Managing the Flow in Radiology

Integrated RIS/PACS Saves Rockwood Clinic Time and Money
7 Medical Launches On-Demand Health Care IT Services
Study Shows CAD Leads to Higher Patient Recall Rate
Combined PACS/CTRM Solution Focused on Making Communication Easier

Integrated RIS/PACS Saves Rockwood Clinic Time and Money

Three years after installing an integrated RIS/PACS, the Rockwood Clinic in Spokane, Wash, has seen a 45% increase in the number of examinations.

By Renee DiIulio

In 2002, Rockwood Clinic, Spokane, Wash, decided to replace its antiquated software with 21st-century technology, including a RIS and a PACS. “We were still paging through screens using F5 and F12 buttons,” said JoAnn Tarlton, Rockwood’s director of radiology. By 2006, 3 years after installing an integrated RIS/PACS, the clinic increased its volume by 45%, from 65,000 examinations in 2001 to 94,000 in 2006.

Tarlton credits the growth to a thriving area, but also to the new system, which had not been in the clinic’s original plan. In 2002, Rockwood already had selected a RIS vendor and was scouring the market for a PACS.

The purchasing team was walking the show floor of RSNA 2002, comparing the PACS solutions of eight preselected vendors. Criteria included 100% uptime and user friendliness. While in the booth of DR Systems Inc, San Diego, Tarlton caught a demonstration of a new scheduling product. She pulled the team in, and they became intrigued.

The scheduler had a lot of functionality. Combining the software with a PACS would fulfill most of the clinic’s radiology needs, with the exception of billing and film tracking. The team soon began discussions with the scheduling software developer, from which DR Systems had licensed the program, to integrate the system with a PACS. After unsuccessful attempts, marred in part by a hurricane and a company sale to DR Systems, Rockwood found itself speaking directly to DR Systems, whose integration of the scheduling program with its PACS was advancing more rapidly than Rockwood’s.

So, the institution maneuvered out of its RIS contract, and in August 2003, Rockwood Clinic installed the first DR Systems Unity RIS/PACS Integrated RIS Solution, about 6 months after deciding to go with the company. The move saved Rockwood $750,000 in capital investment alone, much of it earmarked for the RIS, Tarlton said.

The integrated RIS/PACS that the clinic installed was in the beta phase, but Rockwood was happy to work with DR, making suggestions that included requests for billing and film-tracking modules. (DR Systems responded with an HL7 interface for billing applications and a patient-tracking tool that includes a film-tracking migration tool.)

With its expanded functionality, the new integrated system has created additional benefits that have increased the clinic’s resulting returns even more. Two days after installation of the new integrated RIS/PACS, radiology stopped printing film for CT and MRI. Within 6 months, it stopped printing film for all of the remaining modalities. The clinic is now filmless and paperless. Tarlton noted that this change has saved significant amounts of money. “By purchasing an integrated system, we were able to realize a cost savings of approximately $750,000 that would have been spent on a RIS,” she said. “In addition, we were able, through attrition, to decrease our clerical staffing by two full-time employees.”

The new system also has generated time savings, as greater efficiency has been achieved throughout the entire workflow. On the front end, scheduling and check-in have been streamlined. The new system has more functionality than the clinic’s previous program, Tarlton noted. Now, schedulers can view 15 or 20 appointment options at a time rather than paging through individual options and having to restart the process to return to an already-reviewed time. Subsequently, the time that schedulers spend on the phone with one patient has been reduced dramatically, according to Tarlton.

The software also can handle conflict scheduling. “For instance, if a patient will need to schedule an ultrasound and an upper GI on the same day, the program will recognize which procedure should be completed first and will offer options for same-day scheduling,” Tarlton explained. She compared this to the previous, more labor-intensive method of manually paging through schedules to find time for the appointments on different days.

Similarly, check-in has been streamlined, reducing the lines that used to form at the front desk. When a patient’s arrival is noted in the system, the program flashes green and alerts the radiologic technologist that the patient is in. The ICD-9 and CPT codes follow the patient through check-in to the technologists, who have the option of modifying them.

On the back end, electronic billing has shortened billing turnaround to nearly the same day. Prior to the integrated system installation, billing was handled manually, taking more time and labor to complete. Interfacing with the billing module presented one of the few challenges that Tarlton recalled during implementation. “Our biggest challenge was getting the program to work with our billing and clinic information systems,” she said.

But the installation was a great success. Tarlton cited the ease in training as one factor that contributed to the quick return. “Billing is easy,” she said. “Scheduling is easy. The software has enabled us to have faster throughput on all patients throughout the entire system.”

Renee Diiulio is a contributing writer for  Axis Imaging News. For more information, contact .

7 Medical Launches On-Demand Health Care IT Services

New from 7 Medical Systems LLC, Minneapolis, are on-demand electronic medical records (EMRs) and digital imaging solutions, available so far in Minnesota, Florida, Georgia, North Dakota, Washington, Texas, and Iowa. In Q306, the company entered into 5-year service agreements with 14 health care facilities to offer EMR and PACS on an as-needed pay-per-use basis. Designed to eliminate the up-front capital outlay required to invest in PACS, and offering ideal risk management and off-site archive protection, the 7i Digital Imaging On-Demand Suite seemed like a smart investment to Dan Rohrbach, CEO of Bridges Medical Center (BMC), Ada, Minn.

“The number one priority that drove us to look at 7 Medical’s product was financial,” Rohrbach explained. “It emerged as a big money saver for us versus bringing in our own in-house PACS.”

BMC’s upfront outlay was minimal. “Basically, there’s a very minimal setup fee for [7 Medical] to come in, set up, and make this stuff work. From there, we pay a per-scan fee for images to be stored on 7 Medical’s services and for 7 Medical to administer the PACS for us. If you have higher volumes, the price comes down; if you have lower volumes, it’s a little more expensive—but still very affordable on a monthly basis versus a standard PACS for around $300,000,” Rohrbach said, noting that BMC is a 100-bed hospital. “For a hospital our size, if we figured that [price] out as a per-procedure cost, there would’ve been no way to afford it.”

Rohrbach is pleased with the efficiencies that his hospital has realized for such a reasonable capital investment. “We don’t have radiologists on-site at our hospital reading images,” he explained. “They’re an independent radiology group about 45 miles away. Before, we would courier films down to their site to have them read at the end of the day. They’d get them the next morning, do the dictation and transcription, and we’d get them back sometime later. Now, we hit a button, and the image shows up on their desktop; within a few hours, we’re getting the reads back. Sometimes, if it’s a stat read, we get them back almost immediately. Before, we really didn’t have such a thing as a stat read.”

On the back end, 7 Medical supports its clients with a best-of-breed open PACS operating on a 64 terabyte infrastructure from IBM Corp, Armonk, NY. “There is some ongoing internal development as well,” explained 7 Medical CEO Jason Studsrud. “There will be a proprietary element, but at this point, it’s about 6 months away.”

Studsrud noted that the 7i Suite will spread according to demand. “It’s a nationwide offering, and we can provision it worldwide,” he said. “It’s just a question of how soon we get there—we’re driven by customers.” Studsrud also stressed that training is minimal: “It’s a very fast turnaround. We’re physically on site for about 3 days, and that includes everything from hardware installation to clinical training.”

Rohrbach concurred—with 7 Medical assuming responsibility for all the administration and maintenance of the PACS, it has not been necessary for BMC to train and pay an expert PACS administrator. “It takes away some of the worry,” he said. And that is why he does not anticipate transitioning away from on-demand PACS any time in the foreseeable future. “Even if the cost of a PACS came down to $100,000, you still need to have someone who’s designated as your PACS administrator. This way, we pay a monthly fee, and 7 Medical takes care of it. Facilities can get this type of solution without the capital expenditures.”

—C. Vasko

Study Shows CAD Leads to Higher Patient Recall Rate

A prospective study published in the American Journal of Roentgenology found that CAD increased the breast-cancer detection rate and decreased the false-negative rate, but that it also led to higher patient recall rates.1 The study, performed at Boston University Medical Center (BUMC), included 5,016 screening mammograms.

Over the 26-month course of the study, 48 cancers were found—radiologists detected 43, and CAD located two more, both ductal carcinoma in situ presenting as microcalcifications, as well as one mass. “CAD is best suited to detect microcalcifications, and in reality, faint microcalcifications are the most commonly overlooked finding by most radiologists,” observed study author Priscilla J. Slanetz, MD, MPH, associate professor of radiology at BUMC.

The radiologist alone detected 90% of malignant asymmetry or masses and 89% of microcalcifications; meanwhile, CAD alone detected 67% of asymmetry, but 100% of microcalcifications. Slanetz noted that although neither the radiologists nor the CAD system was perfect, the overall false-negative rate was reduced when they acted in tandem.

The study also examined the recall rate resulting from the 5,016 mammograms and found that the use of CAD resulted in 89 women being recalled, on top of the original 607. Of these, six were biopsied, and two had cancers. “We continue to routinely employ CAD in the interpretation of screening mammograms,” Slanetz said. “The tradeoff of earlier detection for a slight increase in recall rates seems reasonable and is well accepted by most patients.”

The CAD system in use by the researchers was the MammoReader system from iCad Inc, Nashua, NH.

—C. Vasko


  1. Ko JM, Nicholas MJ, Mendel JB, Slanetz PJ. Prospective assessment of computer-aided detection in interpretation of screening mammography. AJR Am J Roentgenol. 2006;187:1483–1491. Available at: Accessed April 10, 2007.

Combined PACS/CTRM Solution Focused on Making Communication Easier

Agfa HealthCare, Greenville, SC, and Vocada Inc, Dallas, have partnered to integrate Vocada’s Veriphy Critical Test Result Management (CTRM) solution into Agfa’s Impax PACS. The CTRM system improves patient safety and outcomes and boosts staff productivity by promptly verifying the communication of critical test results from a reporting clinician to the responsible ordering clinician.

“Reports show that a breakdown in communication is accountable for 80% of all malpractice lawsuits,” said Lenny J. Reznik, business unit manager for RIS and PACS at Agfa. “In 1971, Keene v Methodist Hospital found a radiologist negligent for failing to communicate with an attending clinician. Since that time, the courts, for the most part, have been siding with the patients and saying that radiologists are legally responsible for communicating unexpected findings. So, this is an issue that’s been growing for a long time. Agfa offers a whole suite of radiology IT solutions—RIS, PACS, and reporting—and adding a component to verify the communication of critical results brings significant value to our customers.”

Veriphy offers automated compliance with all legal and professional standards concerning critical communications; Reznik also touts the system’s ease of use as a major benefit. “When the radiologist is reviewing the images and reporting the images on either the Impax PACS or Talkstation, which is our reporting solution, all the radiologist has to do is hit a button that says, ‘Vocada,’ and the patient information and ordering physician ID are automatically transmitted to the Veriphy solution,” Reznik explained. “The radiologist dictates information on the findings, and then Veriphy notifies the clinician by whatever preferred method he or she has identified.” All communications are stored for 10 years, and an auditable record of the transmission and receipt of critical results is available.

Agfa and Vocada have entered into a co-marketing agreement; in other words, customers of both Veriphy and Impax solution are now offered a professional service to integrate the two systems. And thanks to the open architecture of Impax, Reznik said that the additions will not stop there: “At RSNA 2006, we announced a relationship with a company called Ascom [Berne, Switzerland]. The Ascom system is an internal hospital pager system, and we actually connect Impax automatically to the Ascom system, sending the clinician who ordered the exam a notice.”

Other new developments include the introduction of the Impax Clinical Suite, which, according to Reznik, “is essentially a new IT solution that can bring disparate clinical data to the Impax radiology desktop.

“One way of putting it is that we need to put the communication back into PACS,” he continued. “A lot of people haven’t been focusing on communication, and this partnership is all about changing that.”

—C. Vasko