Information Liberation

How our journey to Meaningful Use paid off for our practice and our patients.

On March 26, 2012, Regional Medical Imaging (RMI), an independent, full-service radiology practice with five locations in the Flint, Mich, area became one of the first radiology practices in the nation to successfully comply with CMS federal ambulatory Meaningful Use regulations. RMI received a check for stimulus incentives totaling $216,000—representing about a third of the total incentives ($660,000) expected under the American Recovery and Reinvestment Act (ARRA) of 2009. This article highlights our journey to Meaningful Use and explains why we believe the time has come for radiologists (and all providers) to get on boardFrom the start, we believed that implementing a Meaningful Use strategy would deliver unparalleled returns for our practice. And while there was undoubtedly a strong business case for Meaningful Use, what was more important was that it was going to help us become better physicians so our patients would receive better care.

For us, Meaningful Use is just the start of an evolution toward “information liberation,” which will ultimately enhance patients’ ability to manage their own care. We believe that, throughout the entire US medical community, the process to achieve Meaningful Use will make it possible to take all the information that has been stored in drawers and on shelves for the past 200 years and set it free in a way that has never been done before.

Our basic message is to stop worrying about Meaningful Use and the perceived work that accompanies it. What you should be doing is investigating ways to implement a Meaningful Use strategy so your practice and your patients can start to reap the rewards. From our experience, it’s definitely worth it.

History of RMI

When the topic of Meaningful Use first began to be discussed on a national level, we were excited because it fit our mission perfectly. For 26 years, we have worked to ensure that physicians have access to the very best in diagnostic and screening modalities to meet patients’ needs. We are regarded as mid-Michigan’s imaging leader, with five centers across the state. Our particular specialty is women’s imaging, and we have led advances in this area over the past decade. In fact, RMI has earned recognition from the American College of Radiology with the prestigious Breast Imaging Center of Excellence designation. Our reputation for being able to work with a full range of health care professionals in this area is what distinguishes us in the radiology field, and we were able to grow our practice very quickly around this particular niche.

The Decision

After the 2008 election, rumblings began with respect to health care reform and we gradually realized what a crazy industry we were in. As the Meaningful Use conversation continued on a national level, we started thinking locally in terms of our own practice and patients. Every day we would see incredible, state-of-the-art 3D and molecular images and then have to deal with requests for a particular patient’s procedure that were sent by fax or carried in by hand. It was like stepping back 20 years! Sometimes we had to make sense of pieces of paper folded several different times, containing smudged or illegible handwriting. With all of the high-tech information systems and software we had, there was still no continuum or continuity of care in the area of patient information transfer, which would allow providers to share information quickly and seamlessly.

We were confident that the adoption of a Meaningful Use strategy would help us become leaders in this area. We also knew it was where we were all eventually headed. We wanted RMI to be at the forefront of this movement and provide a great example of how Meaningful Use of technology could help us do two things:

1. Become better physicians so that patients get the best care possible.
2. Ensure that RMI had a leg up on competition from a business standpoint.

Preparation for Meaningful Use

We read about and studied up on Meaningful Use. We realized more and more that we all were becoming early advocates for its implementation. I recall saying to myself, “We can do this—if we get some people to help.” At the time, we were AMICAS customers. When Merge Healthcare and AMICAS combined, RMI was one of the very first companies invited to Merge’s Chicago headquarters to meet senior management. We were very nervous about the transition, and did not know what to expect. Quickly, we witnessed that Merge’s philosophy about health care was almost exactly like ours. It sealed our conviction to move forward with Meaningful Use and Merge.

In subsequent conversations with Merge Healthcare’s CEO, Jeff Surges, we found that we agreed on many points about the current state of technology in health care. We agreed that nearly every major industry makes significant use of advanced technology except health care—a fact we both found astounding. We saw situations where doctors were unable to read requests or understand what was wrong with patients by the brief patient histories that were provided. These physicians couldn’t tell from patient histories what was going on with patients—whether they smoked, had allergies, etc, yet they were being asked to care for these patients.

We were fed up with the fact that 20% of our country’s GDP is related to health care, but we could not do what our teenage children could do with their smartphones, such as the basic transfer of images and related information. With all that in mind, we agreed to work together.

Our basic agreement was that RMI would champion Meaningful Use from the clinical side and Merge would champion it from the technology side. The RMI team prepared a detailed strategy on how we would update our workflow in order to implement this process, while Merge also ramped up. We began preparations in earnest in 2010 and began the implementation process in January 2011. The goal was that by the end of 2011 we would be up and running and Meaningful Use compliant. We spent a good amount of time planning for this. In that sense, we were pioneers—and as such, there was no specific road map for us to follow on this process, or peers to look to for advice.

Getting the Buy-In

When the time came to update our workflow, we talked to the staff and helped them understand that this change was extremely important for patient care. Obviously, employee buy-in is the key to the successful implementation of any new process, and this was no different. We basically said, “We’re going to change the way you interact with our patients. We are going to drive technology so that our patients can be better cared for. This isn’t about us, or money, or our radiologists. It’s about patient care and common sense.” With that in mind, we went ahead with our plans, and it literally took us 1 week to implement the new workflow.

Issues and Key Learnings

Since we were early adopters, there were not many people for us to go to and ask, “Now what?” And there was much about this process that didn’t make any sense. But we just plugged away, and tried to keep in mind that at the end of the day, it was just a new infrastructure.

Sometimes it was hard to sell it to patients, who are naturally very protective of their information. We would ask them questions as per the Meaningful Use requirements, and they would want to know why we were asking that. Referring physicians voiced concerns, too. Very few have implemented Meaningful Use solutions. Therefore, there were many questions about why we were implementing this change and how it was going to affect patients and workflow.

We also learned a lot along the way, particularly regarding the 15 core requirements and 10 menu set requirements for Stage 1. For example, an eligible provider must comply with and report all 15 core items, and also comply with five of the 10 items from the menu set. However, we learned that exemptions exist, especially for radiologists. If any of these requirements didn’t apply to our practice, we would tell the government just that. And they were fine with it. It wasn’t a test, with wrong answers. The point is to share data with other professionals in a way that is meaningful and, for us, that was the routine common denominator.

Another key find was that it is very important to work with a vendor whose product has complete certification versus modular certification. We believe modular certification is not as effective with this kind of workflow process change.

Looking to the Future

Because of our Meaningful Use journey, the technological advances we can now offer are tremendous. Others in our community simply can’t match it. Our goal for this year is to connect patients in a way that makes them say, “Wow.” And we’re achieving that. Right now, we can deliver images via iPads and other mobile devices. Patients will be able to see their reports on such exams as mammograms in near real time. And they’ll have access immediately to test results from MRIs, x-rays, and CT scans.

Our long-term vision is connectivity on a statewide and national level. As radiologists, we’ll be able to share images and reports with our colleagues instantaneously, while providers overall will have the ability to make faster and more well-informed diagnoses. As a result, patient care will improve exponentially. But that’s just the beginning. Soon we’ll be playing in a much different arena, using products that others aren’t even thinking of. We are driving others to hook up now—in the name of better care.

What it all comes down to is that Meaningful Use requirements are just a government effort to get people to talk. We’re all doctors. Shouldn’t we talk and share patient information freely with each other? But if you want to spend the rest of your life with fax machines and toner, that’s up to you!

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Randy Hicks, MD, MBA, is CEO of Regional Medical Imaging, an independent, full-service radiology practice with five locations in the Flint, Mich, area.