Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.
How PACS Can Contribute To Success
Illustration courtesy of Konica Minolta
Efficiency is the root of value-based medicine. Efficiency boosts productivity, as it lowers cost and increases patient comfort. It accomplishes this medical trifecta by helping to keep schedules on track and, thereby, satisfying patients. Effectiveness too is impacted, as it is intertwined with efficiency.
In radiology, where workflow and productivity go hand in hand, no single technology has greater potential to impact efficiency than picture archiving and communication systems (PACS).
Yutaka Ueda, president of Global Health Care Information Technology for Konica Minolta, said the company’s Exa platform exemplifies this through its leveraging of the Internet. “Image quality is very high on the browser; scalability is provided by using a web server,” Ueda said.
These strengths and the efficiency they provide are evident in two recent deployments of the Exa platform — one by a teleradiology service; the other across a chain of imaging centers.
One year after Radiology Imaging Solutions replaced its existing picture archiving and communication system with Exa PACS from Konica Minolta, the number of studies interpreted by company radiologists more than doubled and turn-around-times were cut, according to Randy Robinson, owner of Radiology Imaging Solutions.
Time savings have allowed the teleradiology provider to double the number of studies that its radiologists interpret across some 30 teleradiology clients served by Radiology Imaging Solutions in Michigan.
An Exa PACS feature called TAT (Turnaround Time) has helped, he said. TAT color codes studies to reflect their reading priority, thereby alerting radiologists to the most urgent cases.
It is one of several Exa PACS features that have increased efficiency for the teleradiology operation, according to Robinson. Another is server-side rendering, wherein data is processed by a centralized server located in the Radiology Imaging Solutions office in Grand Rapids, Mich. This capability has increased efficiency as it constrained cost.
“Because the server does all the work, you don’t need gateway devices or expensive reading stations,” Robinson said.
By leveraging the Internet and Exa software, Radiology Imaging Solutions is able to hold costs to a fraction of what they would have been if the company had installed a PACS that does not offer server-side rendering, he said. Yet the Exa platform provides features commonly found on other PACS, including ones that support hanging protocols and prefetching prior studies.
Server-side rendering supports the interpretation of even large files such as 3-D mammograms, Robinson noted. The data is processed by the server and sent as images over the Internet. Radiologists using zero-footprint viewers send commands via, and view images, with a browser.
Images are typically interpreted on diagnostic monitors by radiologists who work as contractors for Radiology Imaging Solutions, but they may be reviewed on desktop PCs or even mobile devices, such as iPads or smartphones, according to Robinson. This flexibility has increased involvement by referring physicians in the imaging studies.
Before Exa PACS was implemented, only a few imaging facilities looked at the images on PACS, Robinson said.
“They would just wait for the report,” he said. “Now nearly every provider uses the PACS. It is so easy to use; so convenient; and adds so much to the actual study that it is worth their time to open and look at the images.”
Scalability and Flexibility
Being able to handle increasing patient volumes and a broadening venue of imaging modalities, while maintaining a “local feel” at each outpatient center has contributed to the success of a chain of Florida imaging clinics. In the two decades since founding the flagship center, Palm Harbor MRI, the number and type of modalities has ballooned and six centers have been added.
The seven outpatient centers now provide uniquely local imaging services to patients in West and Central Florida. Before implementing the Exa platform earlier this year, these seven centers were using paper charts to track patient scheduling and each center was doing its own billing, said Greg Anderson, chief operating officer of the center chain.
“From an efficiency standpoint, we definitely needed to move forward,” Anderson said.
The trick was to maintain the local feel “that makes our customers (patients), physicians and local municipalities feel good about using our products. We want them to look at us as their local imaging center,” he said. “But we want to utilize resources — to use centralized billing and medical records to create efficiencies.”
Working with Konica Minolta, the centers customized the Exa workflow engine to tailor orders, appointments and image capture to fit their individual characters. Efficiency was improved from the very beginning said Anderson, who credited the scalability and flexibility of the Exa platform.
“Most places see a revenue dip as they figure out the (functions) of a new product like this,” Anderson said. “But our revenue actually went up during the implementation process.”
During the six-week period, beginning in April 2018, Anderson and colleagues expanded the Exa platform across the chain, adding a center to the platform each week, integrating patient data and images into a single database. Authorization and billing were centralized by the end of summer.
The Exa RIS/PACS was leveraged to handle the process of patient contact, scheduling and image capture, as well as interpretation by radiologists. Exa software was also put in place to help staff perform authorizations and billings, Anderson said. “The platform integrates the different processes,” he said.
Data is processed server side at the Konica Minolta data facility in North Carolina. Staff at each Radiology Imaging Solutions outpatient center and the radiologists contracted to interpret images access the system via the Internet.
“There is no lag,” he said. “When my people are on the phone with a patient trying to get answers for a physician, they move fast between windows — and those windows are intuitive. The speed of the product and the PACS for radiologists reading the images has been a major plus.”
Flexibility and scalability in PACS are needed to meet the demands of tomorrow’s value-based medicine, said Konica Minolta HCIT President Ueda. In this, he said, “we have already started.”