Managing the Flow in Radiology

Be Savvy About Service Contracts

Many PACS vendors offer extended warranties and service contracts for their solutions and, just like the extended warranties at the big box retailers, they can sometimes take away more than they give. When executed correctly, service contracts enable health care organizations to avoid the fear and considerable risk associated with the failure of an exceptionally complex, mission critical system. When done incorrectly—too quickly or simply out of the stress that comes from managing a can’t-fail system—service contracts can limit technology options, increase costs significantly, and provide little more than a false sense of security. So what does “correct” look like?

When evaluating service contracts associated with PACS solutions, there are a few key details on which to focus before signing on the dotted line. First, understand that when you purchase a service contract, you eliminate or severely hamper your ability to use alternative service providers that may offer lower costs or faster service. You are essentially locked in to a specific service company for the contract duration and cannot take advantage of better cost options until the contract expires or you cancel the contract—a choice that often comes with its own hefty fees.

Second, IT professionals should inquire which items set the price of the service contract to get a better understanding of the services for which they are paying. Often, the actual service performed on your organization’s infrastructure plays little to no role in how prices are determined, because most contract pricing is based upon the cost of fixing worst-case scenarios and addressing the most frequent repairs seen by the service organization—regardless of whether they actually happen to you.

Third, buyers should compare the extended warranties offered within the service contract to the warranties offered by the hardware original equipment manufacturers (OEMs) within the solution. Two years of server support sounds great, but why pay (or why pay the full cost) when the OEM already covers the first 12 months? You may actually need that second year of support, but be sure that you aren’t paying twice for the same thing. Purchasers are well served to aggressively negotiate these costs within their current service contracts.

Finally, know the technologies that are addressed and included within the service contract. Some contracts cover only one or a handful of OEMs, or specific technology sets. Adding new technologies or using different vendors outside of that list may leave you without adequate support for a critical system component. This both increases dependence on particular vendors, and could very well limit your ability to pivot to new (or cheaper) technologies when they become available.

Being smart can save you bigTo save money and increase ROI, remember the following:

  • Unpack Service Contracts: Look into service contracts and explicitly list which individual components are covered, such as software and hardware infrastructure. Compare that to the PACS system inventory and associated warranties to see exactly what is and what is not already covered.
  • Look Hard into the Hardware: Because most PACS hardware is resold from the major OEM, ensure that the service contract fulfills the basic maintenance requirements for those pieces and includes first-tier support. Many “all-inclusive” software service contracts do not include top-level support, making it difficult to reach OEM technicians for complex problem solving.
  • Stick with Validated Hardware: While the PACS vendor might imply that their workstations won’t be supported if the hardware is not purchased from them, often when push comes to shove, they will support the solution as long as tested or validated hardware is used.
  • Divide and Conquer: Analyze each service contract individually. This process allows your health care organization to determine which components to have serviced in-house, by third-party vendors, or by full-service OEM contracts.

When implementing a state-of-the-art PACS solution, it is understandable to want all the bells and whistles to ensure the system operates as needed and expected. Keep in mind that the best time to negotiate hardware and hardware service options is before you have selected your PACS vendor. When the hospital has narrowed down to two or three options, hardware purchasing flexibility is something that can often be negotiated. Once the OEM has locked in a contract, hardware purchasing options become limited. Knowledge is power; a deep understanding of your organization’s service contracts can mean saving big dollars and even bigger frustrations down the road.

—Jeff Heck is business development manager for CDW Healthcare.

Is Your PACS Administrator CIIP?

Paul G. Nagy, PhD, CIIP

PACS is now an integral part of any radiology practice or hospital imaging center, but its implementation and management can vary greatly with the institution and its PACS administrator—for better or for worse. While PACS administrators cannot be expected to know the intricacies of every vendor’s PACS platform, a certification program from the American Board of Imaging Informatics (ABII) is offering an objective way to ensure that they have an effective level of technical knowledge and management skills.

The ABII is a nonprofit organization founded in 2007 by the Society for Imaging Informatics in Medicine (SIIM) and the American Registry of Radiologic Technologists (ARRT). Paul G. Nagy, PhD, CIIP, is ABII’s chair and also associate professor, Department of Diagnostic Radiology and Nuclear Medicine at the University of Maryland School of Medicine, Baltimore. He said that the need for the Imaging Informatics Professional (IIP) certification program came out of the maturation of the PACS industry.

In the early part of the decade, SIIM members began discussing the fact that PACS administrator training was mainly tied to a particular vendor’s application; consequently, it was difficult to show transferable skills between jobs and institutions. Furthermore, it became clear that the radiology community wanted some kind of competency analysis for what a basic PACS administrator should be doing and a certification to define a PACS administrator’s basic competency.

By 2005, SIIM had published a PACS administrator job analysis that was defined with 127 tasks. Further discussions of building a centralized certification program led to the founding of ABII.

Nagy noted that the IIP program was built with the knowledge that some PACS administrators come from information technology (IT) backgrounds while others come from more clinical training, such as being a radiation technologist (RT)—and both skills are required.

Nagy said, “It’s always hard to get IT people and clinical people seeing the problem with the same eyes. That’s one of the reasons we thought we needed to create this certification program, to unify those types of personalities, and to have an individual with IT know-how who can work closely as part of a clinical team.”

As a result, there are minimum qualifications and experience from both backgrounds that must be satisfied in order for a CIIP candidate to sit for the exam. These are listed on the ABII Web site and include at least 2 years of experience working in a clinical informatics setting.

In addition, successful candidates will also have a basic knowledge base of widely used IT health care standards, such as DICOM and HL7.

Nagy explained, “The intention is that if you’re an RT without any IT experience, you will not pass this test. Likewise, if you’re IT without any clinical understanding, you will also not pass this test.”

How does the exam stay relevant in a fast-moving information technology field? Nagy said that the test is continually evolving and that new questions are added to address the latest PACS informatics trends and standards.

While every PACS administrator cannot be an expert with every platform and the minutia of every standard, Nagy noted that one of the key skills being tested is the candidate’s ability to do competent technology assessment.

“You’re not going to be highly certified in every piece of hardware,” said Nagy, “but you have to be a communicator with the vendor, the network team, the clinician, the technologist, the radiologist, and the administration. So, the truth is that you need to be a really good communicator and aware of the technology changes, but you’ll probably not be able to master all of the intricacies of all of the technology that you need to deploy.”

Thus far, there are 541 CIIPs. The next certification test will take place in major metropolitan areas throughout the United States in September. The next test after that will take place in March 2011. Check the ABII Web site ( for more information.

In terms of cost, the September exam fee is $400, but the fee is increasing to $500 for March 2011. After receiving the CIIP, PACS administrators must also maintain their status through continuing medical education courses.

—Tor Valenza

Look to the Cloud for Peace of Mind

North Metropolitan Radiology Associates recently chose Accelerad’s

Every piece of medical technology offers different, specific benefits for each radiology practice that uses it. For North Metropolitan Radiology Associates, which provides imaging services to Gwinnett Medical Center—a multilocation, Atlanta-based trauma center—Accelerad’s offers peace of mind.

The group recently entered into an agreement with Accelerad to implement SeeMyRadiology, primarily to provide business continuity, protecting, safeguarding, and sustaining the practice’s PACS during upgrades and system failures, something that occurs occasionally with the radiology group’s McKesson solution.

Val Phillips, MD, a managing partner with North Metropolitan Radiology Associates, said that until was installed in May, the group, which is completely digital, had no backup if its PACS went down, a severe problem for a busy trauma center like Gwinnett. And it would be a severe business issue for the radiology group, which conducts more than 400,000 studies per year. Being down for just an hour would result in either a loss or backlog of several hundred studies, jeopardizing the care of its patients.

This made the cloud-based particularly attractive to the 25-radiologist group. The system also helps in off-hours coverage, allowing one radiologist to cover numerous imaging systems at several locations remotely.

But this is only the beginning of how will fit into the North Metropolitan Radiology Associates’ business plan. In addition, Phillips says that the online imaging management resource can be used to give referring physicians access to patient studies without needing access to the enterprise’s PACS; it can be pushed—with the patient’s consent—to off-site physicians, and can be used by patients to manage their own imaging records, reflecting the goal of government officials to empower patients.

As long as an image is DICOM compliant, a user can view the study using SeeMyRadiology, a big advantage for referring physicians and for radiologists viewing images from referred patients.

Phillips said that in addition to being easy to use, the system was painless to install. Accelerad offered training to staff, technologists, and radiologists, and continues to give ongoing 24-hour, 7-day-a-week support.

Among the advantages that SeeMyRadiology gives to radiologists is a universal worklist that combines studies from multiple sites, providing the flexibility to efficiently match specialty radiologists to the appropriate cases. It has an advanced speech recognition module that improves turnaround times and eliminates transcription costs. And it provides an online community of health care providers involved in the care of the patient to easily view and discuss imaging results.

SeeMyRadiology has a number of other features that aid workflow and efficiency, including mobile access; integration with EMR, PHR, and HIS/RIS systems; an advanced viewer; private labeling; preference notifications; detailed HIPAA audit trails; and 3D imaging.

While the access the system allows radiologists, referring physicians, and patients makes it a powerful clinical tool, SeeMyRadiology is also completely secure, featuring a 24/7/365 monitored data center with biometric security, multilayered network security, sophisticated cloud computing infrastructure with full disaster recovery, encrypted data transmissions, identity verification, and user authentication.

Phillips says that the first stage of the implementation with its emphasis on having a backup to the group’s McKesson PACS has met with kudos from Gwinnett’s administration. “The administrators are very pleased,” he said. “We prioritized this as our number one mission to provide imaging 24/7 and to be able to handle an emergency.”

With the success of stage one, the remainder of the implementation will follow over the next few months, said Phillips.

—C.A. Wolski

Synapse Fuses PET and CT Images Automatically

Fujifilm just added an efficient new feature toits Synapse PACS

Functionality has been the hallmark of every advance in PACS. FUJIFILM Medical Systems USA Inc recently made its Synapse PACS even more user friendly with the release of the Maximum Intensity Projection and Multi-planar Reformatting (MIP/MPR) Fusion.

The Fusion, which will now be standard on all Synapse PACS versions 3.2.1 and higher, promises to make radiologists even more efficient. While delivering the same image quality, the system has several features that make it easier and flexible for radiologists and other clinicians who may need access to patients’ images.

Among its most notable features is the ability to automatically fuse PET and CT images. Users can drag and drop PET images into CT scans to quickly create the fused images. The standard uptake value (SUV) calculations, measurements, and displays can be made almost immediately, according to the company.

But this is only one way the Fusion makes radiologists more efficient, according to Jim Morgan, executive director of medical informatics. For instance, users will no longer have to use a PET workstation to view images. “It’s a Web-based [product] so it’s available anywhere and is diagnostic capable everywhere,” he said.

And because of its availability anywhere and at anytime, it removes the technologist from doing any of the image processing, allowing the radiologist to view the “raw” image as a compressed or uncompressed scan on their own computer. “The goal is to make the radiologist’s computer the reading workstation,” said Morgan.

The system features an integrated workflow, allowing radiologists to seamlessly toggle between MPR, Fusion, and the orthogonal slices without having to close patient studies or log into another system, according to the company.

Synapse features customizable reading panels that allow radiologists to configure them for their reading preferences and workflow needs. Among the options that can be customized are window leveling, slab thickness level, overlay types, and various image reading formats. While the way an image is viewed will change from user to user, the interface remains constant.

The interface is based on a standard Web browser in a Microsoft friendly format, making the system very intuitive for most users. “We think that’s very powerful,” said Morgan. And while many users require little or no training on the system, he added that the company recommends it.

The Web-based system is fully encrypted and can be limited in any way the enterprise wants. For instance, a referring physician could be granted limited access to a particular patient’s record.

Image access is perhaps one of the most flexible features of the Synapse. The system is a volume-based product with no limit on the number of users or modalities. This fee structure was developed with the customer in mind, according to Morgan. “We wanted it easier for users to plan [their budgets],” he said.

Since all Synapse contracts are “evergreen,” every current user will receive the Fusion as part of the regularly scheduled system upgrade with no change in price.

In addition to managing images, the Synapse can be used to store images, including disaster recovery. The Synapse portfolio includes Synapse PACS, Synapse RIS, Synapse cardiovascular, and Synapse women’s imaging.

—C.A. Wolski