Diversified Radiology: It Begins With a Secret...
Radiologists at Diversified Radiology leverage the practice’s PACS workstations to provide efficient subspecialist teleradiology services throughout Colorado.
Diversified Radiology of Colorado believes its practice is a model for specialized radiology reads via teleradiology. Here’s how.

This Denver-based imaging service, which dates back to 1927, currently employs 55 radiologists staffed across 12 hospitals and reads for about 20 surgery and imaging centers throughout Colorado. The practice averages 750,000 billed services annually including subspecialty reads and teleradiology services. Embracing a philosophy of “from anywhere to anywhere,” Diversified’s 50 reading stations are purposed with pushing exams to general and specialized radiologists—all focused on increasing the practice’s efficiency and growth. It’s a model worth emulating.

Networking the practice

What started as a secret ended as a skilled teleradiology network, according to Chris “Kip” McMillan, CEO of Diversified Radiology. Beginning in 2000, the practice made the decision to purchase and own its PACS reading stations used in hospitals to read via various PACS from other hospitals. Thanks in part to Denver’s thriving recreational industry including a vibrant skiing population, the practice noticed the robustness of the orthopedic community and its consistent demand for musculoskeletal reads. With its eyes focused on the orthopedic market, Diversified Radiology decided to isolate the musculoskeletal studies in a “secret” reading room staffed by musculoskeletal specialists. Diagnostic images were pushed out through T1 and telephone line connections. This form of teleradiology sought to increase the efficiency of radiologists reading musculoskeletal exams all day in the secret reading room while providing a needed service to referring physicians.

Although it was dubbed a “secret” and the room was lined with posters of Maxwell Smart and Underdog, the idea was so popular that another specialized reading station was added and the operation was dubbed a network where referring physician-demanded reads were sent to radiologists through a direct push.

Over the years, Diversified Radiology has continued to improve its efficiency by adapting its workflow to the changing technology environment. For instance, when it was discovered that radiologists were bogged down with unnecessary paper, the practice switched over to what McMillan refers to “air traffic control:” employing administrative clerical resources to pre-scrub incoming data in a server environment. “It’s important to not have high-priced physician resources doing things someone else can do,” says McMillan.

When hospitals began widely adopting PACS, it became awkward to integrate multiple local PACS, according to McMillan, and the group’s efficiency took a hit. In 2008, Diversified Radiology partnered with a PACS provider to deploy a single work environment to interface with any PACS and allow the radiologists to dictate, annotate, finalize and send notes back to the hospital’s PACS workstations.

Using a unified worklist, all studies are routed into a single reporting system equipped with voice recognition software. Radiologists embed annotations and arrows in the images for quick problem identification for physicians and patients, according to Sean O. Bryant, MD, who specializes in fetal MRI, pediatric neuroimaging and head and neck imaging. Because patients are more sophisticated about their healthcare, they appreciate clinicians’ ability to visually point out areas of interest from their report, says Bryant.

Subspecialize this

“One of the advantages of our IT infrastructure is that even those hospitals that are general practice hospitals are now, through the network, able to receive higher level subspecialty reading,” says Stephen G. George, MD, who specializes in ultrasound, CT and MR/body imaging. The crux of Diversified Radiology’s practice is its attention to detail. The practice touts a bevy of subspecialties, including breast imaging, body imaging, interventional, musculoskeletal, neuro, nuclear medicine and pediatric radiologists.

The infrastructure is critical to efficiency, says Bryant. “Clinicians are generally interacting with the same radiologists and are familiar and comfortable with the reports and language.”

“Specialization allows us to dig deeper into the literature and attain a greater understanding about the subspecialties we practice and better communicate with other subspecialists to provide a better interpretation,” says Bryant. “Since many of our on-site radiologists screen the ‘bread and butter’ neuroimaging, we get a narrowed scope of complex cases; therefore, compared to smaller practices, we frequently make diagnoses that smaller practices may only see very infrequently.”

Patient care benefits because subspecialty radiologists can more easily identify and understand rarer cases. With a catchment area of roughly 1.5 million people, Bryant recalls a recent case of syntelencephaly that was referred from a rural community hospital, being diagnosed in an adult rather than a child as is most common. Syntelencephaly is a mid interhemispheric fusion abnormality of the brain in which symptoms are usually present in childhood. Bryant says this is an example where some practitioners might not be readily familiar with a rarer diagnosis.

In addition to subspecialty precision, Diversified Radiology has streamlined its workflow as well as increasing the flexibility of its workload. Load sharing, according to George, allows 10 percent of the cases to easily be shifted off an overburdened radiologist to another qualified reader in the network.

Growth of a network

Due to practice growth and an increase in study volume, Diversified added nine new radiologists last year. “We’ve always tried to be very methodical about practice growth. Especially in the subspecialty world, there’s a certain size you have to reach before maximizing the benefits,” says McMillan. Now, for cases that a general radiologist has historically read, referring physicians prefer a subspecialist read them instead.

“In a lot of ways, it’s almost a self-fulfilling system where if you start off the path providing subspecialized reads, the marketplace is going to push you to offering those services 24 hours a day,” says McMillan. George adds that it’s a huge marketing advantage to say that musculoskeletal exams are only going to be read by musculoskeletal specialists who also provide improved turn-around time. “It seems to be where trends are heading and what referring physicians are demanding,” says George.

Peering into the future

McMillan is optimistic about Diversified Radiology’s strategic business position for years to come. “I think in five years, the idea of a large radiology group being directly connected with the hospitals with the emergence of the EMR will be a given,” concludes McMillan. “The things we’re doing now that are ahead of the pack will become common to all practices.”

In addition to setting the strategic bar high, Diversified Radiology continues to push its internal technology capacity. For example, the practice plans to integrate Diversified Radiology reading stations with the practice’s host software environment.