Ideas in Hospital-Based Imaging

Case Study: Beth Israel NY Upgrades Radiology and the ED
MGH Leverages VRN 3D Image Processing Service
Hospitals Transition to KP HealthConnect

Case Study: Beth Israel NY Upgrades Radiology and the ED

by Cat Vasko

Beth Israel Medical Center, New York City, recently announced plans to build a brand-new, state-of-the-art emergency department (ED). With much higher patient loads than the current ED, built in 1991, was designed to handle, Beth Israel’s priorities include patient-centric layout, support for a team-based approach to emergency care, and a new central radiology suite, offering quick access to advanced imaging technologies.

Nursing station rendering
An artist’s rendering of a state-of-the-art nursing station planned for the new ED.

“We’re currently in a footprint that’s about 12,000 square feet,” explained Kathleen Ehrenberg, associate chairman of the emergency department. “It was built for approximately 45,000 visits annually. We’re seeing on average 78,000 visits per year now, and some days our census gets so high it would annualize at over 100,000 visits a year. We’re in Manhattan, and we don’t have as much space as we’d like, but the new emergency department will be 22,000 square feet, almost double our current volume. But what’s most important to us was to get continuous space so that it’s all within one footprint.”

The current layout of the ED incorporates three islands distributed between elevator lobbies; the new ED will be designed with centricity in mind. “In the new plan, floor space will be contiguous,” Ehrenberg said. “And it was very important to us to set up small pods, or team areas, so there’s four of those—three adult pods and one pediatric pod. Each one of those is being set up with all the supplies necessary to work relatively independently of the other three. Radiology is sitting in the middle. We did the best we could to get all of the radiological services in proximity to the pods.”

Proximity is important when you are attempting to significantly decrease report turnaround time, a goal Beth Israel is working toward. Ed Asante, MBA, RT, administrator of radiology, noted, “Our current turnaround time on a radiology report overall is 95% within 24 hours. But our target is to stay well under 1 hour in terms of turnaround time in the ED. That’s a huge improvement in turnaround time, and that’s why we’re locating so much equipment in the ED.”

In addition to a dedicated CT scanner, a dedicated ultrasound unit and two C-arm x-ray systems will be located in the new ED. “We currently do sonography on the second floor, and that’s problematic for us from a patient safety perspective,” Ehrenberg noted. “Many of the patients that [need sonography] are women that are being sent to rule out ectopic pregnancies, and they are at high risk for rupture. So in the new ED we will have a room with a dedicated sonography machine.”

Ever mindful of the most efficient distribution of resources throughout the hospital, Ehrenberg, Asante, and their team have ensured that the emergency department will have its own medical imaging technology by making the devices easy for the rest of the hospital to access in a clinch.

“In the environment that we work in, you want to be as cost-conscious as possible, and the number of CTs or sonograms that are run on off-shifts is pretty limited,” Ehrenberg said. “So we have positioned the radiology suite close to an elevator bank that can be used to bring patients down from the inpatient floors to the CT scanner. If an inpatient on an off-shift needs a CT, we won’t have to staff two different CTs.”

That kind of cost-savvy thinking means the new ED may well be able to upgrade its current 16-slice system to a state-of-the-art 64-slice unit—with even more efficiencies, in terms of both time and patient care. In the first quarter of 2007, the CT in the current ED ran more than 1,500 studies, a 30% increase from the same time period in 2006. Decreasing scan time is paramount. “It would improve acquisition time and cut down contrast enhancement,” Asante said. “It would be a big improvement.”

16-slice CT scanner
A 16-slice CT scanner will be at the heart of the new ED’s radiology suite.

Last but not least, Beth Israel had to think about the most efficient way to staff the new ED. “We have an attending here, and we also have residents on 24/7, but the attending is always a backup,” Asante said. “We’ll use NightHawk Radiology, but we do have our own attending who reads from a remote site after midnight and who we can always call and consult with. The goal is to be able to read cases in real time.”

“In the new plans, we’ve situated the reading room where the radiologist is in a central location as well,” Ehrenberg added. “They’re part of the actual radiology suite, so they’re in proximity to the techs doing the CTs and sonograms, but they’re also accessible to the ED staff. We feel that the physicians being able to talk with each other, the radiologists being able to get clinical information on the patients that they’re looking at, and the emergency medicine physicians being able to talk to the radiologists really add value in terms of being able to correctly identify and diagnose our patients.”

MGH Leverages VRN 3D Image Processing Service

by Cat Vasko

Jon DeVries
Jon DeVries

Massachusetts General Hospital (MGH), Boston, launched its new Tele3D Advantage service in July—powered by the Virtual Radiology Network (VRN) from Neurostar Solutions Inc, Atlanta. Axis Imaging News spoke with Jon DeVries, director of 3D Business Development at MGH, about the new service.

IE: First of all, tell me about the Tele3D Advantage service.

DeVries: Over the past 8 years, Mass General has developed its own 3D service internally, and it’s reached the point where we’re now doing up to 140 studies a day, about 40 different protocols, on a regular basis, with standardized views, with a structured process that has grown to the point where we can now scale it to offer the service to other hospitals and imaging centers. So we’re signing up our first client this week, and looking for additional clients in the near future as we begin to expand service.

IE: How is MGH using the VRN?

DeVries: Our goal is really to efficiently deliver 3D anytime to anyone, and what we’re looking for to do that is a robust web-based system that’s inexpensive, allows for very rapid communications with our clients, is an open platform so we can bring on new clients very quickly at little cost, and is flexible.

IE: What were some other options you weighed?

DeVries: We looked at web-based PACS systems, we looked at simple point-to-point connectivity. We looked at everything we could find. Everybody who came to MGH trying to sell their services, we looked at.

IE: What made you go with a VRN over a PACS?

DeVries: We didn’t feel we needed the functionality of a full PACS. Our clients generally have their own PACS systems, and we didn’t really feel that our clients were looking for us to replicate what they had. And at present we’re not going to provide long-term storage, so it’s really just 3D processing. We’re also providing acquisition protocols so the data is acquired properly; we’re assisting with how to bill for 3D, and how to put into the protocols within the department; and [we’re providing] educational marketing programs to help our clients educate their referring clinicians to the benefits of 3D. We’re really trying to provide more than just the reconstructions. We’re providing the entire gamut of services around 3D that has made it successful here at MGH.

IE: What’s going to happen in the long term, as you bring on clients, in terms of processing and storage?

DeVries: Assuming that we’re successful, we’ll be setting up an outside processing center to provide services. So we can really scale it, raise additional capital, hire people; it’s going to become its own stand-alone business. That’ll be in the first half of next year.

IE: What kind of revenue are you expecting to bring in?

DeVries: The models are varied, but it looks like a pretty significant opportunity for a company providing these kinds of services.

IE: Are other hospitals offering similar processing services?

DeVries: A number of other 3D labs around the country are providing services internally, but I think we’re the first one to step outside our four walls to offer the services to the community at large.

IE: Does that have billing or payment ramifications?

DeVries: It does vary a fair amount, and there’s a difference between exams we bill directly and exams like CT or MRI where 3D processing is part of the acquisition billing code. But one of the services we plan on offering is how to go about putting the processes in place for an institution to bill properly so they don’t get rejected.

IE: How soon do you expect to see ROI?

DeVries: Quite rapidly—within 4 to 6 months.

Hospitals Transition to KP HealthConnect

On June 12, Kaiser Permanente (KP), Oakland, Calif, announced that two of its California hospitals, West Los Angeles Medical Center and Santa Rosa Medical Center, had completed deployments of Kaiser Permanente Health-Connect, the organization’s own electronic health record (EHR). HealthConnect represents the largest civilian implementation of an EHR system to date, with more than 700,000 patients in California covered.

“With paper medical records, critical clinical information is too often unavailable, particularly in the hospital setting,” noted Louise Liang, MD, senior vice president of quality and clinical systems support for KP. “KP HealthConnect ensures that, regardless of the care setting, our members’ records are instantly available, so they can receive the care they need, when and where they need it.”

HealthConnect offers additional services to members, including access to personal health records, secure e-mail to physicians, pharmacy refills, lab results, and online health information.

More than 6 million KP members are now being treated with electronic charts in the outpatient setting, and 8.5 million members have online access to their personal health records.