Keeping Referrals Coming: Neuroradiology Group Reaps PACS Benefits
Case Study: Western Neurological Associates  |  Salt Lake City, Utah

Sponsored by an educational grant from GE Healthcare & Dell

  Linda S. Monty, R/T (R)(MR)(CT), imaging manager at Western Neurological Associates, looks at images in the central PACS reading room, located just steps from a CT and an MR scanner.
Western Neurological Associates first installed PACS in 2002, but soon thereafter decided to upgrade. “We wanted a system that was user-friendly, affordable and scalable to our size,” says Imaging Manager Linda Monty, RT(R)(MR)(CT). “We needed something that would work for us and for our referring physicians, and the Web-based product that we chose has really facilitated that.”

Western Neurological Associates implemented Centricity PACS-IW from GE Healthcare. “When you engage in a Web-based product, you are telling your physicians and your referring physicians that you are state of the art,” says Monty. That, along with the ability for the PACS to interface with other vendors’ imaging and IT systems and similar applications was important to the practice, she says. With a practice management system dating from 1982, “we needed to be able to marry not only the old PACS, but our practice management system, and of course all the new modalities coming in.”

The current storage system runs 2 terabytes of content. The query-retrieve process, pulling from the old archives, has added data to the system. “We are very fortunate that we have, just at a moment’s click, everything that we have ever processed,” says Monty. “It also makes sure that our referring physicians have access to the previous studies. That’s part of the continuity of care that you’re providing both the referring physicians and the radiologists as they read the scans.”

Efficiency & productivity

Western Neurological also incorporated voice recognition, which helps their practice turn reports around in an hour, on average. Physicians generate and self-edit their reports, which aids in getting them out to referring doctors quickly with no need to go back for a final sign-off.

The system also helps the practice’s technologists work more efficiently, Monty says. Two technologists work per shift and they pre-cue studies for the physicians, track special communications such as STAT exams and perform quality control on studies.

Another benefit of the PACS is the ability for referring physicians to show images directly to their patients. For example, a multiple sclerosis (MS) specialist with about 1,500 patients, can compare prior studies to see how many new lesions the patient has—an important tool in caring for MS patients.

The practice’s referring cardiologists appreciate the ability to see heart images in cine mode. The practice performs post-processing multiplanar imaging for the cardiologists to view ejection fractions, systolic and diastolic phases and more. “They’re sitting at home or in their office visualizing the heart in its real, true function, and that’s made a difference for them,” says Monty. “They want to see the flow of the blood, follow the bolus track and visualize the clot.”

As a stand-alone imaging center, “we pride ourselves in being able to make same-day appointments and have a quick turn-around time with reports,” says Neuroradiologist Stephen Carroll, MD.

Since images are acquired almost instantaneously, Carroll frequently can review images before the study is completely finished. “That allows me to go and intervene, if necessary, and follow the study as it’s being done or ask for further series.”

With a Web-based PACS, Western’s neuroradiologists can review images in real-time with referring physicians, all with exactly the same user interface and extensive set of Centricity PACS-IW viewing tools. “They’re able to discuss images with me, with a certain series number and image number. We can even review those things before our report is generated and sent to them,” Carroll says. The system lets referring physicians log on with a unique username and password to access their patients’ images and information. They can call the practice’s physicians to review cases. “We have those images available to us as well, so if there’s an urgent finding, [the referring physician] can be in touch with us closely by telephone and review those findings.” That allows for much more effective interaction and better patient care, he says.

Carroll likes the ability, afforded by Web-based PACS, to manipulate the frames of the images with intuitive hanging protocols and multiple presentation states. “I can move, resize and change the layout quite readily,” he says. “And, I can decide for each particular study how I like to review them, and you personalize that. That [positively] affects your practice. If you can predictably know where each image is and you’re able to have it in the format that you want it, you don’t spend half of your time re-doing things.”

This and more has helped Western Neurological improve efficiency. “A radiologist’s time is limited and the time per study has decreased with the integration of PACS into our work environment,” says Carroll.

Images: A convenience for patients

Interventional cardiologist Sherman Sorenson, MD, has a special interest in stroke prevention and works with a heart and brain integrated program at several facilities in the Salt Lake City area. “We do a lot of work with neurologists and neurologic imaging that is integrated with our cardiology imaging.” 

Sorenson sees patients with neurologic problems and then integrates brain and vascular imaging with cardiology testing. “The ability to see brain imaging, to see intracranial images of the arteries and extracranial images of the arteries, is critical when deciding how to handle cardiac problems that cause neurologic problems, he says.

A picture is worth a thousand words, he says, so screening the images is helpful. Since he is not a neuroradiologist, Sorenson has frequent interactions with Carroll and other physicians in the practice about his cardiology patients. “The ability to interact with the physician, while we’re both looking at the images at a remote location, is pretty incredible.”

The PACS also helps Sorenson educate his patients about their medical issues. “We have a wireless network, so we show patients their transcranial and echocardiographic images [in our office].” Patients with brain injury are particularly keen on being proactive about their care, he says. “For them to see the actual images themselves is very helpful in understanding what’s going on and in making a decision about therapy.”

Another advantage for Sorenson’s patients is that many come from distant, outlying areas. The ability to offer “one-stop shopping” for their brain and heart imaging, he says, is very convenient and allows better care.

Simple set up

To get referring physicians like Sorenson set up on Web-based PACS, Western Neurological marketing representatives, such as Jamie Dearden, manage implementation. In particular, Dearden works with subspecialists who have very specific imaging needs. The practice specializes in customizing the system for subspecialists, including neurologists, neuro-surgeons, orthopedics, cardiologists and podiatrists.

For the initial set up, Dearden goes onsite with an IT specialist and, when possible, a radiologist, to the referring doctor’s office and installs the software. “Having a radiologist there to speak with the referring physician ‘doctor to doctor’ is a great opportunity for us from a marketing perspective. I think that really helps in building the relationship.”

They show the physician how to access and open studies, and how to manipulate images and utilize various tools and reports. “We walk them through one patient at a time and they can see how user-friendly it is. Once we show them the basics, it makes it easy for them to understand what we’re looking at and how we choose key images.”

In terms of IT needs, referring physicians need only a high-speed Internet connection and a good quality monitor to view the types of images that the practice’s radiologists read from, she says.

Pointers from the practice

Web-based PACS is ideal for any organization that needs to get images out to the enterprise, beyond the radiologist or neuroradiologist reading the images, to the specialist who needs to care for the patient. From small practices to large university hospitals performing more than a million procedures a year, there’s really no limit to scale.

Western Neurological likes its Web-based PACS open architecture and “openness,” says Monty. “When you sit down, you understand it. It’s very intuitive.” Although most radiologists are technologically savvy, a product that is used as a practice marketing tool needs to be very functional, but very simple to use, she explains. She knew the product would be going out to a referring population that had a wide range of training and experience.

Monty also knew that all of the practice’s various vendors and outside players would need to hook up with the PACS. She recommends putting all of the imaging system and IT vendors in the same room during the planning stages to ensure a smooth, seamless integration process. “All the work up front made all the difference,” she recalls.

Once the system is installed, the radiologists need a lot of hands-on experience, says Carroll. “Work with the system, try the different features and work through those because then you have a more fuller understanding of what’s at your disposal. It’s easy sometimes to just do what you know, but it’s better to try the different functions.”

Carroll and his colleagues go out and visit other physicians in their practice environment. “We see what they’re using to access the images and we’re able to find out what it’s like on their end. When you have that sort of understanding and you know what their experience is, then it enhances your experience of what you can bring to them and what you should be doing on your end.”

Western Neurological Associates at a glance
Business Scope: MR, CT and fluoroscopy, such as lumbar punctures and arthropathy 
Employees: 42, including 7 technologists, 3 neurologists and 2 radiologists
Operating Hours: Monday through Saturday, 6am – “until we’re finished”
Longevity: 37 years
Billable scans per year: 12,000