Jay Gonyea, office manager, Vermont Radiologists
Being the only privately owned diagnostic imaging center in an entire state – albeit one of the smaller ones – can generate considerable competitive pressure on an outpatient facility and its staff.
But Vermont Radiologists continues to push the envelope in the variety of services it offers, the multimodality technology it uses and the convenience and quality it provides patients. The South Burlington, VT-based outpatient imaging center performs general radiography/fluoroscopy, open magnetic resonance imaging, digital mammography, nuclear medicine, computed tomography, ultrasound and bone densitometry, as well as electronic billing and teleradiology, which enables doctors to increase their productivity by reading from remote locations.
One of Vermont Radiologists’ more recent technological leaps forward involved the implementation of an integrated picture archiving and communications system and radiology information systems – a RIS/PACS with a single database – from BRIT Systems Inc., Dallas.
Jay Gonyea, office manager at Vermont Radiologists, shared some insights with Outpatient Care Technology Editor Rick Dana Barlow about his facility’s experience with a custom, single turnkey system to satisfy the organization’s need for process efficiency without sacrificing patient care quality.
Some healthcare facilities favor a best-of-breed approach where they assemble equipment from different manufacturers to suit their clinical needs rather than going with a single vendor offering a complete package. You use an integrated RIS/PACS but retained your own electronic billing system. What do you see as the advantages and disadvantages of either strategy?
The use of a combined RIS/PACS system like BRIT was a hand-in-glove fit for a small outpatient center like Vermont Radiologists. We have recently employed a new billing service that I was able to easily set up with the BRIT RIS. They are able to access all of the necessary patient insurance data to ensure a timely billing cycle. With the BRIT RIS, I have immediate access to valuable patient information from anywhere in the office. It also gives me the ability to print reports such as patient volumes by modality.
What’s the biggest challenge you faced in implementing an integrated RIS/PACS solution, as opposed to separate systems with an interface? What would you tell other outpatient imaging centers contemplating a similar decision?
The BRIT system made installation easy because I did not have to think about RIS/PACS interfacing issues. That is an obvious advantage over other vendors that only offer a RIS or PACS function independent of each other. If there is a downside to this feature, I would say that it might be a little bit more of a challenge to learn both the PACS and RIS at the same time as opposed to integrating a PACS system with a RIS system that you already know inside and out. Realistically, BRIT is an intuitive system that’s easy to understand after just a little practice.
What are some of the hard lessons you learned – good and bad – during the RIS/PACS implementation process?
Make sure to adhere to the scheduled training times to ensure that all staff are comfortable with using the system — some employees will require more time than others to develop an equal level of comfort. It is also important to have an accurate layout of your network. It is essential that each modality vendor provides clear network property information in order to assist you and the PACS vendor upon installation. If possible, the modality vendors should be made available to help to trouble shoot network problems if they should arise during the install.
I would tell other facilities who are contemplating a PACS solution that under the best of conditions, a PACS install is complicated and little things will go wrong — it is hard to think of every detail. However, with proper planning, you can help to minimize the major problems that will arise. Remember, you didn't develop a smoothly run film-based radiology department in a day or a week! The same is true with a filmless PACS environment.
If you had to do it all over again, what would you change and why?
If I had to do it all over I would hold the training at an off-site location so that there would be fewer interruptions. I would schedule additional training so that each staff member would get ‘real-world’ experience in a clinical setting. If off-site training is not possible, I would make it mandatory that working staff members do not interrupt the training process. This would help to ensure that you don't have staff complaints that they were not properly trained.
What are some of the noteworthy clinical, financial and operational benefits you’ve derived from implementing a RIS/PACS?
There are countless benefits that we have found since our RIS/PACS implementation. First and foremost is the elimination of film storage and cost. Finding the space for film storage was becoming increasingly difficult with each passing year due to a growing patient volume. Now that we are entering our third year of using the BRIT PACS, our film library has begun to noticeably shrink. After a few more years of film purging we will be able to condense our film storage down from three rooms to just two and eventually to just one small room.
Secondly, we have become more efficient. There is no more film developing, hanging or pulling, and lost films are a thing of the past. The time spent filming studies has all but disappeared. Our patients love the fact that they don't have to haul around bulky film jackets anymore. We simply send them on their way with a CD embedded with BRIT viewing software. All of this adds up to increased savings due to the elimination of film cost and greater staff productivity.
Why does it make sense for an outpatient imaging center to invest in and implement a RIS/PACS – particularly if that facility is not attached to a hospital?
A PACS/RIS system is a substantial investment. However, when you look at the big picture it will yield a substantial return on investment over the long term. When you begin to see how much time is saved by eliminating film from a radiology office, you will be amazed! In a small office such as ours, technologists perform many duties such as hanging films and pulling down alternators. Now the only alternator that we have is used for hanging outside comparison films. I believe that it has helped us to reach out to local orthopedic and neurology practices by allowing them to connect directly to our BRIT server. These offices now have the advantage of real-time viewing of our images.
In one particular case, I was imaging a patient in MRI and noticed that he appeared to have a mass in his brain. After sending the images to PACS, my phone rang within two minutes. It was the patient's referring neurologist calling to make sure that I was going to give an enhancement agent to better delineate the tumor. I was amazed at the effect the PACS had on that particular patient's care. Instead of the patient driving almost an hour to his home and then having to return the same day to receive his results, he was asked to return to his neurologist immediately following his appointment. Since we set up that neurology office with BRIT, I believe that almost all of their radiology studies are performed at Vermont Radiologists.