When X-Ray Associates of New Mexico went live with a new RIS in mid-April, Vice President and COO Sagit Frasier was anxious, but optimistic. The moment had been years in the making. The practice’s other mission-critical IT systems—billing, digital dictation and Sectra PACS—whirred to life, fully integrated with the new RIS. There was neither downtime nor a letdown of expectations.
“The conversion took about nine months,” Frasier recalls. “We had been in meetings, collaborating with the various vendors and designing the workflows. It was a stressful, but an amazing day, as things pretty much worked as designed. Patients were seen on time, physicians were reading, and reports were getting out to the referring providers and hospitals we served.”
The road to the April go-live actually began back in 2013, when Sectra let Frasier know it would be sun setting its RIS. A big part of the victory was seeing Sectra PACS work so well not only with a MedInformatix RIS and its billing module but also with Nuance’s Power Scribe 360 dictation software.
Having grown to a seven-facility, 25-radiologist, 240-employee operation in the second decade of the 2000s, X-Ray Associates of New Mexico (XRANM, which despite the name does far more medical imaging than just the x-ray variety) is now poised to open more outpatient imaging centers and win new hospital contracts over the coming months and years, Frasier told imagingBiz in a recent interview.
“Each hospital has its own PACS and EMRs, and we have inbound interfaces with all of them,” Frasier says. “We read the studies on Sectra PACS, we dictate the reports on 360, and the RIS sends the reports back to the hospitals’ EMRs. All this happens within minutes.”
Out with the old …
Reflecting on XRANM’s path to IT victory, Frasier remembers a call coming in from Sectra three years ago.
Mikael Anden, the president of Sectra North America, made the call. Frasier was glad to be in the know in plenty of time to craft a plan for a new RIS. “I actually wasn’t shocked to hear him talk about the sun setting of the Sectra RIS over the subsequent three years, because I knew we were one of the few Sectra customers taking advantage of all its capabilities,” she says. “That included getting ready for Meaningful Use Stage 2 attestation, which was going to make it even harder for an aging RIS to keep up. I knew Sectra had been investing a lot, so I really understood the decision.”
In fact, Frasier adds, she appreciated the heads-up and used those three years to rally XRANM’s radiologists around choosing the best way forward. Their original plan was to implement PACS-focused rather than RIS-focused workflows and processes, but after much internal discussion about accessing patient histories and other non-imaging info, it became clear that they had to stay RIS-focused.
“Our physicians are known for giving complete care and direction to the referring physician community and to our patients,” says Frasier. “This means we need great access to patient histories, reports and schedules.”
Off they went to RSNA2013 with a list of must-have features, not least billing capabilities and Meaningful Use attestation aids. They spoke with more than 20 RIS vendors, then carefully whittled down the field over the following months.
“We also looked at three or four combination RIS-PACS products,” says Frasier. “None of those had the PACS capabilities we needed. None were able to do [breast] tomosynthesis, for example, where our doctors read everything in Sectra PACS, which is fully integrated with MIMVista for our PET/CT imaging, Cadstream for Breast MR and TeraRecon for our 3D reconstructions.”
It was only after conducting extensive vendor interviews, site visits and evaluations, including a deep dive on price points, that they confidently decided on MedInformatix for RIS and billing, Nuance for dictation and an upgrade to their Sectra PACS.
“We did not find one vendor that could do everything well,” recalls Frasier, “but we were very happy with each of these three.”
… In with the truly improved
With those words she’s actually understating her enthusiasm. Asked to expound specifically on what she likes about Sectra PACS, Frasier doesn’t equivocate.
Sectra PACS “allows our physicians to read everything from interventional radiology to breast imaging to general radiology to MSK, all-in-one and at their fingertips,” she says. “We love the product, and it’s been very stable for many years yet still continues to upgrade and improve. We believe it is the best PACS on the market.”
She also believes the best is yet to come. As part of their updating of Sectra PACS, XRANM this year installed a Sectra add-on called Patient Linking. As data enters the new RIS, via the Corepoint interface engine, software pattern matching determines whether the patient already exists in our system and then sends a link message to Sectra PACs. This allows the radiologist to view and compare images from multiple facilities and imaging centers, all with different patient identifiers.
“On the day we went live, our doctors sat in their chairs—the same chairs they’ve sat in for years—and opened up a case,” says Frasier. “Under this new configuration they were able to view the patients consolidated history. They could bring up the images considering them in the chronological order in which they were captured. That was an immediate improvement for our doctors.”
Frasier says the new RIS-PACS integration makes up for the many and varied ways in which data arrive from the hospitals, adding that the jumble still includes plenty of paper.
“The hospitals still send us images and records under their medical record numbers and their accession numbers. We can’t change how things are done on their end, of course,” she says. “They send patient info like they always did and then our systems, between MedInformatix and Sectra, do the linking. Our doctors no longer have to do that manually. The hospital staff no longer needs to pull and send their priors separately. It’s very cool.”
Physician efficiency is a top priority at XRANM, Frasier notes.
“If there’s anything we can do to make them more efficient,” she adds, “we’re going to do it.”
Vendor collaboration is key
Frasier stresses that it’s not enough for vendors’ solutions to work well together. The vendors themselves have to play well together too.
“The collaboration of Sectra with MedInformatix and Nuance, and of everyone with Corepoint, the interface-engine experts, is really allowing us to maximize our efficiency,” she says.
Among the fruits of the collaboration now in the works is a referring physician portal that will show, in one display, exam-specific info from the RIS and the PACS.
“That’s collaboration that Sectra and MedInformatix are doing to enhance our workflow,” says Frasier. “Instead of referrers needing to log into two systems, they’re going to be able to log into one and get everything all together.”
Next up will be transitioning the hospitals to a more paperless workflow, setting up tablets for patients at the front desks and a portal for their use at home and/or mobile devices.
None of it will be doable without the kind of multi-player collaboration XRANM proved could work with the April go-live.
“Ultimately, we have a great, longstanding partnership with Sectra and Corepoint. We are excited about our new relationship with MedInformatix and Nuance,” Frasier concludes.
“I think everybody has a goal to provide us with a great system to work with. When everybody’s got that same goal in mind, it’s not like issues no longer come up. Things still come up all the time. But everyone’s working to solve the issues and perfect the system.”