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Strategic Systems Implementation in a Dynamic Radiology Group Setting

December 26, 2012
by Mark Hagland
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At Jefferson Radiology in East Hartford, Connecticut, CIO Michael Quinn has been leading a technology revolution

Michael Quinn, the chief technology officer and CIO at Jefferson Radiology in East Hartford, Conn., has been helping to lead his colleagues through a comprehensive information technology transformation, including the implementation of a vendor-neutral archive solution, in partnership with the Milwaukee, Wis.-based TeraMedica, Inc. Jefferson Radiology, with 65 radiologists, 450 full-time employees, and 10 outpatient centers, is the dominant radiology group in Connecticut. Its radiologists read for seven hospitals in the state. Quinn, the organization’s CIO, works with an IT staff of 19. He sat down with HCI Editor-in-Chief Mark Hagland during the RSNA Annual Conference held at Chicago’s McCormick Place, at the end of November. Below are excerpts from that interview.

How long have you been at Jefferson Radiology?

I’ve been there for two-and-a-half years. In the last two years, we’ve basically revamped all the IT. When I came onsite, we had [the Los Angeles-based] MedInformatix for our RIS [radiology information system]. We are still using that solution, and in addition, we are using [the Montreal-based] Intelerad for our ambulatory PACS [picture archiving and communications system], and TeraMedica for our vendor-neutral archiving. Meanwhile, we have Nuance’s PowerScribe 360 for voice recognition.

When I came onsite, we replaced just about every system. We had the old GE Healthcare’s Stentor PACS, and GE’s RIS; in 2011, we replaced our PACS system so that we could get to a unified worklist for the radiologists. That was the benefit of Intelerad. And this year, we went out and procured an archive through TeraMedica; and we replaced our billing system. We went live with our EMR, from Medinformatix, on Sep. 4.

Michael Quinn

You’ve been busy!

Yes, we’ve been busy. We also implemented EMPI, and also Micrsoft’s BizTalk as our interface engine.

What were your organization’s overall strategic goals?

To gain efficiencies within the organization, especially via the unified workflist. Our radiologists find it easier to do their work. And with the RIS system, as we get used to it, I think we’ll see increased efficiencies. But our goal was to be efficient, to help keep our costs down, and to be able to grow. And one of the reasons we went with a vendor-neutral archive was that we’ve been asked by some of our hospitals to provide PACS services or archive images for them, and TeraMedica allows us to do that. So if there were ever a professional divorce, their data is right there. And a lot of the hospitals, especially the smaller community hospitals, see that as cost-beneficial to them.

When did you go live with TeraMedica?

We went live in July of this year.

And when did you go live on Intelerad?

In July 2011.

Did you consider anyone else besides TeraMedica for your vendor-neutral archive?

Yes, we considered four other vendors’ solutions; we did an RFP. We wanted to be able to provide a range of services to our hospital partners, and not only to be able to store radiology images, but also potentially cardiology and pathology information. And we wanted to provide all of that to them in their native format, rather than through a DICOM wrap.

Was it easy to go live with the TeraMedica solution?

It was very easy to do. And they’ve been a very good partner. In one of our implementations with one of our hospital partners, we were having problems with their DICOM headers. If you look at an image, it’s the tag. The problem was, they had put extra data on the tags, and that wasn’t going to work; so we went to TeraMedica and said, here’s the problem, can you help us? They came up with the ability to interrogate the tags and standardize them. And they came up with that solution in two days. And that’s what really impressed me.

Have any process changes occurred since then?

Not so much; but now that we’re live on our own vendor-neutral archive, we’ve had conversations with other hospitals about vendor-neutral archives, and so we have several other hospitals moving to that archive. And the other piece is that some of our hospitals have asked us to help them with cardiology. So we will use TeraMedica as the back-end storage for that solution. So it’s really playing into the vision that we had for all this.

What have the lessons learned been so far?

 I believe that PACS will evolve, and we’ll get to the point where we’ll be able to start picking and choosing what we want to be our back-end structure, and the middleware for workflow management; and the viewer. And having a back-end system like TeraMedica will help, particularly since having a company that’s keeping up with the standards will help us move in that direction. And I think you’ll start seeing more applications built on top of that platform. That’s why standards are so important. And if we ever had to migrate again, that migration will be very easy.

Developing the vendor-neutral archive has also provided us the ability to do analytics that we may not want to do in our production system because it might impact production; so we could do some advanced analytics on the system. And next year, we’re going to talk about how we may want to use this as we interface with HIEs [health information exchanges]. We are not yet in one. But we’re going to have a meeting in two weeks about image-sharing with one of our hospitals. In addition, the leaders at major integrated health system in this region are deciding how they might do HIE; and the state of Connecticut is in trials, figuring out HIE. We feel that we’ll be well-positioned for [all that potential activity].

Based on your experiences so far, do you have any advice you might like to offer your fellow CIOs?

The last two years has been very, very grueling for our staff, because we’ve basically redone all of our systems. So my biggest advice is around planning: you have to be prepared for the unexpected.We sit down and talk about things; and we’ve learned from past installations. I wouldn’t recommend replacing all your systems at once. But I’ve talked with all of our vendors, and the one thing they’ve told me in our conversations is that they were very impressed with our planning. They’ve said that one of the things that they don’t see in most implementations is the thorough planning we’ve done. And we always feel we can do better. But for organizations going through changes like this, they should reach out to colleagues. We gladly tell them the good and the bad. So it’s been a ride, and it’s been very good; we’re very happy. And now we’re ready to do what we see as part of our vision. Jefferson wants to be a regional player in radiology; and now we’ve put everything in place to do that.

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