It is not uncommon to visit a radiologist reading room today and see multiple reading stations being used. If you take a closer look you will see that user interactions required to access tools, priors images and hanging protocols vary among each system. The end result is inefficiency, increased error rates due to limited clinical data, and mounting frustration levels.
Radiology practices are already experiencing added pressure due increased government regulation and plummeting reimbursement rates, so inefficiencies due to outdated system architecture and convoluted workflow must be addressed immediately to avoid staying out of the red.
Why has this become a problem?
Radiology practices have had to adapt their business models due to changes in the scope of their coverage. Advancements in teleradiology have allowed the radiology groups to begin covering both in and out-of-network hospitals, as well as numerous other imaging practices, all of which may use their own preferred vendor’s solution for image management and workflow.
It is unrealistic to expect every medical facility to utilize the same software platform, so radiology groups must be forward thinking and evaluate solutions that can mitigate the negative aspects of reading for multiple sites. Unifying your radiology worklist will lead to increased levels of user satisfaction, improved patient care and decrease frustration levels for the radiologist.
Below are a few paths available for radiology practices in today’s environment:
1. Enterprise Worklist with Disparate Image Viewers
As more vendors embraced IHE initiatives within their products, a consolidated worklist platform has become more accessible facilitating successful implementations by radiology practice across the country. An enterprise worklist allows a practice to organize and prioritize tasks, even though multiple PACS and dictation systems are at work.
To implement this solution, separate PACS and dictation platforms are installed on a single reading station and directly integrated via HL7, API or other methods such as XML to the enterprise worklist application.
PROS: This solution allows practices to have complete control of their workflow. Work can be divided by subspecialists anywhere in the practice, shared across multiple facilities, and be managed from a single location. This solution has proven to have many benefits including cost savings by eliminating contracted specialists and fully utilizing subspecialists within the group.
CONS: Challenges that you may face include potential performance conflicts between disparate PACS viewers that are impossible to overcome or require intense oversight and management. Another is that vendors and internal IT staff have to be coaxed to install each software package along with other packages on hospital-owned equipment.
Network connectivity could also become complicated due to VPNs and DICOM traffic coming from multiple sources simultaneously. Practices must also consider validating software updates, patches, and system maintenance. This can become overwhelming very quickly.
2. Radiology Practice Purchases their Own PACS
Due to both the IT and political challenges that come with the Enterprise worklist solution, many Radiology groups have instead invested in a practice-owned PACS with embedded dictation. This provides a single interpretation platform for the radiologist so study access is consistent which results in improved efficiency and user satisfaction.
To implement this solution, the hospital PACS forwards current and prior studies to their practice’s PACS. This requires a VPN unless both systems support DICOM TLS. Some PACS require an HL7 orders interface to accept images. To deliver electronic reports back to the hospital EHR, an HL7 results interface is required. If both systems are Meaningful Use Stage 2-compliant, Direct Messaging can be used instead of an HL7.
Additional considerations include buying a server, operating in a hosted environment, shared services, ASP, or cloud-based PACS (we will be covering the difference among these offerings in a future post).
PROS: With this solution, the radiologists have the capability to interpret from a single platform. Improved efficiency, decreased frustration levels for your radiologist, and the ability to divide work across the practice in one system are a few of the biggest pros. This model also allows the practice to choose the solution that best fits their needs, rather than being forced to use whatever system is being offered by the imaging facility.
CONS: You may face a combination of political, financial and technical challenges. However, compared to the Enterprise worklist solution, they can most likely be overcome with the right approach and careful planning. Hospital security will likely require an evaluation of your PACS. It’s important that you build that into any timeline. There will likely be some upfront investment required for an HL7 interface, so the ROI should be reviewed on a site by site basis.
3. Continue to read from disparate systems.
Of course, practices always have the option of doing nothing and continuing to read from disparate systems. But for those practices faced with increased volumes, reduced reimbursements, and competition from other large radiology groups, this is not a recommended option.
The #1 reason that practices hesitate from investing in a system that will allow them to grow is the upfront cost. In light of this, vendors have begun to offer cloud-based offerings with a very low entry point. These models allow a practice to ramp up in a controlled fashion and avoid the financial burden of a large upfront investment. Practices have also found ways to offset costs by offering add-on services like long-term archiving for clients that can’t afford to do it themselves.
CONS: One word: challenges. You are already aware of them, as you face them on a daily basis.
To wrap up, talk to your peers in other practices and see what they are doing. When ready, evaluate available solutions by performing a proper product and service evaluation. Make sure the SLA is spelled out in the contract and also do a site visit. Calling one reference site is not enough. Just like test driving a car, get behind the wheel and take it for a spin.