Disparate technologies and multiple locations pose a challenge, but ultimately, Eagle Imaging soars with an integrated system.

Byron Christie, MD

Eric Slimmer

After 3 years in a fast-growing practice providing 90,000 interpretations per year, Eagle Imaging Partners reached a critical juncture in the winter of 2009. We serve hospitals, imaging centers, and medical clinics in Oklahoma City, rural Oklahoma, and Texas, yet we could not take on additional business despite demand for our services.

We could not accept any new business without feeling like our hands were tied by inefficiency. Most of the 15 facilities we served had different technical workflows from each other, as many as five workstations to accommodate the various PACS our customers used, and different dictation systems. Space-wise alone, there was not room for an additional workstation for another customer. Time-wise and stress-wise, our radiologists could not train on another customer-specific PACS. The situation was nightmarish.

Scheduling also was problematic because our practice had not outfitted every facility served with every customer?s technology and equipment. Additionally, some radiologists were not trained in every customer?s technology. When a subspecialist was reading at a facility that did not have a particular workstation, they might not be able to read specialty images without driving to another facility. Facilities could be as far as 400 miles apart?clearly not optimal efficiency. As a result, efficiency and productivity suffered, and frustrations mounted.

The Goal, the Options

The challenge was getting all customers? images on a single integrated system to be able to distribute images to radiologists regardless of their location. The goal was to become more efficient in interpreting studies and improve service to customers and patients.

We explored purchasing a PACS of our own to unify our customers, and we thought about creating and staffing an in-house IT department.

However, we decided against that route, thinking that it wasn?t a good idea to reinvent the wheel. More important, we wanted to focus on what we?re good at. Given the many IT issues of this undertaking, it was a tall order to do it on our own.

The technology needs of our practice were twofold: a common PACS and a program that would unify disparate worklists. An additional need was for around-the-clock seamless image reading.

We were using a teleradiology vendor, but it required our customers to change workflow processes between daytime and nighttime services. That wasn?t seamless service, and it created opportunities for error. We wanted to provide a 24/7 radiology services package. If we could find the radiology and technology solutions in one package, so much the better.

We evaluated several IT and teleradiology vendors and ultimately selected one that met all of our needs: Virtual Radiologic (vRad) of Eden Prairie, Minn. vRad has been a leading virtual radiology provider since 2001 and also offers technology solutions to radiology practices, hospitals, and health systems.

Equipment vendors did not provide the clinical, administrative, and technical support we wanted. vRad offered the only comprehensive solution. We were looking for an experienced partner who had done HL7 integrations at major facilities, and we were confident that their IT staff could do the heavy lifting required to integrate our facilities. We convinced our customers and their physicians that this was a solution to our problem. It would have been a big black eye if the integration had failed.

Connecting the Enterprise

Eagle Imaging began to use vRad? Enterprise Connect, a Web-based platform vRad uses to interpret more than 2.7 million studies per year. This workflow management product provides a single integrated worklist, viewer, and reporting system, along with operational support when needed.

Now, Eagle Imaging uses a standard workstation at its facilities, and all radiology orders appear in a common worklist. Radiologists need be trained in only one system, increasing their productive time. Studies can be routed to a specific radiologist based on comprehensive rules, and interpreted reports are sent to referring physicians within minutes.

We also achieved our goal of providing seamless 24/7 coverage by having vRad do after-hours and overflow daytime final interpretations. The new software and integration with a teleradiology provider give us the flexibility to distribute studies regardless of the time or day of week.

This change toward uniformity in ordering, workflow, and reports, no matter where the radiology coverage is coming from, has increased our customers? satisfaction with us. More important, turnaround time for patients has improved, which means they can be diagnosed and treated faster.

In addition to improving customer satisfaction, our practice has been able to continue to grow. Since adopting this technology solution, our business has grown by 15% to 20%.

Integration of a new facility is now relatively simple, too. In the past, adding a customer meant adding a new workflow, PACS, and transcription system. That was especially challenging when adding smaller clients; it took just as long to integrate them for significantly less return. Now, we simply connect every client?s system and add a single unique on-site workstation. Regardless of how big the client is or how many orders per day they send, the orders all go to the same worklist and through the same process. Adding new clients is much simpler. That?s a huge relief. Getting new business should be a positive thing, not a hassle.

The Gains

For our practice, integrating the technology was the equivalent of bringing on an additional full-time radiologist. We were a six-man group that would have had to hire a seventh due to the inefficient way we were operating. Instead, we ?hired? technology. Our radiologists feel like their workload is less, but actually they are doing more. It?s just that it?s easier now, and they spend less time doing things that are not our core business.

Our radiologists are on-site at customer facilities and contribute to the enterprise-wide workload, enabling them to be productive all day long, with no thoughts about availability of the right technology.

In the past, when a customer facility needed a study read urgently, we got the call to track down the radiologist. We also employed support staff to help traffic-manage the process. Now, we rely on our teleradiology and technology provider?s operations center for that support.

It is far more expensive for us to employ support staff to run interference and manage workflow than it is to outsource it. Now, when a facility needs a study urgently, it calls the operations center instead of calling us. The team there completely understands the imaging order workflow and processes because that?s what they do all day, every day. This outsourcing allows our professionals to stay focused on what they do best and not waste time tracking down people and images. Fewer communications errors occur, and we do not have to hire support or IT staff for this purpose. We have gained efficiency in our radiologists?36% more volume without additional staff. Moreover, we have improved customer satisfaction as well as turnaround for patients, which is reduced by half on average.

Our practice has been energized by this change, and we feel we?re providing a higher quality of care to the facilities we serve. The radiologists in our practice feel less stress now that they work with one consistent workflow. In addition to all the other benefits to the practice, this improved efficiency gives us an advantage in recruiting physicians to Eagle Imaging?a critical advantage, especially in a more rural area.

Eric Slimmer is chief executive officer and Byron Christie, MD, is president of Eagle Imaging Partners based in Oklahoma City.