Patient Engagement and Quality of Care: Adams Diagnostic Imaging
Rahul SmithAdams Diagnostic Imaging (ADI), founded in 2006, is an outpatient imaging center in Gettysburg, Pennsylvania, that provides an array of subspecialty services—with just one radiologist on staff. Rahul Smith, executive director of the center, says, “We have one medical director on staff: a board-certified nuclear-medicine radiologist who interprets our PET/CT exams. We also use 12 to 15 subspecialty radiologists from Virtual Radiologic (vRad) who read our MRI, CT, radiography, and dual-energy x-ray absorptiometry images.” The arrangement is economically sustainable for the practice, enabling it to offer advanced technology—its PET/CT is the only stationary system in the area—as well as exceptional patient care, Smith says. “Patient engagement builds our business,” he notes. “At a time like this, when there is a lot of competition with hospitals consolidating and strengthening their radiology programs, service to patients is invaluable. It’s the only thing you can do that puts you above the rest.” Designing for Patients Smith’s philosophy of patient engagement was first extended to the design of the imaging center. “We wanted the feel of the office to be nothing like the feel of a hospital. It’s very comfortable,” he says. “The MRI suite has carpeting and couches where patients are welcome to bring their family members (after they have had safety checks). Some patients are claustrophobic, so we allow them to listen to music. We take any extra steps we need to take in their care.” Rather than have patients fill out the center’s questionnaire in the waiting room, Smith encourages technologists to find an out-of-the-way place to sit with patients privately and work through the forms together. “I encourage the technologists to spend time with the patients and talk to them, rather than herding them in and out,” he says. “We have little nooks where we can sit down and talk to the patient.” Even the imaging center’s daily schedule is slower than the schedule might be at a center of comparable size. “We allow more time for each patient here so that we know we have the time for extra service,” Smith says. “Most patients who come here do want to come back because they like the environment. Our MRI technologist told me yesterday about an athletic family in which we’ve seen every single family member. They just like it here better than anywhere else. Our service really encourages referrals.” In addition, Smith says, he and his staff work with patients facing financial challenges to ensure that they get the care that they need. “We do a lot of pro bono work,” he says. “We work with physicians, if the patients have financial needs, and we try to take care of the insurance verifications and other issues in-house. It’s a mutual benefit for them and for their referrers.” Automating for Physicians As evidenced by its use of remote subspecialists, ADI is no stranger to using health IT to make its practice more efficient—and it extends those capabilities to its referring physicians as well, Smith says. “We use a Web-based PACS that gives exceptional-quality images to our referring physicians and can be used as a reading station,” he explains. “We can install the PACS viewer in our referring physicians’ offices, and if there’s a really pathological finding, when they open up the report, they will see it on the left (with key images on the right).” As a result, referrers to ADI have the ability to discuss patients’ images with them in their exam rooms—no small benefit, Smith says. “Patients can actually visualize their disease state and their care,” he notes. “For instance, we have a urologist who orders CT urograms. We do a 3D reconstruction, and the physician can point out the problem areas to the patient.” ADI In fact, Smith says, the inspiration for the offering came from ADI’s relationship with a local cancer center, where clinicians were discovering that patients had trouble visualizing their own pathologies. “The way things are moving, a lot of physicians are having to adopt electronic medical records (EMRs,) so there will be laptops and computers in exam rooms that weren’t there before the EMR stimulus,” he says. “We should be able to show these patients what’s wrong. At the cancer center, when you can explain what’s going on with images, it validates the physician’s opinion and enables him or her to give better care.” So far, Smith says, adoption of the viewing-station capability among referrers has been slow, but steady. “A lot of physicians are hesitant about it, but slowly, this is growing: It’s the way they will practice in the future,” he predicts. “They reap the benefits if they are forward thinking, and we encourage that.” Among those referrers who take advantage of ADI’s offering, the reaction has been excellent, Smith continues. “We get a lot of good feedback from primary-care physicians, orthopedists, and podiatrists. Before, if they wanted to view key images, they would have to log into the PACS and look for them. These just come right up,” he says. Smith notes that in the case of this patient-engagement initiative, positive feedback from patients goes to the referrers, not ADI. “It’s not for us to get the compliments; the patients compliment their physicians,” he says. “From the beginning, this was an idea I wanted to put in place for the sake of patients. We see more referrals because of it. It’s part of our vision for improving the clinical quality of care.” Cat Vasko is editor of Medical Imaging Review and associate editor of Radiology Business Journal.