Manhattan’s Physician Group is an 80-plus-physician multispecialty practice that covers a service area spanning a broad swath of Manhattan, from the Wall Street area in the south up through 185th Street, with seven locations, plus a central business office in nearby Jersey City. It is an independent organization whose patients are primarily referred to the four-hospital Continuum Health Partners health system and to Lenox Hill Hospital for inpatient care.

One significant operational challenge for Manhattan’s Physician Group (MPG) has been in the area of managing imaging informatics, with MPG’s physicians working with more than 50,000 radiological studies a year, across 80,000 unique patients. In an effort to get a handle on process, storage, and sharing issues for diagnostic images across diverse radiology information system (RIS) and picture archiving and communication system (PACS) solutions (MPG’s own and those of the hospitals to which it refers patients), MPG engaged the Oak Brook, Ill.-based CriticalKey LLC to develop a diagnostic imaging informatics strategy. MPG’s CIO Steven Vickner has been leading that effort.

Vickner spoke recently with HCI Editor-in-Chief Mark Hagland recently regarding this organization’s ongoing work in this area. Below are excerpts from that interview.

Can you tell us about what led you and your colleagues to move towards a more comprehensive imaging informatics strategy and to roll it out?

What happened before I arrived was that MPG had purchased a full RIS/PACS solution, and was shooting studies at our largest site, on the East Side at 95th Street; then we added an x-ray location at 22nd Street. We were using the Carestream RIS/PACS. Our EMR is NextGen, so the reports would filter into the NextGen, and staff could view images via the PACS server. But for whatever reason, we weren’t getting paid on all the claims, because we weren’t certified through the body that certifies you to perform radiology services, so we were being reimbursed by some payers, but not all.

We used to have two radiologists, one onsite and one offsite, but no longer. Also, some of the physician practices that became part of Manhattan’s Physician Group had been Continuum-owned, while West Side Radiology [a radiology group that collaborates with MPG] is partly Continuum-owned, and the rest is privately owned. And some of the practices had been Continuum-owned before they became part of Manhattan’s Physician Group. So it really was a patchwork quilt [of affiliations and organizations]. So one step is that we formed a relationship with West Side Radiology, where they own the equipment, and pay us a fee to work out of our 95th Street and 22nd Street locations. We used to have two radiologists, one onsite and one offsite, but no longer. So we still have our Carestream system, and there are still studies being used on a historical basis for reviewing, but all the new information is going into the Continuum system, which is ImageCast, that’s the RIS, and their PACS is McKesson.

Steven Vickner

It’s a very complicated imaging informatics landscape, isn’t it?

Yes, it is.

So how does CriticalKey come into this?

Because we have such a tight business relationship with, and send so much business to, West Side Radiology, they wanted to be able to send us their reports. And West Side Radiology contracted with CriticalKey. West Side Radiology is partly owned by Continuum, but they independently entered into a contract with CriticalKey. So CriticalKey came in, and the plan was, for phase 1, we would receive the radiology reports from them via CriticalKey. We haven’t really mapped out the rest yet; I know in my mind what I want to get done.

Right now, the provider on our side will enter the order and print it out; sometimes, the patient will walk down the hall, since they’re in our physical space. They’ll be registered in Continuum’s registration system; that information will flow over to CriticalKey; the study will be performed; and when that study is finalized by the radiologist, the CriticalKey engine will take the final report. And there’s some manipulation we need to have done relative to the header and receiving information, and that is deposited directly into what’s called the PAQ—“provider activity queue”—that is how the doctor knows that there are radiology results ready for review, or lab results—anything needed.

What are the advantages in this system of automation?

Well, the previous process was a very complicated, time-consuming one that involved West Side Radiology printing out all its radiology reports and then having one of our FTEs entirely dedicated to scanning in reports and notifying referring physicians. In other words, one person on our staff was completely devoted to printing, scanning, and indexing radiology reports. We’ve been able to eliminate that role, and that person is now in our central business office with the rest of the medical records team.

So you’ve gained the productivity of a full FTE?

There are six or seven medical records people, scanning and indexing records. We just had someone leave the other day but there was no need to replace them, since we had this whole FTE back. So we gained back the productivity of a full FTE, and the reports are available in our EMR as soon as they are finalized by the reading radiologist.

What had the time lag been?

On average, it was about a day from the time it was finalized to the time it was available to the provider.

How many radiologists work at West Side Radiology?

At 95th Street, there’s just a single reading radiologist. Now, West Side Radiology has eight or nine radiologists across the city. Our patients will go to either 95th Street or another one of their facilities; but if everybody does what they should, per MPG patients, we’ll always receive the report. And 95 percent of the time, if it’s happening at one of the sites in our physical sites, we’ll receive the report. It also eliminates the paper and faxing costs.

What are the next steps in this process?

Because Continuum and their imaging system are on different platforms—they’re all GE/IDX, but they’re on different versions—they’re not ready yet to receive electronic orders. So that’s the beauty of having the CriticalKey engine in between. So the next thing I want to accomplish is to send the order electronically from NextGen; and CriticalKey would hold that order, and ideally, the RIS system would accept that order electronically, but if not, they would manually key in the order upon registration at radiology, and when they came back, the RIS system would match the order numbers and send it into our system, so the patient wouldn’t need to remember the piece of paper, the staff at West Side Radiology wouldn’t have as many items to manually key in, and we send all of our patients to West Side, which means that when my providers order through NextGen, they can be ordering the exact same test, and the details of the order would be automatically matched. That would save us work and would give us a better tracking system so that we can manage the system better. The other thing that we do want is that we’d like a link to the image sent over with the report.