NeoTool — Singular Focus, Healthcare Integrated

The Deficit Reduction Act (DRA) of 2005 is having an impact on imaging centers. A recent Aunt Minnie article entitled The DRA at Six Months: How Outpatient Imaging Centers Are Coping examines the various impacts of DRA on both outpatient imaging centers and hospital radiology group practices.

Some of the interesting impacts are highlighted in the last section of the article. Although many radiology practices are waiting to determine the impacts, many are acting now. In the article, Darlene Zase, executive director of Advanced Radiology Consultants (ARC), states:  “We prepared for this. We didn’t wait for it to happen.”

The focus in the “Strategies for Survival” section is how to improve productivity and efficiency. With protecting profitability and streamlining radiology workflows, imaging centers are hiring a “new breed” of radiology administrators. 

According to Steve Renard, SR Consulting, “They’re looking for people who can think strategically about how to protect their profits. It’s a different style of manager than I’ve seen before, more entrepreneurial, more tactically minded. These new managers are going to conferences and marketing classes to understand how payor networking works and how effectively the center is billing.”

Information technology (IT) also is at the center of the efficiency effort. IT is being leveraged in ways to streamline radiology workflows to increase productivity or reduce the cycle times, especially in billing.

Strong imaging centers are adapting by thinking more strategically about their practices while acting more tactically in improving operations. They are not waiting; they are taking actions now, in light of DRA, but also as part of an effort to enhance overall management practices.

Turn Around Time or TAT. An important concept for many radiology practices or any healthcare institution.

An article entitled Are Your Physicians Happy? appeared in RT Image in 2004. Granted, it was several years ago, but the article highlights the importance of understanding key radiology processes, knowing the cycle time of each process, and identifying the “weak” areas. The workflow discussion and approach is still valid today, especially if the objective is to improve TAT.

What has changed today is that many radiology practices and diagnostic imaging centers have begun to realize how the HL7 standard and interface engine solutions can take TAT to the next level of healthcare integration.

We wrote a white paper entitled Rethinking Radiology Workflow which illustrates how steps in a process can be automated and supported by an HL7 interface engine with the objective of improving quality, service, cycle time, and TAT. In fact, imaging centers like Radiology Ltd. have achieved improved cycle times in several of their key workflows (e.g., delivering patient reports within hours).

The points in all of this are simple:

• Understanding the key activities, steps, and metrics in your radiology processes is still essential today, just as it was in 2004. In fact, it may be more important.
• Enabling the workflow has improved with HL7 and interface engine solutions.
• Are your physicians happy? Delivering better TAT will assist in strengthening physician relationships and expanding your referring physician community. An even more important concept in today’s competitive and changing market.

There is an interesting article entitled “Attracting Business” that appears in Advance for Imaging & Oncology Administrators. The crux of the article is radiology practices have evolved into customer-centric businesses in which the operations need to match the marketing messages. In other words, the patient’s experience at the facility needs to match the marketing words. Without the consistency of message with experience, the result is “empty promises” for the patient.

The article alludes to their being two customers: the patients and the referring physicians. As the articles states, “Savvy competitors also realized that reducing hassles for the referring physician office staff was a market-differentiating factor…” Although most of the article focuses on the patient experience versus the referring physician experience, the same principles should apply to the “physician as customer.”

For radiology practices, matching the marketing message to the operational experience is critical for the referring physicians, too.

• If the marketing message is about turnaround time on radiological interpretation, then the operational experience must be patient reports delivered within hours, not days.
• If the marketing message is about radiology workflow efficiency, then the operational experience must be productive, electronic flow of patient orders and reports.
• If the marketing message is about developing close relationships with referring physicians, then the operational experience must be seamless systems (e.g., RIS to EMR, EMR to RIS) between the two facilities (imaging center to clinic and clinic to imaging center).

We have written several past posts about radiology workflow and operations, including:

• The Many Roles of a PACS Administrator
• Increasing Radiologist Efficiency and Productivity
• Healing Radiology Workflow Gaps

Some of these previous posts on healthcare integration & radiology workflow may be of interest as you determine the best ways to align your marketing messages with your radiology practice operations. To keep physicians referring patients, the radiology practice must deliver on their promises.

Early in the morning on the RSNA exhibit hall floor, silence is only broken by vendors busily preparing their booths for the opening. At 10 am, as attendees begin to enter the hall, the volume of the conversations begins to rise. Conversations are essential as radiologists, PACS administrators, and others begin to explore new ways to produce and analyze images and new solutions that enhance radiology workflows.

The RSNA exhibit hall is filled with vendors, but a large portion of the floor space is dominated by the large players. While McKesson, Siemens, GE Healthcare, Philips, etc. dominate the space, the conversations are not all taking place here. There is a long list of new vendors that are highlighting their solutions at RSNA.

As noted in a previous post, there are several categories of solutions that deserve time by attendees. Innovation is occurring with most RSNA 2006 exhibitors. Splitting time between the large vendors and the others is critical to understand the changes and opportunities being promoted for both free-standing imaging centers and radiology departments in hospitals.

If you are not able to attend RSNA Chicago, then read through the news reports in the various healthcare IT publications and follow what is being reported. As important, enter into conversations with the vendors after RSNA and explore how technology can enable your imaging center and radiology workflows to a new level of performance with clients, physicians, and the referring community.

Procedure code mapping is one of many code set mappings that may need to be completed in order to successfully interface a healthcare provider with an imaging center via the HL7 standard. Procedure mapping has an impact on radiology workflow.

An imaging center has a defined set of procedures they can perform. In their Radiology Information System (RIS), each procedure has its own internal code. For example, a left-side chest x-ray may be coded as 9999. While these codes are standard within the internal RIS, they are not the same procedure codes that external healthcare providers will be sending them. Hospital 1 may have the left-side chest x-ray coded as ‘R777′ in their system, and Hospital 2 may have a code of ‘12345′.

Complicating this issue even further is the use of procedure modifiers. A third hospital may have a procedure code of ‘CX123′ in their system for a left-side chest x-ray, and they would use the same procedure code in their system when ordering a right side chest x-ray. They would, however, send a procedure modifier value of ‘L’ or ‘R’ as part of their HL7 order message.

The examples below illustrate the format of the OBR segment of an HL7 order message (ORM^O01) that each sending system would send to an imaging center:

Hospital 1:
OBR||0606290001|060629001RAD|R777^Left Side Chest||…

Hospital 2:
OBR||0606290001|060629001RAD|12345^Chest X-RAY Left Side|||…

Hospital 3:
OBR||0606290001|060629001RAD|CX123^Left Side Chest^^^L|||…
These messages need to be restructured so that the imaging centers RIS can accept them, and create an order for the correct procedure in their system.

Imaging Center:
OBR||0606290001|060629001RAD|9999^Left Side Chest X-RAY|||…

This mapping can take place in 1 of 3 instances:

1. The mapping can be accomplished using an interface engine.
2. The imaging center may require that the external system do the mapping in their system prior to sending the HL7 order messages to them.
3. The imaging center may choose to set up the mapping in their RIS for ‘each’ healthcare provider that they interface with.

There are pros and cons to each approach. If you are an imaging center that plans on interfacing via HL7 with a large number of healthcare providers, creating custom mapping for each HL7 interface within your RIS may be possible but, at the very least, extremely time consuming. On the other hand, if you are an imaging center that requires external systems to do their own mapping, you may lose business to more flexible imaging centers that are willing to do the mapping in their system. HL7 integration engines allow you to take the mapping out of the clinical applications, and gives you the ability to create the mapping in a system that is designed specifically for the manipulation and routing of HL7 messages.

Keep in mind that when the report is sent back to the ordering healthcare provider, a similar mapping may have to take place in order to map the procedure code back to the external procedure code value … Receiving the order is only half the battle!

PACS Administrators play a key role in radiology practices and enhancing radiology workflow. Although the PACS title has been around for only ten years, some think that the title does not accurately reflect what they do today. The PACS administrator role could be broken into many parts, including:

• IT manager
• Application manager
• Project manager
• Radiology workflow efficiency expert
• Diplomat
• Communications systems expert
• Quality assurance
• Standards expert (e.g., DICOM, HL7, etc.)

An interesting article entitled Five Steps to Finding the Perfect PACS Administrators outlines some of the responsibilities and considerations in finding the perfect person to fill this role. The Society for Imaging Informatics in Medicine (SIIM) is developing a PACS certification program, but SIIM is not using that term. Instead, they will be certified as an imaging informatics professional.

Just as technology impacting an imaging center has changed so has the role of the PACS administrator. The one element that seems clear is that they play an essential role in successful radiology practices … no matter what the title.

With the instant demands of today’s consumer, and the ability of new technologies to transmit tremendous amounts of data quickly and securely, there has never been a better time for imaging centers to update the way radiology reports are handled and transmitted, and to employ healthcare information technology by adopting informatics.

Automated solutions are now available for many of the applications in this space, such as RIS, PACS, Voice Recognition, EMR, Interface Engine, and Document Capture systems, just to name a few.

If you are still using manual processes, there’s a good chance at least one of your competitors will be employing these available solutions and taking portions of your business away.

If you are attending the upcoming RSNA show, seek out solutions and learn about the value that can be delivered.

The end-goal is to reduce the amount of time and potential frustration required by a radiologist to render an interpretation. The following are just a few of the questions to ask and steps to take that can eliminate inefficiencies in the process to increase productivity:

• Verify all the equipment works without errors or delay. 
• Count the number of clicks. 
• Is the patient demographic information available along side the images?
• Can the radiologist quickly review history of priors? 
• Does the radiologist have quick access to “helplines”?
• Are all the applicaitons effectively interfaced to avoid duplicate entries and excessive searching for information?

There’s an old adage that says something can be “easy as pie”. Unfortunately, this adage does not apply here. Homework and research are required so that you can make an educated decision based on your organization’s radiology workflow and needs. However, once implemented, the impact on your efficiency and productivity will be far more rewarding than any piece of pie.

As the drumbeat for RSNA increases its tempo, many healthcare magazines are publishing articles about new technology and issues in the radiology market. Health Imaging & IT is doing a good job of providing quick summaries of solutions being showcased at RSNA. One recent summary in their current issue is entitled Health IT heals workflow gaps.

Whether you are planning to attend RSNA or not, gaining insights into new solutions that facilitate greater productivity or streamline radiology workflow is beneficial. Other solution areas covered in the issue include:

• Cardiac Imaging is one beat ahead
• MRI faster, more flexible for broader applications
• Oncology imaging more precise, visualization more dynamic 
• PACS remains the driving force 
• Speech & Voice Recognition

In a radiology practice that employs state-of-the-art imaging technology, doctors are often continuing to shuffle through papers to find the information they need. While adopting a Picture Archiving and Communication System (PACS) solution is widely viewed as critical to improving the workflow, other technology advances are commonly ignored. In many instances, supporting clinical information is only available as a paper document. The radiologist, as a result, juggles digital images, papers, and dictation equipment.

This type of radiology workflow severely limits a radiologist’s mobility at a time when many imaging centers have multiple locations that provide professional services for hospitals and other facilities. Sub-specialization poses an even greater challenge to provide the right expertise for each patient in a timely fashion.

Rethinking radiology workflows should be done, because workflows, like the radiological interpretation process, now have the opportunity to be optimized with technology solutions beyond PACS. To begin enhancing the workflow:

• Document critical radiology workflows
• Understand the gaps between the current state and desired state
• Evaluate technologies that can close the radiology workflow gaps
• Implement the changes
• Measure and adjust as needed