By Kurt Woock

Metro Imaging, a full-service imaging center with five locations throughout St Louis, runs a tight ship. Giving patients preliminary results before they leave is one of its differentiators. Because of that, radiologists read exams in real time. When the staff at Metro Imaging started planning for Meaningful Use (MU) in the spring of 2012, Chris Keefe, Metro Imaging’s CFO, wasn’t sure how navigating the new waters would affect the fine-tuned business. “We need to have a very efficient workflow,” she said. “Our system needs to be very reliable, very streamlined. Meaningful Use scared us to death. We thought it would slow down our workflow.”

Chris Keefe5x7 Chris Keefe, CFO, Metro Imaging

Her initial reaction when first tasked with implementing MU wasn’t a reflection of a lack of competence but an echo of a theme heard throughout the imaging world. “Being a small company, we had some challenges. We had learned a lot about MU, but it was tough to see how to apply it to radiology, to our imaging centers. Many radiology practices struggle with this. MU doesn’t apply to all the specialties very well. And I’d say ours is one of the difficult ones.”

Needing to arrive at a solution that worked for Metro Imaging and its patients, Keefe turned to vendors who had dealt with MU implementation. Together, they designed a workflow that would meet MU requirements without disrupting Metro Imaging’s established operational methods. “We were worried about our patients,” she said. “We don’t normally capture blood pressure or weight. We were afraid this would be intrusive.” After a series of revisions, Metro Imaging devised a new set of information to be collected during check-in.

The additional information wasn’t pointless. “There are actually things in MU that are helpful to us,” Keefe said. “For example, the clinical decision support rule, which is basically appropriateness for MRI (ie, does the patient have a pacemaker?), is actually a big help.”       

MU gave additional information to Metro Imaging, which meant additional data to process. Metro Imaging needed a way to process it. They considered installing computer kiosks but felt they would depersonalize the patient experience, create wait lines, and frustrate elderly patients. The staff also thought about using tablets, but they heard negative feedback from others, and they were concerned about breakage.

Keefe heard about NextPen, a joint solution from Anoto and NextGen Healthcare Information Systems LLC, in April. The NextPen is a pen with a digital camera. Forms, printed on regular office paper, contain a barely visible dot pattern, which the camera utilizes to register users’ handwriting. Software translates the handwriting into digital text, which can then be imported into EHR or other systems. “It demoed really well, but we were thinking, ‘I don’t really know if I believe this,’” Keefe said. But after a test period, Keefe and others were sold. Metro Imaging purchased five pens for each location.

Keefe said the staff was apprehensive about the switch, but they quickly caught on. When they reassessed the forms they had been using, they identified ways to increase efficiency. “We see about 600 to 700 patients each day,” Keefe said. “Each patient has at least three forms, some have five. But everyone has a registration, a consent, and a history form. We took those three forms and combined it into one three-page form. I know it seems like a small thing, but it’s a huge step in efficiency.”

Patients have caught on, too. The pen looks, feels, and writes like a normal pen, so it went largely unnoticed. A few patients questioned the additional information needed, but, for the most part, Keefe said by putting something on a form, patients are likely to complete it.

The pen, which does its work in the waiting room, benefits those in the imaging rooms, too. Keefe said that before they adopted the NextPen, the technologist doing the exam went over forms with patients and made notes by hand, only to type the additional information into the computer later. “Now, the patient fills out history with the NextPen, which creates a template in the EHR for the tech to use. The tech can make the notes right in the system, which then goes to the radiologist all cleaned up, as structured data.” Radiologists can customize the on-screen form to show only relevant data rather than long stacks of unrelated checkboxes.

Metro Imaging achieved MU in December. “As much as people don’t like government regulation and MU, it did have some benefits,” Keefe said. “It made our information more accurate. We are capturing more information. It forced us to look at our processes and our workflow and make improvements.”