Regional Medical Imaging (RMI) is an independently owned and operated imaging center organization established in 1985 that encompasses five diagnostic imaging centers located in Flint, Michigan and in surrounding communities in Genesee County, of which Flint is the county seat. Randy Hicks, M.D., is the co-founder, co-owner, and CEO of RMI; he oversees the operations of an organization with 13 full-time radiologists and five part-time radiologists, who produce 120,000 diagnostic imaging studies a year, and who work with a total of over 130 staff, serving a population of about 425,000 in the Flint metropolitan area and in the Genesee County service area.

Dr. Hicks spoke recently with HCI Editor-in-Chief Mark Hagland regarding the crucial role of IT infrastructure for diagnostic imaging centers and radiology groups, and ongoing technological and industry changes that are helping to influence his and his colleagues’ strategic planning going forward. Below are excerpts from that interview.

Tell me about your organization's core IT infrastructure?

We are a client of [the Chicago-based] Merge Healthcare. We were originally a client of Amicas, before it was absorbed into Merge. We have their RIS [radiology information system] and PACS [picture archiving and communication system] solutions, and we also have, through a third party, a document management system. We also have the Merge financial/billing system, as well as their dashboard system and their reporting tools.

Randy Hicks, M.D.

Tell us a bit about how you’re using dashboard and reporting tools these days?

There are lots of things going on in the industry. And one of the key things that I think is important for radiologists is, are you involved with multiple vendors or a single vendor? If multiple vendors, can you run those products well for workflow? It’s really the whole workflow issue that people are interested in, and meaningful use.

What is your understanding of meaningful use, insofar as radiologists now qualify for it, and need to meet many of its requirements?

Yes, it’s the government’s attempt of trying to get us all on a similar platform of electronic information storage. When they originally started the program, the focus was on primary care, and the vast majority of requirements were focused around primary care tasks. Yet we radiologists have actually been performing more meaningful use-related activities in certain ways, because we’ve been pretty much electronic for several years. So we as radiologists went to the government and asked why we were initially excluded. So we were essentially allowed to come in through exemption from many of the requirements. So we’re fully eligible as eligible providers for the full $44,000 [the stimulus funding available to eligible providers under the federal American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act].

And my radiology group was one of the first in the country to receive the stimulus funds. We were up and functioning in the fourth quarter of 2011; we registered at the beginning of 2011; and we had everything up and running on Oct 1., 2011, and attested to that use in February 2012, we received the funds for all 13 physicians who attested. The first year, you get $18,000 maximum per eligible physician, and we attested for all 13. I think we brought in $232,000 for the first year of implementation. And that money is being used to offset the expense of doing these projects.

So you’ve been investing heavily in RIS and PACS technologies?

It’s basically RIS, and we’re trying to achieve more and more integration between RIS and PACS, so we can pull through that RIS data into the PACS. So it’s about integration. What we’re trying to do, and to get vendors to do, is to get true meaningful use out of the systems, so we can get more information in a more timely way, in order to care for patients in a better way. For instance, if you saw your primary care physician this morning, our goal is for the information from that visit to come to us.

Are you participating in health information exchange [HIE] as well?

Yes, we’re participating with Michigan Health Connect, which is in western Michigan. We are participating, with Merge, as an early adopter, to connect with this HIE, in order to not only share reports but also images, with our wider community as a state and country. Using health information exchanges, our goal is to transfer data between different practices in a more seamless fashion. We’re just hooking up the connections now, through Merge. In the next three months, we’ll go live. It’s a time issue.

By participating in an HIE, what will happen?

Our vision for the near future is this: if, for example, I’m going to Chicago for RSNA [the annual Radiological Society of North America meeting] in November and I get sick, my information will quickly go through HIE systems across the country, and my information can quickly go to whatever downtown Chicago hospital I land in, in terms of their ER. So the exciting thing for me as a physician is that I will be able to change how you as a patient interact, and can improve your healthcare.

What should other radiologists understand, and what should healthcare IT leaders understand, about what’s necessary to truly leverage information technology in the radiology area, going forward, especially during a time when radiologists are under more and more intense pressure to turn around their reports as quickly as possible to referring physicians?

I think that creating that basic backbone structure, putting that infrastructure in, is most important. And every practice is different; and it’s a very complex process, and one that each organization has to take on itself, but at the end of the day, the payment issue will go away, and what will remain is that you as a healthcare provider will have to develop a way to practice that’s electronic. And if you don’t do this, the government will say, you’re slowing down healthcare delivery, and we’re going to reduce your reimbursement as a result. So the message is, the time is now, and it’s later than you think. You had stated that the radiologists are frustrated because everyone wants everything now. But if they think they’re frustrated now, just wait until the patients want their information right away, and their radiologist can’t provide it. So the whole industry is changing, and everything will be run through electronic information systems; and if radiologists are not in play, they’re not moving with the flow, they’ll be left behind.