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Turning to the Cloud to Support a Diffuse Radiology Practice

May 14, 2012
by Mark Hagland
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Why one group of Missouri radiologists found cloud-based PACS to be an inevitable choice
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Alliance Radiology is a 52-radiologist medical group located in the Kansas City, Missouri metro area and environs. Within that 52-radiologist group, the nine-radiologist Liberty Division, based in the exurb of Liberty, is based out of Liberty Hospital, but also covers six smaller hospitals, as well as three outpatient imaging centers, producing approximately 140,000 radiological studies a year.

With a diversity of locations, the Liberty Division has a diversity of patient demographics as well, with a patient mix of about 45 percent Medicare, about 30 percent private insurance, and a small percentage of Medicaid patients as well.

Michael Green, D.O., one of the Liberty Division’s nine practicing radiologists, has helped to lead the division’s search for an IT solution that might optimally facilitate their multi-location practice. After going through a vendor selection process, Green and his colleagues chose a cloud-based PACS (picture archiving and communications system) from the Garner, N.C.-based Viztek, LLC. Dr. Green spoke recently with HCI Editor-in-Chief Mark Hagland about the decision to adopt a cloud-based PACS solution, and what he and his colleagues have learned so far. Below are excerpts from that interview.

What made you and your colleagues decide on a cloud-based PACS solution? Was it because of your very broad geographic coverage.

Yes, that’s right. We were covering six small hospitals besides Liberty, and we were using six different PACS systems, and six different transcription systems, and we were constantly logging into and out of different systems. We’d log into one hospital, read the studies there, log off, log into another system, and so on. So we were literally spending a third of our time on all that.

Michael Green, D.O.

And you and your colleagues were spending a lot of time driving from one of the facilities you cover to another, correct?

Yes, absolutely. From Liberty, the  closest facility we cover is 15 miles away; the farthest one is 70 miles away. Once we got Viztek, we could cut back our travel time; we still go to each hospital once, twice, or three times a week, but oftentimes, if there’s no physical reason for us to be there, we won’t go. But our turnaround time is great now.

What was your vendor selection process like?

We as a group thought about getting our own PACS, and somehow I and one of my colleagues ended up being assigned to this as a committee of two. So we started looking at PACS propositions and started doing some online research, and went from there. We didn’t go to RSNA [the annual meeting of the Radiological Society of North America, held the week after Thanksgiving in Chicago], because RSNA had just passed.

How many vendors did you seriously consider?

We interviewed and had presentations from four vendors.

What were the deciding factors in choosing the vendor you did, and what were the key capabilities you made your decision on?

In the end, Viztek offered the right product for the right price. In terms of capabilities, it’s web-based, so we can locate a server anywhere, and the radiologists, as long as we have Internet access, can be anywhere, and can work anywhere.

Is this interfaced with the other systems?

I wouldn’t say that. As part of the whole system, we installed the main server at Liberty Hospital, just for logistics reasons; and that in essence is the cloud side, if you will; and at each of the smaller sites, we established a mini-server, a DICOM gateway. So a radiology study is performed at one of the facilities, it goes to their PACS, and then goes to the Viztek DICOM gateway; then the study is encrypted in Viztek DICOM proprietary software, and once the study is encrypted, it’s then transferred to the cloud server via a secured connection, a VPN [virtual private network], and once the study is transferred to the cloud server, it’s from there that we then read the studies.

So as an end-user, you’re only dealing with one system, then?

Yes, in essence. We log into Viztek, read and interpret studies, send them off, and log off.

As end-users, only having to sign in once represents a big advance, right?

Oh yes, it’s huge. From a workflow standpoint, it’s made things tremendously better. We’re probably saving at least an hour each day of not having to do the mundane log-ons and log-offs.

That’s a lot for a radiologist.

Oh, it’s huge. Even though our practice has increased each year as we’re reading more studies, we don’t need to hire anybody new for now.

How many studies do you do on an average day?

75 to 100, maybe.

How might this time savings translate into enhanced productivity?

Actually, we can actually read 10 to 15 studies in an hour’s time, depending on the study. A chest x-ray is a minute or two, but on average, 10 to 15 studies per day. So there’s a considerable gain.

Does that mean that this software product has paid for itself?

On the financial side of things, to say it’s paid for itself, you kind of have to go into the theoretical realm, based on the idea that we’re billing more money. So theoretically, you could say that; in the end, it’s very, very expensive technology. But it has become a necessary tool, for a couple of reasons. For one, it’s made our workflow better. And the quality of the work day has improved. And also, not only did we buy the Viztek PACS; we also bought the Viztek PACS for a couple of the smaller hospitals, too.

So it makes it easier for everybody?

Absolutely. Nobody has any money anymore, the government is cutting back on reimbursement, and these critical-access hospitals are barely making it now. So we bought not only the Viztek DICOM gateway, but also actually bought the PACS for a couple of the hospitals, and have leased them to them, and they can afford to pay a small monthly fee to us, so we actually get a little payment each month from two of the six critical-access hospitals.

What have the biggest lessons learned been?

As we talked about, if you have everything funneling into one system, you have made your daily work easier, which in essence allows you to provide better service to your clients, and that’s what they want. Even though they’re a small hospital, they want quick turnarounds on reports, and if you’re able to do that, you’ve won. Our turnaround time went down dramatically when we went to Viztek. Previously, we had had to log into their systems, write our reports, etc. And also, with several of the hospitals, we hadn’t been able to sign our reports remotely. So now we can turn around reports and electronically sign them within an hour, versus in the past, a day or longer, because we had to drive to them to sign the reports. What’s more, using this system, we have a worklist to read, and anytime a case is designated as stat by the ordering facility, it immediately changes color and goes to the top of the list.

You’re obviously feeling the pressure to provide quicker turnarounds these days, correct?

Correct. And in the world of medicine, oftentimes, time is money, particularly in an ER situation. And the hospitals want the patients to get in and get out, and people want quicker results. In the smaller hospitals, they might not have a true ER physician on duty; often, it’s a family physician. And the non-radiologist physicians are just not as comfortable looking at their own studies; and now they can get quicker turnaround from us. Radiology has always been a technological field; and now the whole computer thing has come to radiology, too.

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