Managing the Flow in Radiology

Study Shows Cost Savings Achieved with RIS/PACS
New Radiology Search Engines Launched
Report Assesses Risks and Challenges of Telemedicine
NightHawk Radiology Acquires Teleradiology Diagnostic Service
Companies Partner to Offer Mini-PACS Solution

Study Shows Cost Savings Achieved with RIS/PACS

A new study published by researchers from the Simon Graduate School of Business at the University of Rochester assesses the financial benefits side of health care information technology. “The Economic Role of RIS/PACS in Health Care”—by Moshe Ayal, a Simon School research associate; Abraham Seidmann, Simon School professor of computers and information systems and operation management; and Arthur Segal, MD, chief of radiology at Rochester General Hospital—indicates that diagnostic imaging centers using PACS and RIS significantly increase their level of performance.

“In addition to the very profound improvement in the turnaround time, processing of charges, increased revenues collected, reduced process delays, and significant improvement in physician satisfaction, there is a marked improvement in physician access to medical images and interpretations, leading to better patient care,” Segal said in a press release.

Simon School researchers looked at 150,000 imaging studies at Rochester General Hospital before and after PACS and RIS implementation, measuring the new IT systems’ impact on imaging charges, revenues collected, turnaround times, process delays, and other factors. During the 12-month period of the study, turnaround times were reduced by 80%, collected revenues per procedure increased 20%, and there was a 10% overall rise in productivity, in addition to an increase in hospital staff and patient satisfaction.

Seidmann noted, however, that the learning period needed to be factored into any imaging organization’s financial impact analysis. “This is not a quick fix,” he said. “After the PACS and RIS are installed, it takes between 6 months and 1 year to fully accrue the benefits. Our data clearly indicates the presence of a steep learning curve starting almost on the day when the PACS and RIS were installed at Rochester General Hospital.

“By carefully measuring a broad spectrum of performance indicators, the team quantified a process of continuous improvement that provides tremendous benefits on multiple dimensions,” he continued. “For example, having the report turnaround time available shortly after the radiology exam means that patients could be released home earlier than before, thereby reducing the expected length of stay, cutting clinical risks for the patient, and reducing the operating cost for the hospital.”

The study, which was partially supported by an unrestricted educational grant given to the University of Rochester by the Eastman Kodak Co, Rochester, NY, concludes that in order to achieve maximum value, RIS and PACS solutions should be supported by appropriate organizational changes and workflow improvement initiatives. “When creative IT systems, workflow optimization, and organization redesign are implemented in concert,” Seidmann said, “they will reinforce each other in a powerful way.”

The report will be presented at the 2007 Annual Meeting of the American Healthcare Radiology Administrators, to be held July 8–12 in Orlando, Fla.

New Radiology Search Engines Launched

On January 12, the American Roentgen Ray Society (ARRS), Leesburg, Va, launched its new GoldMiner search engine for radiology images. GoldMiner provides instant access to images published in selected peer-reviewed radiology journals.

“The images published in our major radiology journals are a treasure trove for radiologists—not only for assembling a lecture, but also to help in our clinical work,” Charles E. Kahn, Jr, MD, a creator of GoldMiner, said in a statement. “Until now, there hasn’t been an easy way to search for images across different journals. Regular search engines, such as Google Images, often find images that aren’t high quality and aren’t relevant to radiology. GoldMiner is more like PubMed for images: It searches by meaning, not just strings of letters.”

The engine recognizes abbreviations, synonyms, and kinds of diseases. According to the ARRS, it knows that “renal calculi” and “kidney stones” are the same thing, and it knows that renal calculi are a type of kidney disease. It offers a “thumbnail” image preview pointing users to the full-size image at its site of origin and links to the original full text of the article, if available.

GoldMiner arrived on the heels of Yottalook, a Google-style search engine for both full-text references and context-specific images developed by iVirtuoso Inc, Baltimore. Yottalook—which debuted on January 5, the 111th anniversary of the announcement of Wilhelm Roentgen’s discovery of the x-ray—leverages the indexing technology of Google, but adds layers of radiology-specific filtering, prioritizing results based on factors like previous user satisfaction and journal prestige.

“We have our own relevance and clustering technology,” says Steve Severance, chief technology officer at iVirtuoso. “For example, if we’re looking for information related to pediatrics, we’ll only get results related to pediatrics. We also have relevance, which is partially weighted by criteria like a journal’s ISI [Institute for Scientific Information] index. So, if we have content from somewhere like the New England Journal of Medicine, that content will have more weight than content that’s been published in a less prestigious journal.”

Severance notes that tools like Yottalook and GoldMiner have the potential to be used increasingly at the point of care. “Having a search engine that can verify content is very important,” he notes.

GoldMiner can be accessed at; Yottalook is available at

Report Assesses Risks and Challenges of Telemedicine

A new report published by nonprofit health care research organization ECRI, Plymouth Meeting, Pa, looks at the growing use of telemedicine—particularly the challenges and hazards posed by this emerging field. Volume 3 of the Healthcare Risk Control (HRC) publication, “Telemedicine,” assesses such considerations as security and quality assurance, offering guidance to facilities that use telemedicine.

“The use of telemedicine carries risks in addition to those normally associated with the provision of care,” the report notes. “Facilities must establish policies and procedures that outline the appropriate use of this technology and determine what regulations apply to the equipment used during telemedicine procedures. In addition, health care risk managers should familiarize themselves with current definitions and uses of telemedicine and examine related liability, privacy, security, reimbursement, credentialing, fraud, and conflict-of-interest issues.”

The 17-page report also contains information on the following:

  • definition and current uses of telemedicine technology;
  • HIPAA’s impact on privacy and security regulations in telemedicine;
  • liability exposure related to the use of telemedicine;
  • CMS regulations regarding reimbursement for telemedicine procedures;
  • Joint Commission on Accreditation of Healthcare Organizations’ standards on credentialing telemedicine practitioners; and
  • possible areas of violation with regard to insurance fraud or Stark laws.

An appendix provides a sample telemedicine policy. The report is available for free to HRC members; it also is available for purchase online at for $75.

NightHawk Radiology Acquires Teleradiology Diagnostic Service

On February 12, NightHawk Radiology Holdings Inc, Coeur D’Alene, Idaho, announced its acquisition of Teleradiology Diagnostic Service Inc (TDS), Arcadia, Calif, a leading provider of off-hours teleradiology services to West Coast hospitals. Axis Imaging News spoke with Tim Mayleben, chief operating officer of NightHawk, about the deal and what it means for the company’s future.

IE: How will TDS be integrated into the company?

Mayleben: TDS will continue to operate as a separate subsidiary of NightHawk. What we expect to do with Dr [Wilson] Wong, who’s the founder and CEO of TDS, is to look at opportunities for integration efficiencies—opportunities to realize efficiencies from more closely integrating our two operations. But for now, they will operate separately and continue to serve their customers as they have done so well over the past 9 years.

IE: Why did you choose TDS?

Mayleben: When you’re acquiring companies, a lot of it turns on not just the health of the business, but also the health of the relationship that exists between the management teams, because that matters a lot as you move forward together. You’re talking about taking two entities that were separate and had their own cultures, and knitting them together over time. I think the great benefit is that [NightHawk CEO] Dr [Paul] Berger has been in this industry for almost 30 years now, and he’s known Dr Wong for a very long time. They’ve developed a professional relationship, and both have an interest in teleradiology going back over a decade. Both of them pursued separate paths, only to ultimately have united here.

Tim Mayleben

IE: What does the acquisition mean for NightHawk?

Mayleben: It certainly expands our presence in California, which is the largest market in the country for radiology services. It’s an opportunity for us to gain a foothold, and, of course, we have much broader service offerings than a company like TDS could economically offer. For example, we [offer] 24/7/365 [service]. More recently, we’ve gotten into cardiac imaging, and also released our Talon customer workflow solution product. It gives the TDS customers the opportunity to access those professional services while still receiving the same high quality of service that they’ve received over the years. But for us, it’s an opportunity to expand the market for these services into the customer base that TDS has developed, and really just implant ourselves as a positive presence in California.

IE: Do you plan to have TDS start doing more than just night reads?

Mayleben: We’re certainly exploring opportunities for deeper integration, but we’ve concluded at this point that it would be premature. We want to work together with them for a while before we make any changes, major or otherwise. We’re going to abide by the old crawl-walk-run, progressing slowly so that we don’t stumble.

IE: Any further plans for expansion?

Mayleben: Sure. As a radiologist-centric business, we’re always looking for opportunities to provide additional services to our radiology group customers. We’re servicing close to 20% of US hospitals and a large number of radiology groups, so we feel like we have a pretty good thumb on the pulse of what’s going on with customers and what kinds of things they’ll be asking for. As we expand our business, we’re simply looking to be responsive to the needs of our radiology group customers. That has led to the additional service hours, the cardiac and subspecialty imaging, and, more recently, the customer workflow product.

Cat Vasko is associate editor of Axis Imaging News. For more information, contact .

Companies Partner to Offer Mini-PACS Solution

At RSNA 2006, Toshiba America Medical Systems, Tustin, Calif, and McKesson Corp, San Francisco, introduced the Horizon Medical Imaging Store 100, a cost-efficient mini-PACS solution for small hospitals and imaging centers looking to store data in a manageable way without the use of an enterprise PACS or DVD storage.

“Our partnership with McKesson makes it possible for us to offer tailored storage solutions for a variety of customers,” Doug Ryan, senior director of the CT business unit at Toshiba Medical, said in a press release. “Now, facilities that do not require a full PACS but need an efficient way to store data have a customized solution.”

The Horizon Medical Imaging Store 100 offers the ability to safely and efficiently store cases online; it is compatible with Toshiba Medical’s CT and ultrasound products, including the Aquilion, Aplio, Nemio, and Xario product lines. Should a facility using the solution need to expand its storage capacity or upgrade to an enterprise PACS, the Store 100 can act as a foundational platform for the McKesson Horizon Medical Imaging PACS, which received the top ranking in the KLAS Community Hospital PACS 2006 and 2005 reports.

“This archive allows for a combination of modalities to be connected at one time,” said Gordon Parhar, director of Toshiba Medical’s ultrasound business unit. “It also will allow for DICOM data review at the workstation, which will increase efficiency for our customers.”

Earlier in 2006, Toshiba Medical and McKesson signed a distribution agreement to offer the Horizon Medical Imaging PACS with Toshiba’s diagnostic imaging products.

—C. Vasko