Josie Timm, MD, uses a web-based RIS/PACS to help manage neuroradiology exams at Clarus Imaging in Beaumont, Texas.

Faced with reimbursement cuts and pushed to convert to digital records, imaging centers are under the gun to maintain their market share. Smart centers are extending the value of PACS with digital dashboards, web-based tools and more. Health Imaging & IT spoke with a few financially fit imaging centers to discuss how they are optimizing PACS.

“The most value comes out of the PACS when physicians can be as maximally efficient as possible,” says Jim Whitfill, MD, CIO at Scottsdale Medical Imaging in Scottsdale, Ariz., a group which completes 300,000 exams annually. Whitfill advises imaging centers aiming to optimize PACS to:

• Look at the PACS workflow and interface to know what will make radiologists most efficient: The goal, says Whitfill, is to deliver the optimal amount of information while attempting to get all tools radiologists need on one desktop;
• Understand IT resources required to maintain and optimally use PACS: Some systems are managed remotely by the vendor while others might require hands-on work on site; and
• Assess corporate culture to understand its flexibility to workflow change.

Scottsdale incorporates all digital image information it can—including comparison CDs from outside institutions and over-read exams—into its PACS so radiologists have everything they need in front of their eyes to maximize efficiency. According to Whitfill, by harnessing the power of PACS, Scottsdale has been able to offer more specialized reads and boost efficiency.

Scottsdale Medical Imaging’s model is working; the facility improved efficiency 5 percent since deploying PACS in 2003. Efficiency, however, is an ongoing objective. Since 2007, the 45-physician practice has put radiologists’ efficiency under the microscope by integrating PACS data into a digital dashboard that examines workflow bottlenecks and productivity across the enterprise.

Since launching the digital dashboard, Scottsdale uses data to help allocate resources such as equipment use and physician time to balance needs within subspecialty departments. Looking at changes over time adds an element of objectivity, says Whitfill. Through a dashboard, a reference point in time can be taken when all departments are optimally staffed and then departments’ productivity can be examined over time and compared to the baseline value.

“The mammography workgroup may only have 80 percent of the workload they had six months ago when we said we were going to equally distribute work whereas the neuroradiology workgroup may have 120 percent,” offers Whitfill. “When we decide which workgroup needs more or less physician time, the dashboard is one piece of objective data to help distribute resources more intelligently.”

But PACS-driven integration can extend beyond digital dashboards. Mountain Medical Physician Specialists (MMPS), an imaging center in Murray, Utah, maximizes PACS value by employing open-source technology. The practice monitors PACS data use via an open-source application to understand disc space usage and why a CPU might perform slowly.

With a growing volume of 30,000 studies a year, CIO Kerry J. Cox, PhD,  says that MMPS tries to mitigate data efficiency issues before a clinician or radiologist recognizes them. For example, Cox recalls an instance where he noticed that completed studies weren’t marked as read and thus couldn’t properly move through the workflow. “Monitoring disk use and CPU cycles, the system let us know that we were seeing abnormally high CPU usage and that data that should have been cleared out were starting to fill up the drives,” says Cox. MMPS tracked and solved the issue with updates to the system and personnel monitoring, according to Cox.

Using an open-source bandwidth monitoring application saved the system more than $25,000. “Instead of purchasing commodity and proprietary products that eat into the budget, we can allocate our resources to hardware and dedicate our resources toward bettering the software,” Cox says.

Web-based PACS delivers

Since the advent of web-based PACS, smart providers have tapped into the systems to grow their referral base.

Take for example South Jersey Radiology Associates (SJRA) in Voorhees, N.J., which serves 10 locations across southern New Jersey. When SJRA first implemented its remote web-based PACS in 2004, the 44-radiologist center had five referring physicians viewing images online; that number is now more than 2,000 referring users, shares PACS Administrator Kim Baldwin.

Web-based PACS provides clinicians with immediate access to images as needed, whether a patient is on an imaging table or the physician requires images prior to a consultation. “Previously, we had to get third-party software to push exams to referring physicians and that wasn’t easy.” SJRA also used to travel to referring offices for setup purposes. Now the center saves time as referring users are set up to connect to the PACS over the phone within 20 minutes.

An uptick in referrals allowed SJRA to hire a full time PACS assistant dedicated to referring operations. “It’s easier for a dedicated administrator to troubleshoot with referring offices because they all have similar problems,” says Baldwin.  Typical problems include software upgrades such as antivirus software blocking the PACS viewer from being downloaded or users using different versions of Windows software.

Looking forward, she says that SJRA will be linking up with the Voorhees, N.J.-based Virtua Healthcare System health information exchange (HIE). With projections to go live in the HIE by November, SJRA will set up a VPN connection to transfer messages through an HL7 engine to providers, including the 20 referring physician EMRs in line to also connect to the HIE. Baldwin hopes the linkage will provide the ability to use the HIE to correlate images with other facilities, which should improve communication and patient outcomes.

Clarus Imaging in Beaumont, Texas, also uses a web-based RIS/PACS to manage  12,000 annual radiology exams and fuel growth. The outpatient imaging practice recently expanded to a third site and expects to open another new facility in 2011.

Like SJRA, Clarus experienced an uptick in its referral base after deploying web-based PACS. “PACS made it easier to [consistently maintain a 48-hour] turn-around time and gave us a centralized location for all our radiologists to read from,” says Bridwell. Fifteen percent of the practice’s 50 to 70 regular referring physicians are set up to view the images remotely, which also contributes to efficient turnaround.

On the clerical side, Bridwell says that Clarus has seen an increase in CPT coding via technologists’ ability to change CPT codes in the RIS to match the performed exam. Because of this, Clarus has increased the efficiency of its billing department, according to Bridwell. “We have seen a decrease in incorrect exams being billed out as well as a decrease in patient demographic errors.”

Armed with targeted, creative strategies to stay on top of maximizing PACS efficiency, forward-thinking imaging centers will be better equipped to stay afloat and succeed among the mounting pressures they face. Providers should review their practice and referring physician needs to determine which strategies will work best and select the appropriate tools. The results, if implemented well, should alleviate pressure and allow practices to focus on workflow efficiency and clinical needs.