary menu set measures slated for attestation are breast cancer screening and assistance with smoking/tobacco usage cessation, to name a few.

Gibson says certain functionality built into the systems is rendering the pre-attestation phase easier on several fronts. Notably, he elaborates, “We have been able to automate MQSAs for all mammographic studies. Reporting in general is much better, and we can create custom inquiries on the fly. Most important, we can monitor data, pulling it up to see if we meet certain meaningful-use thresholds and change courses if we need to rather than pulling records at the end and scrambling to make things right.”

Smooth Operations

Conversely, few, if any, physician compliance challenges have been encountered to date. Gibson attributes this lack of obstacles to the fact that there exists very little, if anything, practitioners need do with most of the data currently being collected. “Physician compliance comes into play more on the Physician Quality Reporting System (PQRS) side and is tied into dictation,” he asserts. “The information we are collecting today is not physician-dictated. PQRS and meaningful use will converge at some point, maybe in Stage 2, not Stage 1.”

Colorado Springs Radiologists/PENRAD Imaging intends to apply its anticipated meaningful use incentive funds to the debt it incurred in purchasing the RIS and billing systems. However, preparation for meaningful use Stage 2 attestation is not yet on its radar. Explains Gibson, “We want to digest the Stage 1 elephant first. There is plenty of time for the next phase.”

Meanwhile, the executive has several critical pieces of advice for those who are just embarking on the meaningful use Stage 1 attestation journey. He says, “In applying criteria to selecting technology, keep meaningful use qualification secondary to functionality; you don’t want to go through this entire exercise again in a few years because the system does not do everything it should. Hire a consultant to help figure out which criteria to attest to; when you are spending so much money on a new system, it makes sense to invest in doing it right the first time. Finally, look at workflows, and train and test staff before you go live. Attestation is an involved process, but it need not be a painful one.”

Julie Ritzer Ross is a contributing writer for