Advanced information technology has transformed radiologist practice patterns at St. Paul Radiology.

Despite the erosion of reimbursement dollars, business is strong for groups like St Paul Radiology of St Paul, Minn. It is a paradox, but not a mystery: St Paul Radiology’s ongoing-and growing-success is due, say administrators, to adroit use of technologies like picture archiving and communications (PACS) and, soon, the Internet.

Mary Jo Olson, RT, vice president of operations, says, “PACS allows us to strongly focus on patient care. As a result, we’re attracting business in sufficient volume to offset the effects of declining reimbursement rates and other payor-related challenges. At the same time, PACS introduces new efficiencies in the form of faster turn around time of examination completion and report. This allows us to offer more and better services to meet market demands that previously were going unsatisfied.

“For example, drawing on the capabilities afforded by PACS, we recently divided our MRI work into subspecialty areas. Now, orthopedic MRI images are read exclusively by radiologists trained in musculoskeletal work, while those of the brain and nervous system are interpreted solely by neuroradiologists.”

“It is actually far more complicated an undertaking for us to offer these subspecialty services,” she says. “It would have been easier for us to let things stand as they were. We carved out the MRI subspecialties in order to improve the quality of care we offer. That was our motivation.”

Improving quality of care is important to St Paul Radiology for the simple reason that doing so extends the group’s competitive edge.

“Quality of care is a potent selling point for us,” says Myrna Donovan, director of marketing. “Referring physicians want to deal with a radiology group that is continually working to improve quality of care, because their own ability to compete increasingly depends on it.”

According to Donovan, St Paul Radiology’s desire to sharpen its competitive edge is a reflection of marketplace realities, for although St Paul Radiology is the market leader, its market faces continuing challenges.

“We have competitors in the Metro area, so we’ve got do what it takes to stay ahead of them,” she says. “Introducing new and enhanced services is just one strategy to accomplish that.”


Building a Partnership

?St Paul Radiology chose as its PACS vendor Lexington, Mass-based eMed Technologies because of that company’s proven ability to combine market-leading technology with comprehensive network-based customer support services.

With systems in approximately one of every four hospitals, imaging centers, and radiologist homes throughout the nation, eMed is a leading provider of client-server and Internet-based medical imaging workflow solutions-a status that also held appeal to St Paul Radiology’s decision-makers.

Even so, in the course of selecting a vendor, St Paul Radiology looked at the product offerings of several companies, not just eMed’s.

“Our decision to go with eMed was based on their PACS solution and on what the company presented to us in terms of relationship,” says Mary Jo Olson, RT, vice president of operations at St Paul Radiology.? “As we reflected on the interactions we had with the vendor candidates, we realized that eMed had treated us with the greatest candor and openness of all. Anytime we had questions; we were given unfettered access to everyone in the company-including the top engineers.

“It was clear that eMed wanted us to enjoy a high comfort level with them, and that’s why they were so accommodating of our inquiries. It was also clear that eMed wanted to become our partner. We came to appreciate that this was a company intending to go far beyond simply selling us a technology solution.”

eMed stationed some of its engineers at one of St Paul Radiology’s imaging centers so that they would have direct physical access at all times to the PACS equipment and thus be able to continue to meet the evolving and rapidly growing needs of the practice.

“This arrangement has paid back huge dividends,” says Olson. “Having eMed staff? on-site has resulted in them having a very clear understanding as to what we’re trying to accomplish with PACS and where we’re going with it. Consequently, the road we’re on has proven much smoother to travel than I think would have been the case otherwise.”

Another factor in St Paul Radiology’s choice of eMed for PACS was eMed’s reputation as a company on the forefront of knowing how to create interfaces among modalities and sites.

“We knew we were going to have to do a wide-area PACS deployment in order to provide coverage at our clinics and client hospitals,” Olson indicates. “As such, we also knew that we might as well not even bother to implement PACS if it did not come with a smooth, seamless networking capability.” n

-Rich Smith

Not only is St Paul Radiology big in its market area, the group of 73 radiologists also ranks among the largest private imaging outfits in the country.

The enterprise owns five MRI imaging centers in the Twin Cities market and a sixth in North Dakota. It also supplies imaging services on a contractual basis to eight hospitals in the region.

St Paul Radiology offers a comprehensive range of diagnostic and interventional radiology services: on the diagnostic side, services include MRI, CT, mammography, ultrasound, PET, nuclear medicine, fluoroscopy, and bone densitometry; among the interventional procedures are angiography, angioplasty and stent placement, vertebroplasty, needle biopsies and additional interventional procedures.

In operation for more than 80 years, St Paul Radiology has always sought to position itself on the cutting edge of new imaging technologies. It was in 1995 that St Paul Radiology first began preparing for PACS, a technology it acquired from eMed Technologies two and a half years later. By 1998, St Paul Radiology had amassed an archive of 2 million images via the new system. Since then, it has stored more than an additional 8 million images for a total archive in excess of 10 million images.

Usage demands grew in proportion to the opening of new facilities, the broadening of services, and the welcoming of additional client sites. To accommodate this growth, St Paul Radiology recently upgraded its PACS by replacing its original server with one many times faster and more powerful. The server is a Sun 4700 utilizing a Unix operating system with a processor speed of 4x 400 megaHertz with a 180-gigabyte RAID array (which has since been upgraded to1 terabyte).

“The upgrade made a dramatic difference in system performance,” says Olson. “We’re now able to easily handle the ever-increasing volume of image and text transactions.”

When St Paul Radiology first looked into acquiring PACS, the group’s goals concerning the electronic handling of images were relatively simple.

“All we wanted was to be able to quickly send images from several sites to a radiologist at a centralized location,” Olson recalls.

The enterprise had already by that point established teleradiology links to its radiologists at their homes. However, St Paul Radiology administrators noted that it was beginning to take too much time to transmit images due to the growing volume and size of the data files being sent across the network. Moreover, this teleradiology system-primitive by today’s standards-was proving incapable of delivering the high degree of resolution necessary for satisfactory diagnostic interpretation of the images.

Once PACS was in place, these problems were eased. But, then, a much greater issue became evident-connectivity.

“Connectivity was a more controllable issue within the confines of our St Paul Radiology owned-and-operated centers,” says Olson. “We faced challenges linking a few of our image-generating scanners to the PACS server but were able to work with the vendors to solve the issues. This gave us the ability to funnel studies to the radiologists for interpretation on high-resolution, two- and four-monitor diagnostic workstations in specially designed reading rooms.”

Greater challenges were presented by the group’s client hospitals and treatment centers.

St. Paul Radiology’s commitment to excellence extends acroos all specialties.

“Establishing connectivity with our clients was initially problematic,” Olson says. “There were several reasons for this. First, the hospitals each had systems from different vendors, each with a little different form of DICOM, so compatibility was an issue.

“Also, in 1997, the hospitals had varying degrees of expertise themselves with networks. It was left to us to help them along the way, but there was only so much we could ask of them.”

Underlying all of this were sensitive political considerations.

“Among our clients are four major medical groups, a medical management group and an independent group,” says Olson. “The connectivity issues are as much a matter of the very different work styles of these clients as they are a matter of them not having compatible equipment.”


Meanwhile, PACS is exerting a powerful influence over St Paul Radiology’s profitability by contributing to big gains in productivity.

“Since introducing PACS, our productivity has increased by a high percentage,” Olson exults.

She explains that some of the increased productivity is attributable to the parallel introduction of faster scan technology in certain of the group’s digital modalities. However, the bulk of the gain, she says, stems from optimization of St Paul Radiology’s work processes, thanks to PACS.

“The tasks that slow people down are now gone from the work flow,” she says. “For example, with our manual method, it could be time-consuming for technologists to print, label and hang films. Now, the time on these tasks is devoted to scanning-a much more productive activity.

“Similarly, the electronic environment that PACS brings to us has eliminated the need for technologists to print films for our neighboring hospitals and emergency rooms. Images are now sent to physician review stations. Consequently, the technologists are able to concentrate on tasks where their expertise is most profitably utilized.

“Equally important, our radiologists not only read as studies are produced, they read better because of PACS-the capabilities of this technology are such that interpretation of images can be made with greater exactness.”

Additionally, PACS is contributing to enhanced compensation for radiologists.

“The technology allows us to distribute images in ways that let each radiologist have as much work as he or she wishes at any given point in the day,” says Olson. “Thus, the workload of the group as a whole is balanced. We don’t have situations now where one radiologist has too little work while someone else has a surfeit of it. If a radiologist at a remote site finds he has an hour block of time with nothing to fill it, he can phone in and ask us to send him, say 10 cases to read from one or more of the other sites. We’ve even got it set up now where he can instead simply sign on and pull 10 cases on his own. The associated paperwork issues continue to plague us. An image we can send anywhere; the paper flow remains an issue. “

St Paul Radiology attributes improved productivity and image interpretation to PACS.

It turns out that technologists, too, are enthusiastic about PACS.

“They are no longer handling film and performing the menial but quite tedious and time-consuming administrative chores associated with film, so they are able to concentrate on interacting with the patients and moving them through faster,” Olson says.

But PACS also has enabled St Paul Radiology to accomplish more with fewer technologist full-time equivalents. This, in turn, has had a positive impact on the group’s bottom line.

“It has allowed us to meet our goals to finish first in the competition for imaging business,” says Donovan. n


Rich Smith is a contributing writer for Decisions in Axis Imaging News.