Governance, Mission, Growth

DRA Needn’t Affect DR
Physician-Provider-Payor Network Is Up and Running in Minnesota
Practice Goes Paperless

DRA Needn’t Affect DR

With DRA cutbacks and growing concerns over the cost of new technology, Anne Ji of Canon Medical Systems, a division of Canon USA Inc, has heard many customers describe tales of CEOs revising their budgets and refraining from purchasing a brand-new digital radiography (DR) system. So what this marketing supervisor tells them next is probably music to their ears.

“They don’t have to spend all this money to throw away 10-year-old analog equipment just to get DR,” Ji said. “There’s a more budget-friendly solution out there for them—upgrading their existing x-ray equipment by retrofitting a Canon DR Sensor.”

Specializing in the sale, service, and maintenance of new and remanufactured diagnostic imaging equipment, Florida-based Virtual Imaging is the national distributor for Canon’s DR technology, which they offer to high-volume hospitals or imaging centers. “One of the greatest things about the Canon DR is that it can be integrated into existing fluoroscopic and radiographic rooms without the physician or hospital having to replace their existing equipment,” said Chris Duca, Virtual Imaging chief operating officer. “Canon DR also can be easily placed into numerous mobile and portable x-ray configurations.” To sum it up, Ji said, “They are able to take our DR imaging technology and marry it with whatever configuration the end user wants. This results in an economic way to convert from analog to digital radiography while reaping the benefits of an increased workflow and patient comfort.”

Therefore, facilities looking to upgrade from an analog to a digital system do not need to throw out their entire existing setup, nor are they required to undergo restructuring or recertification. Rather, Virtual Imaging can replace the old analog detector with Canon’s digital one. For example, its RadPRO DR upgrade kit has the ability to transition an AMX4/4+ from conventional film use to full digital capabilities in a matter of hours, instead of days. Customers can also purchase an entirely new system, in the form of Virtual Imaging’s RadPro mobile with Canon’s CXDI-50G portable detector.

Canon DR can be integrated into existing fluoroscopic and radiographic rooms without the facility having to replace its existing equipment.

According to both companies, the joint solution improves on the high costs associated with physical storage of cassettes, cassette readers, or films. Replacing CR cassettes also comes with a cost. “With the number of patients that facilities are seeing on a daily basis, and then needing to store their films, over time, it can be quite exorbitant,” Duca said. “With DR, all of those steps are gone. You take your exposure and send the images through the host network or through the Internet to be read, and then images can be stored in hard drives by the thousands.”

Facilities and practices are seeing that reimbursements are declining, Duca continued, while the cost of maintaining their medical systems is rising—a dichotomy that leaves administrators scrambling for ways to reduce operating costs while providing optimal care, time, and staff. “When replacing film, both CR and DR have initial costs, but with CR, the cost of replacing cassettes must be weighed against a DR panel, which is more durable over time,” Duca said. “By upgrading to DR, you improve workflow and patient throughput, and extend the life cycle of your existing equipment.”

Agreeing with Duca, Ji emphasized that their technology offers facilities a variety of choices depending on what their needs are. “Whether they don’t have enough space or don’t have the budget, but they need the workflow, we can provide them with a solution,” she said.

—Elaine Sanchez

Physician-Provider-Payor Network Is Up and Running in Minnesota

Medicalis Corp, Kitchener, Ontario, recently announced the creation of an integrated radiology ordering and decision support network in Minnesota. The Web-based network unites referring physicians, imaging providers, and payors, applying evidence-based clinical guidelines to physician orders and facilitating real-time communication between physicians and radiologists.

“We’re convinced that this is where radiology will go in the future,” said Liz Quam, director of the Center for Diagnostic Imaging (CDI), Milwaukee, a participating practice. “When you’re talking about advanced imaging, there will always be a place for imaging not integrated with the physician practice, but that advanced imaging needs to be appropriate.”

The Medicalis network features a structured ordering process and clinical decision support designed to facilitate appropriate acquisitions, reducing unnecessary testing.

“The three dominant payors in Milwaukee all decided to institute a radiology benefits management system at around the same time,” explained Quam. “They let us try something a little different—we’re known in Minnesota, and I think the payors were more willing to take a chance on us. They were looking at appropriateness criteria tools, but we’d been looking at them too. We looked at Medicalis for around 3 years before deciding. Everyone had to evolve a little bit, but after a whole lot of research, from both the quality/policy area as well as IT, I am ready to tell radiologists that I think this system is the most friendly for their treating physicians.”

To implement the Medicalis network, CDI dedicated several staff members to clinical decision support, training them to use the system. “More than 50% of our referring physicians still use the phone,” said Quam. “They call in, and our staff takes them through the decision tree. If there’s an issue, that’s when the call pops to a radiologist; we always have a radiologist in each subspecialty on call.”

Quam says referring physicians find the system convenient and efficient. “It’s as simple as them calling by phone,” she said. “I don’t know if it’s made us more efficient, but it’s certainly made us more responsive to the treating physician. It saves them so much time.”

The system is not without its challenges, however. “We keep running into things with the decision process,” said Quam. “A patient comes up with a condition that the tools on the software don’t have an option for, and so on. These systems will all get better, but right now there’s still a way to go.” Lack of IT infrastructure on the part of referring physicians is also an issue. “Where we want to get is a totally electronic tool,” said Quam. “But a lot of the physicians don’t have their laptop in the room with them. You can go only as fast as they’re willing to go.”

But with pressure to reduce costs always escalating, Quam believes now is the time for practices to implement radiology ordering and decision support. “It’s the wave of the future,” she said. “Our industry needs to get used to it.” More than 20 organizations have already joined the Minnesota network.

—Cat Vasko

Practice Goes Paperless

Work was a constant paper shuffle for staffers at Central Oregon Radiology Associates in Bend, Ore, an outpatient imaging facility that sees 327,000 patients a year.

Going paperless often means adopting PACS, RIS, and a digital documentation management system.

“For filed documents, we continually battled with misfiled, checked-out documents on someone’s desk or lost documents,” said Marico Oliveira, director of human resources. “We were spending an enormous amount of time looking for documents.”

In order to eliminate the manual work processes, the practice, which has approximately 170 employees with 15 radiologists, developed a three-pronged plan to digitize almost all areas of its operations. It began with the installation of a PACS system, which would store and manage images. This first step prompted Central Oregon Radiology Associates to go paperless. The group implemented a radiology information system that would handle appointment scheduling, transcriptions, and billing. Later, it adopted a digital document management system from Laserfiche, which capped off its complete digital transformation. After 1 week of training, staff members were able to use the user-friendly solution.

Although Laserfiche didn’t integrate or interface with Central Oregon’s PACS vendor, it did partner with its RIS vendor, allowing it to seamlessly store and manage consent forms, explanation of benefit forms, personnel files, and other documentation.

“Our Laserfiche reseller did a demonstration at our RIS vendor’s user group meeting, and we recognized that Laserfiche was precisely what we needed,” Oliveira said. “We saw that the system’s security features and auditing capabilities would help us meet HIPAA requirements, and the ability to store documentation electronically fit perfectly with our decision to go ‘paperless’ throughout our organization.”

From patient driver’s licenses and insurance cards to consent forms, users can scan a number of items into the Laserfiche repository, where they are stored as TIFF files. Search tools enable staffers to quickly locate the documents that patients, physicians, or insurers inquire about. Furthermore, according to Oliveira, sensitive patient information is stored more securely than in the past, with documents no longer in record rooms and filing cabinets.

“You have the ability to control who has access to a document with security lists and authorization control,” Oliveira added.

Now in the process of upgrading to a newer version of its RIS software, Central Oregon Radiology Associates is working with Laserfiche to integrate the software with its document repository. “This will enable our billing department to see documents scanned into Laserfiche at the touch of a button down to the claim level,” Oliveira said. “Overall ease of retrieval related to a line-by-line claim will help handle patient calls in a more timely manner. We’re very excited about the integration.”

—E. Sanchez

Laserfiche helps facilities implement digital document management systems that streamline workflow.