Managing the Flow in Radiology

Veriphy 3.0 Helps Radiology Departments Deliver and Track Critical Results
Upgrade and Slim Down!
One PACS, Multiple Modalities

Veriphy 3.0 Helps Radiology Departments Deliver and Track Critical Results

Communicating critical results in a timely manner has long been a difficult problem for radiologists, who spend valuable time each day on the phone tracking down ordering clinicians. To compound the issue, leaving a voice message just isn’t enough for auditing purposes—to avoid a malpractice lawsuit, radiologists must be able to show that the ordering clinician received the information.

In 2004, The Joint Commission’s National Patient Safety Goals included improving the effectiveness of communications among caregivers, with a special emphasis on critical-results delivery. According to Tom White, vice president Veriphy with Nuance Communications, Burlington, Mass, hospitals still have a long way to go to meet this goal.

“In 2006, The Joint Commission wrote citations to 58% of the hospitals that they surveyed, which requires them to take corrective action,” he says. “So, it’s a big problem.”

To help create a solution, White and his team developed Veriphy, a software-as-a-service system designed to notify ordering physicians of critical results and to track the delivery and receipt of the information. Nuance purchased White’s company in 2007, and Veriphy is currently used in 180 hospitals across the nation.

The radiology department at Virginia Commonwealth University (VCU) Medical Center in Richmond, Va, brought on Veriphy last April as part of their efforts to meet the National Patient Safety Goals. They also hoped to streamline the workload for their radiologists.

“We realized that they were spending an inordinate amount of time—sometimes as much as 35 minutes—trying to locate somebody,” says Ron Miller, MS, RT (R), director of radiology for VCU. “And oftentimes when they located a person, what they found was the wrong person.”

When a hospital subscribes to the system, Veriphy compiles profiles of the referring physicians in a database, which allows the system to automatically retrieve the appropriate contact information. The Veriphy software integrates with PowerScribe, the speech-reporting software from Nuance, so that radiologists can create a voice message for the ordering clinician as part of their dictation process. The message is then automatically sent to the primary number listed for that clinician in the database.

The clinician must listen to the message in its entirety in order for the message to be logged as received. If the clinician fails to do this, or if he or she does not retrieve the message in the allotted time, another alert is sent. After a predetermined time period, the message is sent to the clinician’s backup, often an answering service, which will then contact the on-call clinician. If these steps are not successful, Veriphy’s call center, which monitors all activity, will step in to ensure that the message is delivered.

According to Miller, the biggest step at VCU was to standardize the terminology the ordering clinicians use when indicating a critical test. Before integrating Veriphy, the department accepted multiple terms that implied urgency, such as “stat,” “rush,” “priority one,” and “level one.”

“We were getting anywhere from 10 to 60 of those a day, and we knew they all weren’t in that category,” Miller says. “So, we settled on the terminology ‘life-threatening.'”

Exams marked as “life-threatening” are turned around in 60 minutes, and ordering clinicians know to expect a call any time of day. The radiology department then audits these orders to ensure that the tests are correctly classified as life-threatening. The department also uses Veriphy to deliver results classified as “significant,” such as the discovery of new lung nodules, and “potentially concerning,” such as the finding of a hip fracture.

These classifications have been instrumental in reducing the time VCU radiologists spend tracking down ordering clinicians. “As they get off the phone, obviously, they can read more studies,” Miller says.

The VCU radiology department presented the Veriphy system to groups of referring clinicians, many of whom are residents. This also gave the department the opportunity to learn how these groups prefer to be contacted. In some departments, a virtual pager—which represents multiple patients—can be used to reach the person on-call for a specific patient in that group any time of day.

“What that did is take me out of the realm of having to have everyone’s beeper number and everyone’s schedule,” Miller says. “So, we don’t go into backup a lot when we’re looking for someone because the virtual pager gets to the individual taking care of the patient.”

As VCU is a teaching hospital, the radiology department also uses Veriphy to communicate changes that attendings find when over-reading cases read by residents. The attendings use Veriphy to send the changes to the ordering clinician, and a copy of the message also goes to the resident for teaching purposes. These cases are generally not life-threatening, but using Veriphy has helped fortify the process of communicating these changes.

“We’re talking about another four or five patients in the course of a week, but it’s four or five that we used to worry that we weren’t getting the information into the right hands,” Miller says.

Miller notes that VCU is looking to incorporate Veriphy into the lab, and they are contemplating other applications for it as well. “We’re now toying with whether we can take Veriphy institution-wide,” he says, adding that heart station and endoscopy are potential candidates. “It’s forcing us to look at their processes to see if we need to have really standardized processes throughout the organization.”

—Ann H. Carlson

Upgrade and Slim Down!

Radiologists place extreme demands on technology. For our significant investments we expect and require machinery that can handle the heavy loads of imaging files, that can easily communicate with other machines and partner locations, and do it all with the utmost speed and accuracy.

These demands were just the beginning for Scottsdale Medical Imaging (SMI) in Scottsdale, Ariz, in upgrading its desktop PCs and workstations. For its 10 outpatient radiology imaging centers, it needed a system that could expedite patient diagnosis, improve data capture and processing for quick interpretations, and enhance connectivity, allowing radiologists at any location in the network to get what they needed, when they needed it.

In the end, it found its solution right at home. To handle the thousands of high-resolution images per day, SMI enlisted its existing technology partner, HP, to update its legacy systems with new, super-slim and powerful desktop PCs and a series of HP workstations. The end result was an integrated computing platform that helped make the center an ideal environment for clinicians and their patients.

“We chose HP for our medical imaging technology several years ago, based on their performance and cost, and they continue to exceed our expectations as we upgrade,” said Andrew Willy, information systems supervisor at SMI. “They make very reliable desktops, with components we have confidence in, for incredibly cost-effective investments. As a result, they’ve inspired us to upgrade with them.”

SMI worked with HP to select and upgrade to redesigned HP Compaq dc7800 Business Desktop PCs. The new machines are nearly half their predecessors’ size, offering SMI a solution for space constraints, and represent cost savings through an energy-efficient power setup. The system leverages dual-core processing power to fuel imaging applications that are typically supported by Workstation-class machines. In the SMI digital mammography exam rooms, for example, the PC acts as a PACS station for technologists. The PCs are also used in back offices for day-to-day operations such as finance and billing.

By integrating the slim desktop PCs with workstations, servers, and storage systems, SMI has boosted its computing bandwidth to better handle graphically intense patient images. It has created a platform to power its PACS system, enabling radiologists anywhere on the company’s network to call up studies for review, evaluation, and diagnosis. And it has gained room to grow as the business grows.

“Our HP upgrades have improved the radiologist experience at Scottsdale Medical Imaging,” Willy said. “We’re able to do things faster and enhance performance. We can provide all the tools to make their jobs quicker and more accurate. We can treat these machines like servers, and radiologists are never slowed down and never interrupted. As a result, that improves patient experiences. That’s why we believe in and work with HP.”

—Amy Lillard

One PACS, Multiple Modalities

One of the largest radiology centers in Puerto Rico has installed the innovative and comprehensive ThinkingPACS™ system to archive and manage its digital images to create a more efficient workflow and improve patient care.

Diagnostic radiologist Armando Bonnet, MD, said Radiology Institute Imaging Center (RIIC) chose the ThinkingPACS solution for its ability to seamlessly manage image archiving and provide clinical solutions for a wide range of modalities in the busy radiology practice.

“We expect that this implementation ultimately will help us attain our goals for growth and commitment to serving our referring physicians and their patients,” Bonnet said.

Thinking Systems is a Florida-based PACS and RIS company. It provides management and communication solutions for all modalities, especially PET/PET-CT, general nuclear medicine, nuclear cardiology, ultrasound, echocardiology, and cath lab.

Xiaoyi Wang, co-CEO and co-founder of Thinking Systems, said the implementation of ThinkingPACS will provide the radiology center with a uniform environment for radiology, cardiology, and molecular imaging.

“It provides not only seamless and efficient image management, but also state-of-the-art clinical tools for these modalities,” Wang noted. “The streamlined workflow greatly improves communication, shortens patient wait times, and ultimately helps physicians deliver optimal care more efficiently and with better patient outcomes.”

Wang said Thinking Systems develops solutions tailored to meet its clients’ specific needs. “For a freestanding imaging center such as RIIC, this is a great advantage for the organization to overcome challenges and deliver efficiencies that contribute to the bottom line,” he noted.

Thinking Systems’ distributor in Puerto Rico, Cruz Ruiz, president of Alpha Biomedical and Diagnostic Corp, said the ThinkingPACS solution was a natural choice for RIIC because the comprehensive system would support the full range of modalities at the center. “This installation will give RIIC a seamless solution to enhance their services for years to come,” he said.

At the 94th Annual Meeting of the Radiological Society of North America (RSNA) in Chicago, the company debuted its new release of the Web-based ThinkingRIST unified with its ThinkingPACS powered by a single database. Also debuted was its integration with international leading third-party PACS systems to provide nuclear cardiology, PET-CT fusion, SPECT-CT fusion, and general nuclear medicine solutions to users of these third-party PACS.

In addition, Thinking Systems showcased its enhanced PACS solutions for nuclear cardiology, PET-CT fusion, SPECT-CT fusion, and general nuclear medicine. The company’s other new products include structured reporting for nuclear cardiology and echocardiography, and general nuclear medicine quantification protocols for MUGA, renal, gallbladder, gastric emptying, and lung studies, as well as general return-on-investment analysis tools.

Thinking Systems has installations in more than 200 facilities at more than 150 organizations of all sizes. The company recently received the “2008 Frost & Sullivan Technology Leadership Award” in the North American Cardiovascular Image Management market.

—Verina Palmer Martin