Case Study: Rochester General Hospital

Arthur J. Segal, MD, FACRAll-Digital Workflow Marries Increased Physician, Patient Satisfaction with Revenue Gain

For more than 160 years, Rochester General Hospital (RGH), a 528-bed tertiary care facility, has been a key provider of healthcare services for the Rochester, N.Y., community. As the recipient of more than a dozen quality and recognition awards in the past seven years alone, including six designations at a Top 100 Cardiac Hospital by Solucient, RGH is known for its commitment to performance improvement. In addition to recognizing RGH for its high-quality patient care, Solucient also has cited the hospital for operational efficiencies that have enhanced its financial standing and contributed to its success.

As part of its continued commitment to quality improvement, the hospital recently focused on improving the delivery of radiology services. This has been beneficial to the hospital, physicians and — most importantly — its patients. RGH converted from film- and paper-based image systems to an integrated Kodak RIS/PACS that expedites and enhances all stages of the exam process from patient registration and exam scheduling to the viewing, storage, and distribution of imaging studies and reports. The implementation of RIS/PACS has boosted internal productivity and increased the satisfaction levels of both patients and physicians.

Dramatic improvements in less than one year

Less than a year after implementing an integrated RIS/PACS (RIS went live in Aug. 2004; PACS went live in March 2005), part of Kodak Carestream Radiology Solutions, the results are impressive:

  • Revenue is up by 11 percent, due in part to greater efficiency and room scheduling by the RIS/PACS, which has fueled growth in modalities such as CT and ultrasound;
  • Feedback from referring physicians indicates satisfaction is much higher, since radiology reports are furnished in as little as one hour;
  • Inpatients benefit from a more efficient process with reduced wait times, and outpatients are now routinely scheduled for imaging exams the same day.

Rochester General Hospital The all-digital workflow begins with centralized scheduling that expedites booking of exams, including interventional and other specialized procedures that require physician availability. This more efficient process also benefits patients, since wait times during examinations are reduced and multiple schedulers are available to arrange appointments within 24 hours of the request if necessary.

All general radiology exams at RGH are now conducted digitally using Kodak DirectView CR 850 and CR 950 systems in the operating suite, ICU, and throughout the department, as well as a Kodak DirectView DR 9000 system that serves the emergency department.

Images from these systems and all other imaging modalities are transmitted to the PACS in seconds, ready for viewing and reading. Rapid access to soft-copy images is the foundation of PACS — and its benefits are most clearly evident in the ICU and emergency department, where images can be immediately viewed in response to emergency situations, allowing quicker diagnoses that can dramatically affect patient care.

Integration creates efficiencies throughout the system

Tight integration within the RIS/PACS suite enhances productivity and affords greater convenience to RGH’s team of radiologists and other clinicians. After an initial sign-on, physicians can instantly access the fully integrated RIS/PACS without enduring multiple system log-ons and a series of windows dedicated to each application.

For RGH, there are benefits beyond achieving efficiencies within the department, notably the cohesive communication that expedites auxiliary functions. The RIS/PACS is integrated with the hospital information system, medical records system, and laboratory and billing systems. Real-time access to the status of unbilled and billed procedures has improved timeliness of billing. In the past, it was sometimes difficult to bill for procedures because paper bills could be lost or misplaced, or because the bills were not submitted within insurance carriers’ accepted time limits.

An electronic workflow led to a more efficient allocation of coders on weekends and to the redesign of the billing process. Procedure codes are added by the schedulers and confirmed or sometimes changed by the technologists. All billing information is verified by the radiology department’s billing staff as they match procedure codes with the dictated report. This is supplemented by the medical records team that reviews specialized coding for invasive procedures. Information is then transferred seamlessly between the RIS and the billing system so that accurate bills can be quickly generated for all procedures.

Accurate information allows better management

Comprehensive reporting — achieved through a menu of standard reports and the ability to generate ad hoc reports — enables RGH to better utilize its personnel and equipment. Imaging study volumes are viewed by room and modality to see which rooms are under- and over-utilized. Staff assignments are tailored to match each day’s schedule, which simultaneously promotes productivity and patient satisfaction.

RIS/PACS also provides information about outpatient imaging that allows the staff to determine the number of patients sent by each referring physician and the types of imaging studies requested. Detailed information about patient volumes for each modality now drives capital investments and has enabled an improved decision-making process regarding expansion of capacity. Scheduling adjustments and reallocation of exam rooms made as the result of RIS/PACS reporting has helped foster a 20 percent volume increase in modalities such as ultrasound and CT.

Outpatient imaging is an especially competitive area that is expected to see continued revenue gains. The hospital’s streamlined scheduling process allows same-day scheduling for most patients and is much more efficient for managing interventional procedures that require specific physicians and equipment.

The benefits of the hospital’s digital imaging solution were realized just months after installation — and are expected to continue producing improvements in productivity, revenue, and service. It’s important to realize that the impact of an efficient digital workflow goes far beyond the radiology department. It shapes a hospital’s reputation within the local community by dramatically improving service to referring physicians and their patients. At RGH, this improvement in quality of service is something the staff strives for each and every day.


Arthur J. Segal, MD, FACR, is chairman, Department of Diagnostic Imaging, Rochester General Hospital in Rochester, N.Y.