Picture This

A picture is worth a thousand words—except in the radiology business, where it’s worth far more. These days, radiology studies come encumbered with multiple documents. In addition to the radiologist’s own report, there are letters from referring physicians, pre-testing documents with patients, insurance forms, lab results, consent waivers—multiplied by the variety of imaging technologies in use together, these auxiliary documents can turn the individual patient chart into a bulging file.

Just ask Sam Korsmo, the chief operating officer at Alaska Open Imaging Center in Wasilla. Armed with six imaging modalities, the four-physician radiology practice uses as many as 130 forms in its daily operations. Not only that, but the practice also has four imaging centers scattered as far as 325 miles apart. With referrals coming from 2,800 physicians statewide, it’s a major picture- and document-management challenge. But by combining technologies, Alaska Open Imaging has managed to streamline its workflows and expedite the delivery of its images and results. “We take a best-of-breed approach,” Korsmo says. “We have been very careful about not putting all our eggs in one vendor’s basket.”

Blending technology

The imaging center is now the hub of a complex, Web-based technology wheel. Images from its MRI, CT, PET, ultrasound, X-ray and bone density imaging devices are fed into a picture-archiving and communications system from Dynamic Imaging in Allendale, N.J. Physician reports are dictated into a voice-recognition application from Agfa HealthCare in Mortsel, Belgium, which is housed on the practice’s radiology information system from Elmwood Park, N.J.-based Emdeon (formerly WebMD). Forms are managed by a document-imaging and management system from Alpharetta, Ga.-based Optio Software.

All the data is stored in a central repository managed by Anchorage-based telecom vendor GCI, which also provides the T1 wide-area eight terabytes of data—and the network has only been running for less than two years. The systems work so well together that the imaging center is looking to open another clinic and hire a fifth radiologist by the end of this year, Korsmo says.

Running such a widely dispersed practice would be unthinkable without the connecting glue of technology. Prior to incorporating the document-management system, for example, the center had to fax patient records to its satellite clinics. Now, auxiliary patient documents are either scanned in or received directly via a fax server, which converts imaging requests into a digital snapshot. Each document is assigned an accession number, which links records to a given patient. After an image is captured, it is appended to any corresponding paperwork. As a result, the radiologists who analyze the images can pull up other background information they may need.

Controlling costs

The information technology has not come cheaply. By itself, the PACS software and hardware, including servers and workstations, costs up to $500,000, Korsmo estimates. Each workstation includes four side-by-side high resolution monitors. One is dedicated to report dictation, while the other three display images. Physicians can access the Optio document-management application through any of the monitors. Although much of the patient information is not stored in discrete, searchable data fields, Korsmo says the system has enhanced physician productivity and made the business more efficient. “We used to do a lot of redundant faxing,” he recalls. “Or worse, we would assemble an entire record and fax it.”

The imaging center has held down the cost of the technology by embracing the “application service provider” arrangement. Instead of buying the document-management application from Optio outright, the practice leases the software, paying a monthly subscription fee of less than $6,000, which is shared among the four facilities, Korsmo says. “We are paying a fraction of what it would cost to buy the system,” he says. Easier upgrades and system maintenance are other virtues of the ASP arrangement, Korsmo adds. Because Optio hosts the software on its servers, the vendor’s tech staff can monitor its performance first-hand and install upgrades without traveling to Alaska.

The set-up also makes it easier for referring physicians to retrieve radiology reports, Korsmo says. Doctors can access both the images and the results through the Web using a username and password assigned by Alaska Open Imaging. Only about 10 percent of the referring physicians use the Web option, but the number is starting to grow. In the meantime, the practice continues to mail out copies of imaging results to the referring physicians. “We will deliver the information in whatever form they want,” Korsmo says.

Gary Baldwin is technology editor of HealthLeaders. He can be reached at gbaldwin@healthleadersmedia.com.