Informatics investments prove vital in competitive world

There is no doubt in any imaging center operator's mind that today's myriad new imaging technologies are changing the way in which they do business. In many instances, these new technologies also drive the future success of the operation.

While these technological advances certainly afford patients many benefits and physicians an enhanced diagnostic platform for new and exciting applications, they also bring with them the need to change the way in which a center's operations are positioned and managed.

Technologies such as 64-slice CT, digital radiography, computer-aided detection software, and other postprocessing products require informatics expertise at the imaging center level. Without such expertise, new imaging technologies have the potential to cause frustration and cost overruns. In this setting, hiring someone well versed in informatics and IT is a must, as is incorporating this function into a center's business development efforts.

Whether an operator is planning to open new sites, expand existing centers, or add new modalities, success can hinge on the appropriate deployment of informatics and the appointment of a skilled IT staff.

The fast pace of imaging technology has opened up new opportunities, such as cardiac CT angiography and virtual colonoscopy. Imaging center operators will need to adopt these new technologies to remain competitive. But with these opportunities come the costs of upgrading the imaging equipment and the costs of new informatics and IT investments. These include increased storage capacity and shared patient information.

During the past five years, the size of CT studies, particularly of cardiac CTA exams, has grown exponentially. This has led to an increase in costs associated with online storage, long-term archiving, disaster recovery, and image distribution. These costs include not only the hardware and networks required for managing large data sets, but also the expertise necessary to design and maintain a complex IT infrastructure.

The ability to share information with patients and referring physicians has grown way beyond what was possible when reports were delivered on paper and images on film via a courier service. Today, patients often walk into an imaging center bringing with them a comprehensive medical history that may include paper reports and films, but with ever-increasing frequency, CDs contain the results of previous imaging studies. Technologists, radiologists, and administrators face the difficult task of importing studies from CDs that may or may not be compatible with today's PACS. Not only do many CDs fail to conform to DICOM and IHE standards, but many legacy RIS, HIS, and PACS platforms can't electronically add prior studies to patient records.

Radiologists at imaging centers must also deal with prior studies on film; printed reports stacked on their desks; a mixture of orders received as faxes, electronically through RIS/PACS, or marked high priority via the phone; and 3D images obtained on systems outside of a PACS. Integrating all these inputs into the interpretation process represents an informatics challenge that imaging practices of all sizes face. Film digitization, document scanning, and the use of work lists in RIS/HIS/PACS all help deal with this problem. However, adapting these and other techniques to meet the specific needs of an imaging center requires a thorough analysis of workflow and the systems available for managing it.

Failing to manage this disparate collection of data tends to produce slow report turnaround times. Failure to meet expectations of a prompt report turnaround time has become the number one complaint about imaging centers among referring physicians.

Referring physicians increasingly expect easy access to reports and images electronically, either on the web or on CD. Systems for web delivery of reports and images can be costly and require training for referring physicians. But keep in mind that imaging centers often have only one chance to impress referring physicians with the speed of report delivery and the ability to provide results efficiently.

Today, most study interpretation takes place remotely, and many professionals may be involved in the process. Interpreting physicians expect to access PACS, dictation, and electronic signature systems not only from the imaging center or the hospital, but also from their home computers or laptops while they travel. More and more interpreting physicians are poised to take advantage of web-based distribution of images and reports for real-time collaboration or overreads.

At the same time, the Health Insurance Portability and Accountability Act presents many challenges in the quest to protect patient information. Login features, firewalls, and other protective measures create skyrocketing expenses that IT departments must figure out how to assimilate.

OPTIONS FOR IMPROVEMENT

A multitude of choices exist for those trying to streamline a center's operations. PACS, RIS, HIS, and speech recognition systems, among others, all pose learning challenges for interpreting physicians.

Once confined to a dark room with a light box and a telephone, interpreting doctors now find themselves being asked to operate many complex software tools. They may also find themselves moving back and forth between several different PACS over the course of a normal busy day. They often have not one work list but many, contained in each of the systems they must access. Inconsistent interfaces across these various software systems coupled with a plethora of authentication credentials and multiple work lists can result in extensive inefficiencies for interpreting physicians.

During the past few years, web portals have emerged as a way to pass images to and from the referring physicians. This has forced centers to create faster turnaround times and also has positioned them as ISPs. Centers are expected to employ a system that is up and running all the time, with technicians on staff to troubleshoot issues at the referring offices and also to perform after-hours maintenance on the system.

PERFORMANCE ANALYSIS

Systems such as RIS, HIS, PACS, voice recognition, and others have allowed imaging operations to improve the services they are able to offer patients and referring physicians. Patients and referring physicians can receive images and reports digitally with a very quick turnaround. Prior studies are more available than ever before, thanks to the capabilities for archiving, retrieving, and distributing them. But how does the imaging operator know if the systems are operating as efficiently and effectively as possible? Faced with an increasingly complex workflow, imaging centers must turn to the systems that manage that workflow in order to analyze performance.

Qualitatively, most everyone involved in imaging operations will agree that networks such as PACS and RIS have improved workflow and expedited operations. Now, new questions emerge: Just how much has PACS speeded up the interpretation process? How much shorter is the average accounts receivable turnaround time as a result of new billing software? Imaging centers must analyze a mountain of data in order to answer these questions. The presentation of business metrics through dashboards and other tools has become commonplace outside of healthcare. Imaging centers need to apply these same informatics principles of data analysis to the systems that control their operations. With the advent of the electronic workflow, an opportunity exists for imaging center operators to establish clear, quantitative benchmarks for performance.

Looking ahead, many realize that informatics and IT must become an integral part of any thriving and expanding imaging operation (which includes new center development, procedures, modalities, professional partnerships, and the like) from the onset of the expansion process. Here are some initiatives centers should employ to appropriately integrate informatics and IT functions:

• Scope projects and define the return on investment. Approach projects with clear objectives, a detailed budget, and an eye for the ROI. Without these boundaries to constrain a project, IT costs can skyrocket. Knowing the best ROI and the most predictable costs will direct imaging operators toward those projects that are real priorities and should be attempted first.

• Set milestones. Use the ocean of data created by the modern imaging workflow to establish metrics for practice analysis. Do not allow complex informatics to muddy the waters of your business. Harness the power of data collection and reporting tools to measure success.

• Focus on goal setting. Determine how to make an investment in informatics that is predictable and provides a return on business bottom line and on service being offered.

• Conduct workflow and performance analysis. Use informatics tools to benchmark all levels of performance and use that benchmark to measure quality improvement.

• Manage and assess vendor participation. Work with vendors to determine internal requirements and then match those with their offerings to create an integrated system for your center. No one vendor has the only solution to any problem. Imaging has become specialized to such a high degree that centers must ensure that their vendors have a keen understanding of the imaging center workflow. At the same time, vendors must take the time to fully understand the specific requirements of a particular imaging center. Successful vendors are those capable of developing tailored systems with customizable deployments to meet specific customer needs. Customers should seek out those vendors able to participate in the development of standards and integration profiles.

Anthony Draye, chief information officer at Liberty Pacific Medical Imaging, oversees the company's IT infrastructure.

Mr. Renard is president and chief operating officer of Liberty Pacific Medical Imaging, based in Encino, CA, an owner and operator of diagnostic imaging centers, primarily in California. Mr. Draye serves as chief information officer at Liberty Pacific Medical Imaging. He oversees the company's IT infrastructure across its five centers.