Managing the Flow in Radiology

Upgraded PACS and RIS Focus on Molecular Imaging
Interventional Radiology Comes Online
Hosted RIS and PACS Offer Centers an Affordable Alternative

Upgraded PACS and RIS Focus on Molecular Imaging

Thinking Systems, St Petersburg, Fla, showcased its upgraded PACS and RIS solutions, which have been optimized for molecular imaging, at the 2009 Society of Nuclear Medicine conference held in Toronto on June 13-17.

The newest upgrade to ThinkingPACS and ThinkingRIS includes advanced features for PET-CT fusion.

The upgrade to ThinkingPACS™ and ThinkingRIS™ includes advanced features for PET-CT fusion, such as additional hanging protocols for viewing and printing and improved 3D SUV (Standardized Uptake Value) measurements. The solutions also feature upgraded SPECT-CT fusion for handling the GE Infinia Hawkeye SPECT-CT; upgraded Web-based structured reporting for nuclear cardiology; upgraded general nuclear medicine processing for MUGA, renal, gallbladder, and gastric emptying; and an upgraded RIS that integrates with third-party billing and reporting software.

These solutions either are available as part of the Thinking Systems’ PACS/RIS platform or can be integrated with third-party enterprise PACS, such as the Philips iSite® PACS or the Fujifilm Synapse® PACS. The Web-based ThinkingPACS and ThinkingRIS are designed to provide comprehensive molecular imaging PACS/RIS throughout the entire enterprise.

“Thinking Systems offers workstation-based solutions that provide high throughput and convenient multimodality comparison, and thin client-based solutions that enable physicians and clinicians to have convenient access from anywhere, anytime with either intranet or Internet access,” said Xiaoyi Wang, co-CEO and cofounder of Thinking Systems Corp.

Wang adds that while PACS has increased the efficiency and convenience of accessing patient information and radiology images in most health care institutions, that same convenient access does not necessarily apply to molecular imaging data in these facilities. “Clinicians still depend on very limited dedicated equipment that is often inconveniently located,” he said. “To bring molecular imaging to the same level as general radiology in improved efficiency and enhancing the level of patient care, physicians need to be able to do their work from enterprise PACS workstations, yet still have the same tool sets and functionality as provided by modality workstations.”

According to Wang, molecular imaging considerations are becoming a key factor for facilities considering PACS purchases, PACS upgrades, and PACS replacements.

“Molecular imaging modalities have been among the fastest-growing modalities in the industry, especially the hybrid modalities, such as PET-CT and SPECT-CT, which combine functional imaging and anatomical imaging,” Wang said. “To support this growth, and to be able to take advantage of the technologies offered, the PACS infrastructure has to be in place so the values provided by these modalities can be extended to the point of patient care, just as what was done for general radiology.”

Thinking Systems has completed installations at such facilities as Mary Washington Hospital in Fredericksburg, Va, and Fletcher Allen Healthcare in Burlington, Vt. The 412-bed Mary Washington Hospital provides care for patients in northern Virginia and the Richmond area, while Fletcher Allen serves more than 1 million patients throughout Vermont and northern New York.

“At both of these institutions, our solutions enable physicians to perform nuclear cardiology quantification analysis, PET-CT fusion, SPECT-CT fusion, and general nuclear medicine processing and review from either dedicated PACS workstations or any computer on the network,” Wang said.

In addition to the above features, Thinking Systems’ PACS solutions offer image archiving, connectivity/data conversion for both DICOM and non-DICOM modality devices, and comprehensive clinical suites for all modalities. They also offer side-by-side comparisons of all radiology and cardiology modalities with specific clinical tools for each modality.  

Thinking Systems’ Web-based RIS provides interfaces for patient registration, modality worklists, report generation and distribution, and billing.

—Ann H. Carlson

Interventional Radiology Comes Online

With the digitization of data, physicians can spend more time interfacing with a computer rather than with patients. But without it, they can spend time and other resources on paperwork, administrative tasks, and quality control—and still not with the patients. Automation and computerization—when they’re available—can help to streamline workflow, save money, and, ultimately, improve patient time and care.

Quana Bert, RN, ARNP, MSN

As disciplines become more electronic, manufacturers computerize more tasks. With the introduction of an Interventional Radiology (IR) solution from LUMEDX Corporation, headquartered in Oakland, Calif, interventional radiology is the latest specialty to come online.

“The software collects and stores detailed information on more than 400 artery and vein procedures, as well as a full complement of general interventional radiology procedures. In addition, the solution captures billing, inventory, and complications,” said Quana Bert, RN, ARNP, MSN, lead clinical product manager for LUMEDX in Bellevue, Wash.

Using the IR software, physicians can document case information, including history and risk factors, laboratory values, images, and associated comments; automatically assign performance measures as required by The Joint Commission; and attach ICD and CPT codes during or immediately after the case. Approved users can access comprehensive electronic procedure records, manage images, schedule time, capture billing data, analyze metrics in real time, and complete registry and accreditation reporting.

Data Gold Mine

These measurement tools, metrics analyses, and reporting capabilities are designed to achieve both clinical and business objectives. With less paperwork, clinicians can work with greater efficiency and provide better quality care. At the same time, administrators can manage billing and inventory in ways that reduce waste, decrease errors, improve documentation, and maximize reimbursement.

“This product manages patient data and outcomes across the specialty over the long term,” Bert summarized. She notes that a health care institution cannot improve the care it delivers without relevant patient data that can be mined and analyzed. Automating this capability can expand both the data that can be collected and the ways in which it can be analyzed.

“Since the data is entered into the system at the point of care, administrators can begin evaluating it right away,” Bert said. New users can begin looking at the metrics over the first quarter of data collection and more fully evaluate trends over time.

Those trends tracked after implementation of an automated system often include a more streamlined workflow, which can be measured as increased productivity, quicker turnarounds, or improved quality. The LUMEDX software was designed to complement workflow and follows the typical progression of diagnostic and interventional processes. The company consulted with clients, particularly those who had expressed interest in interventional radiology solutions, during development. Their goal was to enhance valuable data capture and maintain the integrity of the clinical staff workflow.

Integrating Interventional

Smooth integration with work processes helps to ensure adoption by an institution’s users. The LUMEDX IR solution allows the clinical staff to maintain their primary focus on caring for the patient, according to Bert. Physicians can concentrate on actual care rather than the computer interface or administrative tasks.

Smooth integration with existing information systems also drives adoption. It is easier to implement and use software if it integrates with the other systems in the institution’s infrastructure. Users of the new IR solution will primarily be hospitals, although the system can be used by independent facilities with interventional radiology suites.

Both types of institutions may already have technologies in place with which the IR system may have to interact, including those that manage patient movement (eg, admit/discharge/transfer or ADT), laboratory results (laboratory information systems or LIS), patient records (EMRs), and images (PACS).

“LUMEDX is primarily an interface company, and in being vendor-neutral, the Apollo patient data repository interfaces start at the patient’s point of entry into the system, typically with ADT. In addition, the company offers interfaces to inventory, medication, and laboratory systems,” Bert said.

Investing in Care

The company also provides complete software packages for cardiology and vascular care, along with modules for outbound reporting and registry documentation. The new IR solution represents a natural extension of this effort—for both LUMEDX and its clients. Justification for the cost is found in the associated improvements for care.

“In general, patient safety and quality of care motivate investment a lot more than financial return. The efficiency in care delivery can be used to show improved quality, provider satisfaction, public relations, hospital image, and employee morale, which is the investment payoff,” said Kyle Smith from Sutter Health in Sacramento, Calif.

The ultimate goal of the IR solution is to improve patient care. It enables clinician users to spend more time interfacing with patients—and less with a computer or paperwork—so they can improve care.

—Renee Diiulio

Hosted RIS and PACS Offer Centers an Affordable Alternative

Managing and storing large digital files in-house can be a costly proposition for imaging facilities. Software-as-a-service models, such as the Fusion Hosted RIS/PACS, RIS, and PACS solutions from Merge Healthcare, Milwaukee, aim to provide facilities with affordable access to the latest technology. Axis Imaging News spoke with Nancy Koenig, president of Merge’s Fusion division, about this emerging trend.

Merge Healthcare now offers its Fusion RIS/PACS MX as a hosted solution, providing a convenient pay-per-study model and minimizing requirements for on-site IT system management.

IE: Why is the imaging sector seeing an emergence in hosted RIS/PACS solutions?

Koenig: With advancements in screening technology and modalities, the files for study subsets and images have gotten ever larger. Now that networking bandwidth to get images to and from the site of data capture is more affordable, we can cost-effectively manage and deploy these centralized systems on behalf of our customers. Compression technology has also improved so that files can be shrunk and moved from image capture at the modality to centralized storage in a faster, more economical fashion.

IE: How can a hosted RIS/PACS, hosted RIS, or hosted PACS solution be advantageous to an imaging facility?

Koenig: At first blush, many people think the pricing model makes a lot of sense from a cash-flow perspective. But it’s not just about the fact that you’re paying on a per-study basis. It’s that you don’t need the facility footprint to house these systems. You don’t necessarily need a large staff of IT professionals on hand to manage these systems. So, it’s more of a convenience, and it helps customers and imaging providers upgrade their level of service without having to make “infrastructure” investments in people, hardware, or facilities. Additionally, a hosted environment brings a formalized storage and security process to the organization. Many imaging centers are periodically replicating tapes and storing them in nearby off-site locations (sometimes in the basements of their own homes). This type of ad hoc approach can be risky.

IE: What types of facilities are gravitating toward a hosted solution?

Koenig: We’re seeing a strong pick-up in outpatient imaging centers and smaller medical facilities because they can improve their overall grade of service without having to make big investments. RIS systems, especially, are becoming a necessary solution because if you can’t manage your business effectively and keep your scanners fully utilized, it becomes difficult to survive in this environment where DRA has taken such a chunk out of reimbursement.

Nancy Koenig, president

IE: What can a facility expect to spend on a service like this?

Koenig: It really depends on how big the scale of the operation is, but we’re seeing numbers in the area of $30,000 a year and up.

IE: For users, what is involved in implementing the Fusion Hosted solution?

Koenig: Some level of practice management assessment needs to happen. If we are deploying PACS systems, radiologist workflow must be reviewed. For billing solutions, we need to assess how claims get processed today and how the practice wants them to be processed tomorrow. It may sound like a lot. But our professional services consultants are very seasoned at this, so this isn’t an extended engagement by any stretch of the imagination. And we often bring added value based on experiences in other settings.

In terms of preparing the site, we will need to have network connectivity back and forth to the site, and there is a small amount of hardware that gets deployed to pull images off the modalities and send them to the centralized site.

IE: How do you address HIPAA in this hosted model?

Koenig: We incorporate all the same protections in the hosted solution that we have in systems deployed on-site. We use only certified data center providers to host our system, and we use encryption technology for information sent across networks.

IE: What other factors should facilities consider when researching a hosted option?

Koenig: One of the key value propositions is that in a hosted environment, by its nature, you are getting good backup and disaster recovery solutions as well.

Additionally, the federal government’s new stimulus package includes a large requirement around interoperability. We have taken that to the hosted environment as well by doing HL7 integration with referring physician systems and managing those integrations on behalf of our customers.

IE: What has been the response to the Fusion Hosted solution so far?

Koenig: For some, the decision becomes a bit more complex, because options now exist to buy software, lease software, or engage a hosted service. Now, however, facilities have more choices and can structure the solution to best fit their needs. In some cases, folks are still learning what hosted solutions are and what is included, so there is still an education process involved here. In general, the feedback has been positive just because people now have a choice.

IE: What advice do you have for facilities that are weighing these options?

Koenig: In any technology buy, you’ve got to plan for where you’re going to be in a 24- to 36-month period because if you acquire something that fits your needs for today, you will outgrow it in that timeframe. Look at where your business is going, what you expect for growth rates, and what you need in order to grow your business.

—Ann H. Carlson