Managing the Flow in Radiology

RFID in the Radiology Suite: Managing Contrast Media
Choosing the Right RIS and PACS
Make Room for Another RIS
Communicating Critical Results

RFID in the Radiology Suite: Managing Contrast Media

Bayer’s VistaTrak is specifically designed for contrast agent management and represents the first RFID technology intended for the radiology suite.

Just as barcode improved on manual counting of contrast media, a new solution from Bayer HealthCare Pharma-ceuticals aims to manage products easily, reliably, and efficiently.

Called VistaTrak, the innovative system combines “tagged” bottles of contrast agent with a “smart cabinet” and a specially designed interface. The technology also tracks operational information about technologist dosing behavior, a feat that the company points out had not been previously available to radiology administrators. All in all, VistaTrak was developed to address a number of issues in the radiology suite, including patient safety, Joint Commission compliance, charge capture and billing accuracy, and inventory and utilization management. It sets out to change the way contrast is tracked and managed.

“Our customers grapple with the simultaneous challenge of improving patient care and safety in the face of the DRA-driven reductions in reimbursement, increased regulations, and heightened cost scrutiny,” said Scott Bertetti, Bayer’s director of new product communication. “Normally, improvements in care and safety come at the price of higher costs and greater complexity. We developed VistaTrak as an advanced contrast management tool to enable radiology operations to place a greater focus on patient care and safety while simultaneously simplifying workflow, lowering costs, and improving charge capture.”

Bertetti explains that the VistaTrak system is made of three components. An RFID tag is embedded into the product label, he said, and also an intelligent storage cabinet equipped with RFID readers automatically reads and tracks key information when a product is placed in or removed from the cabinet. Lastly, a set of interfaces to critical hospital systems, such as its RIS, EMR, and billing, allows VistaTrak to automatically receive and send important information about the management of contrast agents.

When prepping for a patient procedure in the radiology suite, the technologist simply selects the patient from the cabinet’s touch screen, confirms the dosage amount, and removes the contrast, Bertetti said. From that point on, the system automatically reviews EMR data for allergies, prior adverse events, and contraindications; documents the type and amount of contrast used and associates it with a particular physician, technologist, patient, and procedure; and updates the inventory management system for the type and amount of contrast used.

The automatic system also generates an accurate billing record with the correct combination of patient procedure code and contrast amount, and it records the opening date and time for pharmacy bulk packs, tracking against the appropriate expiration period. Furthermore, it prints tags for properly labeling syringes as mandated by The Joint Commission, and it updates radiology administrators on compliance with dosing protocols, expired contrast, and other safety-related data.

“While this technology has become prevalent in other aspects of the hospital, such as maternity wards, patient tracking, and asset tracking, VistaTrak represents its first entry into the radiology suite,” Bertetti said of RFIDs.

Bertetti said that unlike other medicine disbursement systems on the market, VistaTrak is specifically designed for contrast management. Moreover, it requires no additional effort on the part of the user, eliminating the risk of human error.

Peter Holmberg, manager of Bayer’s Alliance Management division, said the system allows the market and user to have more actual information to make better management decisions. According to Bayer, the pilot experience has brought about efficiencies in hospitals, which were able to make and evaluate contrast images that were previously unavailable.

—Elaine Sanchez

Choosing the Right RIS and PACS

Sales professionals have their maxim—the ABCs of “always be closing” remind them to keep pressing to seal a deal. But Tim Gould has his own advice for any medical facility wanting to stay on top of the latest developments in PACS and RIS technology.

“Always be in the market,” said Gould, who is PACS administrator for Texas-based Radiology Associates of San Antonio.

Back in 2003, Gould led Radiology Associates in buying a new PACS, and he maintains that the system has worked well. But Gould said that even after a practice has bought the perfect PACS or RIS, it’s important to keep looking—both to get ideas for when it comes time to buy the next system, and also to learn new ways to deploy the existing system.

Gould has learned this and other lessons by overseeing PACS for a company with 300 employees and 10 centers that serves the radiology needs of seven hospitals. In choosing the right PACS and RIS, Gould said an organization should consider factors such as interoperability between the two systems, how to keep costs down, and how the systems mesh with the way radiologists approach their work.

“The best thing about going out and buying a RIS or PACS system is to know what you want before you shop, otherwise you can get distracted by bells and whistles and have to conduct your business differently,” Gould said. “There is a big difference between buying a PACS system or a RIS system, and being sold a PACS system or a RIS system.”

With more than 25 radiologists, Radiology Associates wanted to ensure that its workflow was enhanced, not disrupted by the new systems, Gould said. That meant ensuring radiologists who were used to looking at past reports on a patient could pull those up quickly, while radiologists who preferred to skip the reports and look at prior images instead could do that, he said. In the case of a RIS, choosing the wrong system can force a company to redeploy staff or change the way it manages phone calls, Gould said.

An organization should upgrade its PACS or RIS when those systems no longer meet the demands placed on them, or when an organization is rolling out strategic initiatives that require new technology, Gould said.

Radiology Associates bought its PACS in 2003, but 2 years ago the organization upgraded its PACS and bought a RIS from the same vendor—Merge Healthcare—ensuring that the organization’s RIS would integrate with its PACS. With the benefit of having its PACS and RIS on the same platform, Radiology Associates paid half of what it expected to upgrade its technology, Gould said.

The organization kept costs down by buying its own computers to serve as reading stations for the PACS and RIS, enabling the organization to save money with off-the-shelf Dell computers, instead of buying the vendor’s reading stations at the higher cost of about $10,000 per unit, Gould said. But some vendors do not allow that option, and insist on providing the hardware themselves.

“No different than going out to buy a part for a Porsche, there are very high costs associated with the maintenance” of equipment from a systems vendor, Gould said.

No matter how well an organization chooses its equipment, there is always the possibility for buyer’s remorse if there is another system out there that does things better, he said. But Gould said that is not a problem. He keeps informed by staying involved in local and national societies, reading trade publications, and receiving mail about new products. “Don’t put on blinders and sit back for the next 5 years while you’re under a service contract with the current vendor and think that you’re not going to have to start looking,” Gould said.

—Alex Dobuzinskis

Make Room for Another RIS

There’s always room for a new radiology information system (RIS), especially when it has been developed based on the input of radiologists. CoActiv LLC, Ridgefield, Conn, just launched its EXAM-RIS, the company’s new Web-based, PACS-integrated RIS product. EXAM-RIS boasts an array of features to support complete electronic workflow, including single- and multi-site scheduling, charting, and document scanning.

“Our RIS was developed the same way our PACS was developed,” explained CoActiv CEO Ed Heere. “We were providing IT support to a number of multisite radiology businesses, and they were less than happy about their RIS/PACS situation. We learned what everybody does and doesn’t do, and asked what the radiologists liked and what they hated.”

Likes included the capability to support multiple sites from a RIS for dayhawking and remote reading, an incorporated dictation/transcription system, both individual and group worklists, and single-button loading. “We took an existing client of ours who’s had a RIS for a number of years and went through the question and answer period with him,” said Heere. “He had a high level of dissatisfaction with his current RIS, both its performance and the support.”

The CoActiv team incorporated the client’s requests into their RIS system, then added some new ideas. “We’re very fast,” noted Heere. “The RIS is based on innovative database products. We also give them the option of hosting the server at their place or in our data center, which has a high amount of bandwidth; they don’t have to tie up their own bandwidth with it. We offer the same option on our PACS, allowing users to have a completely virtual RIS/PACS system.”

Another important factor is service to referring physicians. “Radiology practices have a lot of demands from their referring physicians,” said Heere. “They depend on them for their business. With EXAM-RIS, referring doctors can request a time slot for a particular exam within the system. Then their office can check the progress—has the patient arrived yet, has the exam been performed, is the report done. Once it’s done, it’s available online.”

At the 2008 meeting of the Healthcare Information and Management Systems Society, CoActiv debuted its paperless PACS; the new RIS is paperless as well. “Radiologists don’t want any paper whatsoever,” noted Heere. “That’s especially important when you’re reading remotely.”

Additional features include customizable reports and the ability to open an exam from either the RIS or the PACS. “We’re great believers that an imaging center should be RIS-driven,” said Heere. “The RIS carries all the historical information about the patient; that should be the driving force. But some radiologists like the worklist that’s available from within the PACS system, so we allow it to be configured either way.” Pricing is available on either a capital or a per-exam basis.

Finally, says Heere, the EXAM-RIS is designed to facilitate easy adaptation to future EMR systems. “Our intention is to sell this as a completely integrated product that we can then integrate into the larger EMR systems out there,” he said. “That’s what the next step will be in this industry. Once there’s a national health record, we’ll be asked to drop our reports into the system, and we’ll be prepared for that.”

—Cat Vasko

Veriphy-Ready HL7 Integration Server (VIS) is designed to help quickly and effectively communicate critical test results and to speed workflow in radiology facilities.

Communicating Critical Results

A doctor sends a patient for a radiology exam and the test results reveal an unexpected finding—a potentially malignant tumor. The results are mailed to the referring physician, but the paperwork gets misplaced before the doctor can see it, and the radiologist never knows the doctor was not alerted. After that, the patient’s cancer may get worse before it is detected.

To prevent those kinds of human errors, Nuance Communications, which is based in Burlington, Mass, has released a product called the Veriphy-Ready HL7 Integration Server (VIS). The system is designed to help prevent critical test results from getting lost in the shuffle, and to speed workflow in radiology facilities.

VIS is a Windows-based application platform that allows organizations to better integrate Vocada Veriphy, another Nuance-owned product, into their existing applications and systems. Vocada Veriphy, which automates the process of communicating critical test results from hospital diagnostic departments to ordering clinicians, is used at more than 175 hospitals nationwide.

“I wouldn’t want to practice radiology in the 21st century without it,” said Steven Defossez, MD, medical director at North Shore Magnetic Imaging Center in Peabody, Mass.

Defossez said he views the system, which is in place at his center, as a vast improvement on the old way of communicating critical test results. “We relied on the fact that these faxed reports are going to the doctors’ offices, and the paper copies get mailed to the doctors’ offices,” Defossez said. “But it is an unfortunate reality that without Vocada, some of these important findings don’t make it to the treating physician.”

Less than 2.5% of radiology test results come back as critical, but when it happens, a radiologist often wants to alert the referring physician immediately, said Tom White, general manager of Veriphy in the Dictaphone Healthcare Division at Nuance.

“They pick the phone up, as a radiologist, and they’re dialing for dollars,” White said. “They want to get hold of the referring physician … but as everyone has gotten busier and busier, the opportunity to connect live has gotten rarer and rarer.”

With the Vocada Veriphy system, a radiologist records a short audio message about a patient’s test result. The radiologist classifies the finding based on its level of urgency.

The system then sends an automated message to the referring doctor, calling her office line or mobile phone—or whatever means of contact the physician has said is the best way to reach her. For urgent messages, an automated call will go out every 10 minutes until the physician is reached, while for less urgent results the calls can be spaced hours apart.

When the physician answers the call, she will hear a recording telling her to retrieve the radiologist’s recorded message about her patient by calling a number. After the physician has listened to the message, the system automatically pulls the patient’s report and notes that the message has been communicated to the physician.

Defossez said that aspect of the system helps his center guard against malpractice lawsuits, because it generates a case history that can be used in court to vindicate the radiologist if a physician overlooks a critical test result. “Before we had this system, I would dictate a report and hope that the doctor got it, and hope that he would treat the patient well,” Defossez said. In radiology, more than 70% of malpractice lawsuits stem from a breakdown in communication, experts say.

North Shore Magnetic Imaging Center sends out more than 100,000 reports a year.

Doctors’ offices are flooded with paperwork, too, and sometimes nurses put critical test results in a patient’s file before the doctor has a chance to see them, Defossez said. In that case, the doctor may not see the result until the patient comes back for another office visit months later.

Company officials hope that more hospitals will start using Vocada Veriphy following the March release of VIS, which they say allows hospitals to overcome any integration challenges they may have with the system.

—A. Dobuzinskis