With the right solution, you can increase operating efficiency, reduce operating costs, and secure access to EMRs.

The advent of digital radiography has fundamentally changed the use of x-ray imaging in medicine. This is especially true in large and medium-sized hospitals, imaging centers, and other health care organizations, where computed radiography (CR), direct radiography (DR), picture archiving and communication systems (PACS), and electronic medical record (EMR) systems are systematically used to replace film and chemical processors and paper-based patient record systems. Only in recent years, with reductions in price, have CR, DR, PACS, and EMR systems begun to be incorporated in private practices, enabling physicians to use these technologies to digitize their offices.

Many of the private practices use x-ray equipment and ultrasound machines, while their operations are primarily based on film and paper. The federal government and the medical communities envision that medical records and images will be in electronic or digital form by 2014. Some of the private practices have already embarked on their transition from film and paper to digital systems, while many others are learning about and considering such a transition.

The overall goal of digitizing a physician’s private practice is to make the transition from film and paper to digital systems happen. By removing film and paper from operations, the private practices would enjoy the primary benefits of an increase in operating efficiency, reduced operating costs, and secure access to electronic medical records for patients and physicians.

The Problems

Digitization has been done extensively in radiology departments and imaging centers, and considerable experience has been accumulated and well documented. In comparison, digitization in physician’s private practices has started only in recent years. Experiences vary and are less well documented. The digital transition in private practices is much less prevalent than that in radiology departments and imaging centers, creating opportunities for medical digital equipment manufacturers and integrators.

The digital transition requirements of private practices are as complex, if not more complex, as those for radiology departments and imaging centers.

Different than radiology departments and imaging centers, physician’s private practices have several distinct characteristics.

First, the private practice markets consist of various medical specialties. Physician’s private practices are diverse, ranging from primary care physician’s urgent care offices to chiropractor’s clinics to surgeon’s private surgical centers. The requirements for digital imaging, digital workflow, and patient interactions therefore vary according to the medical specialties and the preferences of the doctors. Such diversity requires digital solutions that are tailored to suit the medical specialty and clinical operation of the private practices.

Second, the sizes and imaging volumes of physician’s private practices vary widely. In some of these practices, x-ray equipment and ultrasound machines are used to provide patients with imaging for diagnosis at the point of care, which is much more convenient and efficient than sending the patient to an imaging center. The imaging volumes can vary, for example, from two to five x-ray exams per day in a single doctor’s office (if it has x-ray equipment), to 50 to 80 x-ray exams per day in a busy multiphysician orthopedic practice. The variation of imaging volume directly affects the affordability and return-on-investment of the practice when it considers transition from film and paper to digital systems.

Third, physician’s private practices are very sensitive about the initial prices and subsequent maintenance costs to replace their film and paper systems, as they are usually owned by individual physicians as partners. As medical imaging is not the core health care service of the private practices, the financial incentive and justification have to be strong for the digital transition. One metric to consider is the daily average number of x-ray exams done at the practice. Another is the benefits of elimination of paper and film for more efficient operations and regulatory compliance.

Fourth, the medical staff of physician’s private practices often are not as specialized as those in radiology departments and imaging centers. For example, medical staff with limited licensed radiological technologists (RT) are often used, rather than fully certified RTs. Most of the private practices usually do not have dedicated IT staff to select, install, and maintain digital equipment and computer networks.

Fifth, the physicians in private practices still require optimal integration of digital systems to fit their daily clinical operation and workflow. The key elements in their digital workflow are ease of use and time efficiency. Such requirements include elimination of multiple entry of patient and exam information on their scheduling programs or EMR systems and PACS, seamless sharing of images and reports between PACS and EMR systems, and even a voice recognition system to generate automatically initial impressions and final reports.

Sixth, the physicians usually utilize an outside radiology service for primary diagnosis and sometimes they interact with physicians in other specialties for their second opinions. They also are asked to distribute to the patients their images and reports on CDs, and in the more sophisticated practices, they import digital medical information on CDs from other health care organizations.

Lastly, more and more physician’s private practices operate in more than a single location, with multiple offices or health care partners spanning over a limited geographic area.

It is evident that the digital transition requirements of private practices are as complex, if not more complex, as those for radiology departments and imaging centers. Not all these characteristics are present in every physician’s private practice. Careful identification and considerations of these characteristics for the particular physician’s private practice to go to digital are the key to success.

The Solutions

It is equally important to thoroughly understand the system elements, their functions, and integration standards and mechanisms to package relevant system elements together for a total digital solution to be deployed to a physician’s private practice.

There are many issues that need to be addressed when matching a private practice with a total digital solution of systems (CR, PACS, EMR, etc) to cover all the workflow needs and digital interactions within and outside of the practice.

For smaller physician’s private practices, perhaps the single most important consideration is affordability. With the stringent reimbursement terms from medical insurance companies and other cost factors, private practices often cannot afford or are unwilling to spend a large sum of money just to convert from paper and film to digital. Fortunately, for conversion from film to digital imaging, the reduction in costs for film and chemicals can often be used to pay for or offset the expenses on a digital solution consisting of a CR, a PACS, and even a DR system. Furthermore, there are new, integrated digital x-ray solutions available from vendors that can match the functions necessary for smaller physician’s private practices while meeting their budgetary and expense constraints.

The second important consideration is to carefully examine the integration mechanisms that are built in the systems within the total digital solution. One deployment strategy may be for a physician’s private practice to deploy a digital x-ray solution first, to immediately save on the film and chemical costs, then, at a later time, to deploy an EMR system to capture patient encounter and chart information. In this scenario, integration between the PACS and CR or DR system with EMR will become an important aspect for a functional clinical workflow. The important aspect is to identify and examine whether the integration/interface mechanisms are proprietary or standard based. For the PACS system, as DICOM has been in existence for the last 15 years, conformance to the DICOM standards may be a good indication that integration can be done successfully. Still, unless the total digital solution provides all the system elements necessary for a fully digital physician’s private practice, integration usually involves two or more companies. Therefore, it may be advantageous to identify a total digital solution that has gone through integration exercises for its systems and components.

The third important consideration is to include installation, application training, and operation support and services as part of the total digital package, as these may incur a significant amount of expense during or after the installation. This is particularly important for those private practices that are low in imaging volume, as in those practices, limited licensed RTs are often employed and require more training, and no full-time IT staff are usually available to take care of installation of computers and networks and their maintenance.

Besides these considerations, each practice may have its own set of special needs. These, for example, may include requiring an outside radiology service group for primary diagnosis and interpretation, requiring physician–patient consultation using the digital data during a patient visit, and requiring off-site backup and guaranteed disaster recovery of data from the primary storage, etc.

Still, with careful consideration and evaluation, most, if not all, the requirements for digital transition from film and paper in physician’s private practices can be met by turnkey solutions from integrators and manufacturers with acceptable costs. And most often, the private practices using digital systems are happier and operate more efficiently with expenses less than those from film and paper.

As low-cost total digital solutions consisting of CR, DR, PACS, and EMR systems have been made possible in recent years, it is clear that it is a complex exercise for a physician’s private practice to transition from film and paper to digital. Thorough understanding and careful consideration of suitable total digital solutions are the key to successful digital transition from film and paper for physician’s private practices.

Luke Huang is president of Radlink, Redondo Beach, Calif. For more information, contact .