Speedy System Suits Health Network

By Chris Gaerig

Scott Kayser, MD, chair, department of radiology, JPS Health Network.

Speed and efficiency are critical in all areas of a hospital, but perhaps nowhere more so than in the trauma center, where a few minutes can be the difference between life and death. Ensuring that physicians have the proper studies and scans on hand quickly is vital to the caregiving process. It’s with this in mind that the JPS Health Network recently purchased and implemented the Philips iSite PACS.

The iSite is an enterprise-wide medical image and information management system that the JPS Health Network intends to utilize throughout its entire network. The hospital network sought a solution that would bring not only speed, but also accuracy and ease of use to its image and information sharing.

“We looked at about 10 companies that we narrowed down to five based on what our needs were,” said Scott Kayser, MD, chair, department of radiology, JPS Health Network. “We were projecting about 300,000 unit volumes this year for radiology. We then had multiple on-site demonstrations and from those narrowed our selection to three vendors. Then we did site visits in the area to some of the other hospitals. We spoke with their radiologists, techs, and IT people, and found that Philips was right for us because it’s Web-based and has unlimited licenses, and because of the ease of the interface.”

The iSite solution’s remote Web access was one of the primary selling points for the health care network. With the ability to view images remotely, second opinions and nighttime readings can be achieved easily. In addition, physicians who are connected remotely will have access to all studies and capabilities—including image manipulation—from any Internet-ready computer.

“The Web-based model has not gone live with the remote access, so I’m still curious to see how efficient and effective that component is going to be,” said Kayser. “As we continue to grow, we run out of physical space in the department. This can allow us to be more creative with working remotely, whether it is providing additional reading or overnight coverage. They’ve told me that if you have a good connection at your house, it’s pretty much the equivalent of being in your office at your workstation. That’s yet to be seen. We’re working on that piece now, but that flexibility was a big selling point for me.”

But it’s the speed of the system that impressed and eventually sold the health care network on the iSite. With the network switching to the Philips solution from a separate PACS, there is a significant migration of images and studies that need to be transferred to the new system. As that process pushes into months and potentially even a year in length, Kayser insists that the ease of the system and quick manual retrieval of information outweigh any difficulty they may have.

“The migration of our archive of prior exams is still ongoing, so it’s still kind of hit-or-miss on whether a prior exam will be automatically available or not, but it seems to be easy to manually retrieve them pretty quickly—better than what we had in the past,” said Kayser. “I think complete migration should be finished in the next few months, but we’ve got quite a bit of the migrated component online already. Having the studies immediately available and ready for review is a nice feature.”

While other factors such as uptime contributed to JPS Health Network’s decision—Philips promises a 99.9% uptime, which is especially important in the trauma setting—the diagnostic and workflow improvements that the solution promised, and the facility has experienced, are what eventually sold the product.

“In the first month of using it, I’d say we have all experienced—and I’m guessing—a 10% increase in everyone’s output,” said Kayser. “I think it’s made everyone more efficient. The load times on the CT studies are almost instantaneous. If you’re sitting around for 9 or 10 hours a day, you can imagine how those times add up, especially over weeks and months of dead time when you can’t do anything until the study is finished loading. That will make us more efficient.”

One-stop Solution for Busy Practice

By C.A. Wolski

There are many reasons a radiology group will choose one technology over another. For Carolina Regional Radiology, Fayetteville, NC, the decision to go with Intelerad’s InteleOne was straightforward and comprehensive. “For a practice that reads for multiple facilities and imaging centers, InteleOne offers a one-stop solution,” said Harry Ameredes, MD, the group’s president.

And this one stop encompasses a myriad of benefits, including an advanced voice-recognition reporting system as standard on its PACS. This reporting system allows radiologists, such as those with Carolina Regional Radiology, to continue dictating in the way that is most comfortable for them while creating a standardized report.

Carolina Regional Radiology has been an Intelerad customer for about a year and installed the InteleOne after doing extensive research on it and other competing systems. The Intelerad system solved a number of issues facing the group—which serves two imaging centers, four hospitals, and over a dozen clinics—including having to cope with reading from multiple databases and having to read different modalities such as PET and mammography on different workstations. The InteleOne has allowed the group to consolidate its databases into the single platform.

But there are other benefits with the system as well, said Ameredes. “Intelerad offers an extremely robust PACS solution, and the company has offered incredible support,” he said. Support for the InteleOne comes at no additional cost.

While Carolina Regional Radiology is one of Intelerad’s newer customers, it played a role in helping to prove the viability in the company’s newest upgrade—Multi-Method Reporting module. This module blends dictation, voice recognition, and structured report templates into a single, streamlined interface and workflow.

The module uses M*Modal’s Speech Understanding technology to adapt to the physician’s workflow and speech patterns, rather than the other way around. Carolina Regional Radiology had the chance to adopt the Multi-Method Reporting module when the technology was in its “infancy,” said Ameredes, and he has been impressed with it. “I like its ‘intelligence,'” he said. “It uses the context of your speech during dictation to create a standardized report.”

The M*Modal technology is the key to the module’s “intelligence.” According to the company, the platform goes beyond mainstream speech recognition capabilities because the semantic and syntactic meaning of the dictation is recognized, not just the individual words. Physician intent is recognized, and the system adapts to virtually all dialects, accents, speaking styles, and dictation habits. The Multi-Method Reporting module is completely customizable, creating standardized reports without radiologists having to change their dictating style.

Ameredes recounts that the installation of the module went very smoothly, thanks, in part, to the on-site Intelerad technicians who were able to handle any problems or questions on the fly, with changes and updates handled almost instantly. “It was quite impressive,” he said.

Having a useful tool is only an advantage if the staff uses it. Ameredes says that radiologist buy-in was unanimous from the beginning and the learning curve was pretty shallow. “It wasn’t a hard sell,” he added.

Perhaps the biggest advantage that Carolina Regional Radiology has gotten from the InteleOne and the Multi-Method modules is to its bottom line. “Eventually, it will allow us to work with less FTEs,” said Ameredes. “Today’s radiology practices must run leaner and more efficient while still providing excellent patient care. This is exactly what InteleOne offers.”

Currently, the system serves two of the group’s outpatient sites, and is taking steps to incorporate it into its hospital-based services.

Handling Images at the “Speed of Mind”

By C.A. Wolski

BRIT Systems Inc recently introduced BRIT Vision 3.7.2

According to Houston-based Kelsey-Seybold Clinic radiologist Patrick M. Conoley, MD, the most expensive part of a radiology department isn’t the modality or the informatics system—but the radiologist. This may be a radical viewpoint, but the fact is that, without the radiologist, an imaging exam is useless. So one way to measure the effectiveness of a modality or informatics system is to assess how it impacts the way a clinician works. If a radiologist’s time and talents are not utilized correctly, the entire enterprise will cease to function properly.

Fortunately for Conoley and his colleagues, Kelsey-Seybold Clinic has been using BRIT Systems Inc’s BRIT Vision workstation for the last decade. And while it has certainly made the radiologists more efficient, the newest version 3.7.2 is a kind of breakthrough for Conoley, allowing him to work at “the speed of mind.”

The version 3.7.2 includes a number of enhancements, including the introduction of the 64-bit Ubuntu operating system; performance and speed enrichments; seamless interoperability with Roentgen Works advanced workflow tools such as ER Discordance, Urgent Findings, and On Holds; and an improvement in the comparison tools for hanging protocols.

The open-source Ubuntu operating system is the key to the speed-of-mind use that Conoley has seen as the user breakthrough. And it isn’t just an illusion that the computing speed is faster and more efficient. According to the company, the Ubuntu operating system supports larger hierarchies of files and folders.

But for Conoley, the specifics of what makes the version 3.7.2 work do not matter. “I don’t care what the operating system is—it works,” he said.

And it eliminates all of the things that annoy the efficiency-conscious radiologist. “The spinning hourglass is a waste of my time. If I have to wait, it’s inefficient,” he said. “The version 3.7.2 eliminates all that. It’s pretty much instantaneous.”

He says that his favorite part of the system is how few clicks he needs to review an imaging study. “The most useful feature for me is the F12 function key,” he said. “It allows me to do five functions with that one key. I can close and open a file, set its status to ‘read,’ invoke voice dictation, and capture the next study.” According to the company, because the radiologist doesn’t have to navigate a separate screen, it helps reduce the number of mouse clicks and increase clinical efficiency. It also improves on previous versions’ hanging protocols by automatically selecting protocols for studies with comparison studies versus those without.

The BRIT Vision 3.7.2 allows users to download up to 100 CT images/second on properly configured networks, and enhancements have been made in the viewing of multiframe images. When used in conjunction with a RoentgenWorks server, BRIT Vision 3.7.2 includes tools to enter Urgent Findings and Reasons for On-Holds and respond to ER Discordances directly from the image viewing screens.

While Conoley is clearly a fan of the new version, there is still one minor quibble he has about it. If the user changes the time filter, then the keyboard will go into a “sleep mode” and disable all of the various shortcuts—including Conoley’s workhorse F12 key. To “wake up” the keyboard, he needs to click the study, which is an unnecessary additional keyboard click for Conoley. “It perturbs the even flow of the mind,” he said, noting that he has shared this with BRIT and the company is working on a resolution.

But ultimately, with the BRIT Vision 3.7.2, the only thing that stands in Conoley’s way is his own mind. “Our work capacity is the only rate limiting quality now,” he said. “Now processing has become fast enough that I’m doing radiology at the speed of mind.”