Managing the Flow in Radiology

Is iPad for Medical Imaging a Game Changer?
Curbing Costs with RamSoft
PACS to the Rescue
Smart Scheduling, Better Billing

Is iPad for Medical Imaging a Game Changer?

By now, you have no doubt heard that last January, Apple Inc, Cupertino, Calif, launched the iPad, a new tablet computer based on its best-selling iPhone. What remains to be seen is whether radiologists and referring physicians will adopt the iPad, and how it affects the way imaging exams are read, referred, and reviewed.

Ed Heere, president and CEO of CoActiv, Ridgefield, Conn, thinks the iPad will grow to be a very useful and widely used tool in radiology and the medical information technology world. In fact, the company was the first to announce that it will have an enhanced iPad app available for its EXAM-PACS customers when Apple distributes the iPad in April 2010.

CoActiv has an existing iPhone app that is based on OsiriX, an open source DICOM-compatible image processing platform designed for the Mac. However, the iPhone app does not have all of the functionality of the desktop viewer. With the iPad, that limited capability will be notably expanded.


?The iPad app will give significantly more functionality, including full color views, closer to the OsiriX application for the Mac,? reported Heere in an interview.

The desktop OsiriX viewer for Apple?s Mac computers features multiplanar reconstruction (MPR), maximum intensity projection (MIP), curved MPR, volume rendering, surface rendering, stereo vision with red/blue glasses, and many other advanced viewing tools common in proprietary viewers.

According to Apple, all existing iPhone applications will be automatically compatible with the larger iPad, but Heere said that its revised iPad app will be more than a clone of CoActiv?s current iPhone application.

?First, it?s going to be closer to the operating system of a MAC than the operating system of the iPhone. So, it?s going to have a larger screen, and it?s going to have the colors. That means you will probably be able to do echocardiograms real time, full function ultrasound, and full function 3-D reconstructions on the iPad app,? Heere said.

But will more functionality make radiologists trade in their laptops for iPad off-site consultations? Heere thinks so.

?We see the iPad creating a substantial change to the way we deal with medical information, whether it?s reports, exams, everything. It?s the future. It?s going to knock the notebook out.?

One of the things that will make iPad different from a laptop is its internal 3G phone connectivity. That capability makes a referring physician?s reading capabilities much more convenient. The iPad won?t fit in a lab coat, but it will be lighter and more portable, and not just within the confines of a Wi-Fi hotspot.

In addition, as with the current iPhone app, off-site radiologists will be able to query/retrieve and download exams from the server at any registered facility using EXAMPACS. Once images arrive on the mobile device, they may be viewed using the full range of iPad?s touch-screen capabilities, including scroll, pan, zoom, and window level and measurement functions.

CT and MR exams also can be read at full resolution, since the resolution of the iPhone and iPad is up to 1024 by 1024, which is essentially the full resolution for CT and MRI. In addition to quick consults, Heere foresees referring doctors adapting quickly to iPad because its lightweight design will allow them to easily take it into the exam room, at bedside, or as a mobile teaching tool during rounds.

?Tor Valenza

Curbing Costs with RamSoft

Like any good business, Centrelake Imaging and Oncology kept a watchful eye on its overhead and fixed costs of operation when it first opened its doors in 2006. Three years and three additional sites later, the family-owned practice has proven that its savvy business sense has paid off. During a year of economic decline, Centrelake has been able to thrive, launching two locations in late 2009.

According to the firm, much of its success has been achieved using RamSoft ONE, a fully integrated RIS/PACS solution from RamSoft Inc.

?Starting out buying millions of dollars of imaging equipment, it really helped us that we were able to find a solution for our PACS that was so cost-effective, yet still satisfied our technical needs,? said Shan Niroola, the center?s chief information officer.

Performing upwards of 25,000 imaging exams a year, Centrelake provides diagnostic imaging services to the Inland Empire and San Gabriel Valley of Southern California.

Niroola said Centrelake chose RamSoft for a variety of reasons. ?First and foremost, we wanted to have an all digital environment,? he said, explaining that a paperless environment was desirable because all of the practice?s modalities are digital.

Centrelake Imaging and Oncology performs more than 25,000 imaging exams a year.

Also, Niroola praised the company?s solution for being cost-effective. ?They have a licensing model that really bodes well for small practices looking to grow,? he said. ?Their software has helped us to take on additional projects without being worried that we?ll spend a fortune on IT infrastructure.?

And money is not the only thing that Centrelake can save. Niroola also pointed out that time delays are minimized because the integrated system allows referring physicians to access patient information over the Web. The solution also allows for automated fax, another mechanism that allows for very little time wasted in getting results over to physicians.

?With RamSoft ONE, our practice has been able to share information across our entire enterprise, allowing our radiologists to access patient studies from any of our facilities,? he said. ?The product also enables us to closely track our business performance, which facilitated our decision to expand our practice. When it came time to expand, there was no question that we would continue to build our practice on the stable foundation set in place with RamSoft ONE.?

Not only is RamSoft ONE useful for business practices, but the solution also offers benefits for patients. Records are centralized, which makes it easier for patients who receive care at multiple Centrelake locations. ?Patients receive better quality of care because the tools provided in RamSoft ONE eliminate film losses and provide improved accessibility to patient studies,? said Skip Amiot, national sales director for RamSoft.

?Additionally, end users reap financial benefits due to reduced overhead. They may be able to reduce storage space, eliminate the need to purchase films and chemicals, and manage staffing requirements,? Amiot said.

?We can continue to grow without major reinvestment in our IT infrastructure,? added Niroola, who commented that Centrelake enjoys working hand-in-hand with RamSoft?s approachable support staff, a quality that stands out among vendors.

Niroola said that Centrelake has experienced steady, not exponential, growth since 2006. Because of the steadiness, there has not been a lot of stress on the firm?s infrastructure. ?But [considering] the fact that we?ve been growing, especially in the recent year with the market, we are very fortunate,? he said.

?Elaine Sanchez

PACS to the Rescue

When Philips Medical Systems discontinued its distribution partnership with Sectra North America Inc, University Hospitals in Cleveland, also encountered a crossroads: should it continue operat-ing with its existing Sectra PACS solution or follow Philips?

According to Himanshu Pandya, vice president of System Radiology, the decision was not too difficult to make. The health system, one of the largest employers in Ohio, kept its loyalty to Sectra and has not looked back since the choice it made in 2003.

Under a recent agreement, Sectra will deliver PACS products and direct service and support for the next 5 years. University Hospitals will leverage Sectra?s new generation PACS with RapidConnect to provide radiology services across a large, distributed group of hospitals and outpatient health and surgery centers.

?The product itself is excellent,? Pandya said. ?We have 150 sites in Northeast Ohio, and that number continues to grow. In order for us to have a PACS installation and train all these thousands of people, it was important to have a user-friendly product.?

Before the University Hospitals went digital, Pandya said there were numerous complaints from staff about film. The hospital system used a homegrown PACS, which did not have the functionality for permanent storage. Imaging volume had grown significantly, and the cost of its image library was skyrocketing. Once Sectra went online, however, complaints turned into satisfaction, Pandya said.

Improvements were made in total turnaround time, and users?including surgeons, orthopedists, and mammographers?found it easier to move images around. Physicians also found that there was no delay in receiving large imaging data to their workstations. The Web-based system allows authorized users to access the digital library from any location, making it easier for the network?s 60 radiologists to move from site to site. Furthermore, its speech recognition system, RIS, and critical results reporting systems are all fully integrated with Sectra?s product.

Pandya said he also appreciates Sectra?s accessibility and modest size as a business. ?We get customized support because of their size,? he said. ?They are able to support many of our needs on short notice, and with Sectra, there?s not a lot of bureaucracy to get through to solve a particular problem. That is a huge benefit for us.?

According to Pandya, University Hospitals plans to expand its PACS in the next year as it prepares for the opening of two new hospitals. He is confident that the process will be a seamless one because the health system has plenty of experience in launching new sites and connecting them to the IT network.

?We have leveraged the Sectra PACS platform for over 5 years, and we are excited about working closely with Sectra going forward as we continue to deliver a broad offering of health care services to the northeastern Ohio region,? Pandya said.

University Hospitals performs approximately 750,000 imaging exams a year, distributed throughout all its sites.

?E. Sanchez

Smart Scheduling, Better Billing

In today?s health care environment, brand loyalty has its benefits. That?s what Mankato Clinic has discovered by upgrading to McKesson?s Horizon Practice Plus 12.0, practice management system.

The Mankato, Minn-based multi-specialty group practice has been using versions of the Horizon Practice Plus stretching back more than 34 years, according to IT Director Bob Norman, who noted that the Mankato Clinic was one of the first customers to implement the practice management system more than three decades ago. And there is one driving reason why the practice has stuck with McKesson. ?They?re our standard of what customer service is,? he said. ?They?re good at listening to us.?

McKesson?s Horizon Practice Plus 12.0 enhances efficiency from scheduling to billing.

Of course, there are other, more quantifiable reasons, according to Norman. The system has made the eight-location practice more efficient from a clinician and financial perspective. Norman said one of the big advantages is the physician booking system, which has eliminated double- and over-booking of the clinic?s physicians. The Horizon Plus has paid off in another very impressive way. Mankato personnel process about 47,000 claims per month with only about 3% of those 90 days past due.

From an IT perspective, Norman notes that the 12.0 upgrade was ?awesome.? Typically, he says, an upgrade can result in catastrophic loss of data, but it was a nonevent from the technical side. On the practical, everyday use side of the coin, there was little in the way of growing pains. The system has Windows Explorer functionality, so it?s fairly intuitive and similar enough to the earlier version that training of existing and new personnel has been minimal.

Norman credits the simplicity of the system?s design and its customizability for its success at Mankato. For instance, the Horizon Plus has been easily integrated into the clinic?s PACS without a RIS, a reflection of the clinic?s multispecialty character.

According to Norman, McKesson?s customer service has been an important part of the success of the 12.0 installation. The relationship is clearly a two-way street with Norman and his colleagues having engaged in numerous phone meetings to make sure that any bumps in the road were ironed out before the installation. The result was a painless upgrade. However, when a problem occurs, Norman says that McKesson has a ?very good? incident reporting system that solves the problem in a timely fashion.

Among the Horizon Practice Plus? features are a Master Person Index (MPI) and end-to-end revenue cycle management. The MPI includes advanced search and retrieval technologies to prevent duplicate registrations and errors. The revenue management includes automated co-pay calculation, stop-loss and limit checking, medical necessity checking, and eligibility verification. Online worklists and collection tools track payment activity from patient visit to collection of overdue accounts. The full-featured, flexible, rules-based scheduling tool?one of the big benefits for Mankato?s physicians?shows the simultaneous scheduling of physicians, equipment such as imaging modality use, and rooms.

In addition to its revenue and scheduling features, the 12.0 integrated with McKesson?s ambulatory electronic health record solution, Horizon Ambulatory Care.

According to the company, the system is ideal for hospital-based or mid- to large-sized practices. The 12.0 was recently awarded the Best in KLAS Award for Practice Management (26-100 physicians) in the 2009 Top 20 Best in KLAS Awards: Software & Professional Services report with 100% of survey respondents indicating they would buy the solution again

?C.A. Wolski