RIS-driven Workflow Simplifies a Complex Practice
Sponsored by an educational grant from GE Healthcare

Radiology & Imaging Specialists  |  Lakeland, Fla.

     Radiologist Scott Fargher, MD, reads PET images on a GE Healthcare Centricity RIS-IC workstation at one of Radiology and Imaging Specialists’ imaging centers in Lakeland, Fla. Radiology and Imaging Specialists in Lakeland, Fla., is a complex radiology practice. The group provides professional services for four hospitals in central Florida and operates five geographically diverse imaging centers. Its 17 radiologists interpret 500,000 studies for more than 100 referring physician offices annually. In addition, Radiology and Imaging Specialists leases its image management system to another practice.

The practice’s complex configuration is profitable in the booming central Florida market, but it does present significant challenges. COO and CIO David Marichal explains, “When I arrived in 2003, the practice had no RIS or PACS. There were too many workflow inefficiencies for a standard standalone PACS.”

Marichal realized that web-based RIS architecture could address many of the practice’s challenges by providing a consistent view of the practice from any location.

In 2004, Radiology and Imaging Specialists deployed GE Healthcare Centricity RIS-IC, integrating the system with a third-party PACS. The transition to RIS-driven workflow reinvented the practice; it facilitates streamlined workflow for all users, which, in turn, trims expenses and improves service.

The first step: workflow analysis
Radiology and Imaging Specialists was mired in inefficient workflow prior to installing Centricity RIS-IC; however, simply purchasing a system does not guarantee optimal results. The practice deployed RIS and PACS concurrently and built its workflow around the synergy of the two systems, designating Centricity RIS as the workflow engine.

The rationale behind RIS-driven rather than PACS-centric workflow is simple. RIS begins and ends the work process. Radiology workflow starts with scheduling and ends with billing; PACS can not handle those tasks. RIS puts information in the hands of every decision-maker—from the radiologist to the scheduler and the technologist, says Director of Informatics Sal Tejeda.

Radiology and Imaging Specialists undertook a thorough workflow analysis prior to deployment, examining every step of every process of its business. One of the top complaints of employees? Paper and the requisite paper shuffling in a non-automated practice.

Prior to the RIS/PACS deployment, scheduling and billing required multiple phone calls and considerable paperwork. Both drained efficiency. In contrast, the ideal scheduling and insurance workflows are based on solid, efficient processes that allow a practice to capture all necessary information for authorizations and pre-certifications. RIS/PACS automates theses key workflows; the practice is confident that staff has efficiently gathered all information needed for both reimbursement and patient safety. In addition, items like patient allergies and contraindications are visible across the system to prevent problems.

RIS-driven workflow also helped the practice improve physician workflow, allowing it to deliver everything radiologists need to accurately interpret the study in the minimum number of clicks. The patient record and images are available in a single location. RIS/PACS also separates studies for referring physicians who complete their own interpretations. Images are in a distinct worklist and don’t cross-contaminate radiology workflow. “Everyone is happy,” Marichal says. “The patient exam and report distribution are timely, which satisfies patients and referring physicians. And we know we will be paid. These aren’t mutually exclusive benefits.”

From paper-driven to film-free via IT
Technology is the ticket to the transition from inefficient, paper-heavy radiology to streamlined, digital workflow. Radiology and Imaging Specialists invested heavily in technical infrastructure to support its RIS/PACS implementation.

Its sophisticated network infrastructure is built around a fiber optic network that connects all of the practice’s imaging centers. Recently, the practice upgraded from a VPN mesh to a hub and spoke-straight VLAN configuration. The hefty network also supplies bandwidth needed to share workload among radiologists. Because the web-based system provides consistent, universal access across imaging centers and at radiologists’ homes, they can view and share daily worklists to support every site.

Another critical component in the IT recipe is the workstation. “It’s important to provide a positive experience for end-users. This requires workstations that meet RIS and PACS hardware requirements,” explains Marichal. Radiology and imaging Specialists opted for Windows-based PCs with 256 RAM. The practice also redesigned its reading rooms to accommodate workflow.

“The reading rooms are built around the electronic system, putting everything we need at our hands,” explains Christian Schmitt, MD, informatics medical director. Reading room workstations have a four-monitor configuration so clinical information from the RIS is easily viewed and displayed in addition to the PACS viewing tools on the other three monitors. Workstations are configured with 4 GB of RAM to accommodate any tools radiologists need to view data and images.

A final piece of the puzzle is a robust data center that can pass all data from one location to others. The 600-square-foot center includes an uninterruptible power supply (UPS), backup battery, independent generator, climate control and fire suppression. The result is near-perfect uptime.

Inside the RIS-driven practice
RIS-driven radiology delivers a number of benefits: efficient, accurate billing, improved patient care and streamlined workflow. Prior to RIS/PACS, Radiology and Imaging Specialists relied on paper billing. The practice was not sure it captured all charges because the process hinged on paper.

Centricity RIS-IC, on the other hand, features an electronic charge interface. Coders vet items before they go to the billing interface to simplify and accelerate the process.

Scheduling is equally efficient. With universal access to all sites and imaging resources, schedulers can place patients in the first available slot. “That’s important because referring physicians want the first available appointment, or they’ll take their business somewhere else,” notes Marichal. The integrated, brokerless system also drives an intense resource utilization program at Radiology Imaging and Specialists, in which the practice analyzes how much of the time slot it uses for each type of exam to optimize imaging resources.

“Centricity RIS-IC helps track productivity from schedulers to technologists,” notes Darla Mosley, applications manager. “We’ve been able to determine how long a patient is in the office, how long the exam takes, and then we can adjust our times accordingly, which helps with the schedule. We can accommodate more patients than we did before.”

In addition, if the practice is backlogged in one area, it can shorten exam time a bit. Finally, the system helped justify the RIS/PACS investment. Prior to RIS/PACS, Radiology Imaging and Specialists staffed each center with six radiologists. Post-deployment center staffing dropped to four radiologists. Ancillary staff has been reduced approximately 10 percent through attrition.

Optimized patient care
Automating processes to improve productivity and the bottom line is essential in today’s tight economic environment; however, the first priority in healthcare is patient care. Centricity RIS-IC helps Radiology Imaging and Specialists meet it dual objectives by speeding turnaround time and improving access to images.

Consider for example oncology patients. Many travel to different Radiology Imaging and Specialists sites for imaging studies. Centricity RIS-IC collects images from various sites, making them available in a single application for review at cancer conferences. “We can make decisions about the patient’s therapy based on adequate and thorough information rather than one piece of information or one study,” says Schmitt.  

An ongoing process
RIS/PACS is not a project that begins and ends on certain dates. It is an ongoing process that begins before deployment and, in an ideal situation, continues after installation as the practice taps into the system to derive new benefits.

Radiology Imaging and Specialists initiated its deployment with an implementation team with broad membership including radiologists, technologists, schedulers and IT staff. The team thoroughly evaluated and tested workflows to maximize efficiencies with Centricity RIS-IC and offered a strong training program. The practice wrapped introductory training into a six-week simulation before going live with the system. The training included a post go-live debriefing at the end of the first week, and the practice holds staff refresher training at least once a year or after product upgrades/updates.

The center aims tap into RIS/PACS to raise the bar again. For example, Radiology Imaging and Specialists intends to reward schedulers who meet established benchmarks, which requires metrics and a solid RIS reporting system, says Marichal. Centricity fits the bill. 

Reinventing the practice
Centricity RIS-IC has provided Radiology and Imaging Specialists a means to reinvent its practice, improving workflow and patient care across the board. The imaging center group is completing more studies and turning them around in a shorter time frame with fewer staff. In other words, the practice has found the recipe for success in 21st century imaging center business.