Health Imaging

At 2:46 p.m., March 11, Shigeru Ehara, MD, heard his phone alarm  unexpectedly go off. He was working in the radiology department at Iwate Medical University in Morioka, Japan, and discovered the alarm was part of an earthquake alarm service, indicating a strong quake had just occurred.

After the earthquake and tsunami, the hospital was left without electricity, and limited emergency power capacity had slowed normal imaging services. The PACS was disabled, interpretations were rendered orally and memos were left on requisition forms.

This disaster provides a stark reminder that all medical imaging providers need to have a comprehensive disaster recovery plan that accounts for data protection, as well as allowing operations to continue at the highest level allowed by the situation.

As far as protecting data, in recent years, more facilities have turned to virtualization and cloud data storage as part of that plan. A 2011 survey of 1,200 IT professionals conducted by CDW Healthcare showed that one-third of healthcare organizations are implementing or maintaining cloud-based systems. Thirty-seven percent said they are developing a written strategic plan for the adoption of cloud computing.

Virtualization of servers is on the rise as well, as 89 percent of hospitals with 50 beds or more surveyed by CDW had at least one form of virtualization in place.

Typically, the top reasons for healthcare enterprises to turn to the cloud, where patient images and other data are archived on outside servers, and other offsite data strategies, have been the potential benefits in cost reduction and the flexibility that comes with expanded access.

More IT staffs, however, are recognizing the benefits cloud technology can have in terms of protecting and recovering data in the event of a disaster. A survey conducted at the 2011 Healthcare Information Management and Systems Society (HIMSS) conference showed that more than half of respondents who are using or are considering plans to use a cloud vendor for medical images said one of their major concerns was disaster recovery.

James P. Borgstede, MD, chair of the American College of Radiology (ACR) Foundation’s International Outreach Committee, who has recently been involved with the ACR’s relief work in Haiti, following the devastating earthquake of 2010, says it is important for facilities to know the strengths and weaknesses of their local PACS or offsite data storage system. In the film era, in the event of a power outage, there were hard copies of images.

“In that sense, there was an advantage to the old way of doing things,” says Borgstede. “However, the disadvantage is that there’s no way to transport those data electronically. So, if your systems were up and running but you needed interpretive support, there was no way to get that. You had to bring people into the disaster area, where now you have the opportunity to send the films outside the disaster area.”

From quakes to snowflakes

It doesn’t take a devastating earthquake to disrupt normal workflow; sometimes it can be a more common occurrence like a heavy snowstorm. That’s what Oklahoma City-based Eagle Imaging Partners had to deal with in February.

Eagle Imaging primarily serves the state of Oklahoma, but also some hospitals in Kansas and Texas. It is an onsite group, but it utilizes a teleradiology distribution model and sends images to a vendor-supported cloud. Images are then brought back to workstations where physicians can access them at all locations with the same platform and workflow.

Eric Slimmer, Eagle Imaging’s CEO, says the rural practice serves a number of facilities that are a significant distance from the larger metro areas, which could have been a problem when the region was hit by a “crippling” blizzard.

Many highways and interstates were shut down, some for two days, but Eagle Imaging was able to continue to provide interpretations using the cloud-based system. Some physicians provided interpretations from their homes.

“Cloud technology enabled us to provide a continuum of care to the rural hospitals that we cover,” says Slimmer, adding that a number of imaging centers were closed, but the hospitals remained open. “Our group was able to continue to provide care in the middle of this blizzard. In the past, we wouldn’t have been able to do that and hospitals would have had to go on divert and cease radiology reading.”
Tiptoeing into the cloud

Not every organization is ready to jump headfirst into the cloud. This month, University of Massachusetts (UMass) Memorial Health Care in Marlborough, Mass., will implement partial virtual storage in a vendor-supported cloud service. UMass plans to move clinical apps, pharmacy, billing and patient registration to the cloud, but Rick Mohnk, associate CIO at UMass, is a little hesitant to shift everything to the cloud. “I’m not quite ready to run my PACS images out to the cloud,” says Mohnk, adding that the cost-effectiveness of the approach has not been definitively proven. While some large industries with a single core competency may see great cost-benefits with cloud storage, a healthcare enterprise consists of dozens of departments with different needs, he says.

Mohnk isn’t alone. The HIMSS survey found that one in five respondents were concerned with the cost effectiveness of cloud storage. Mohnk doesn’t rule out moving more data to the cloud, but would like vendors to allow more flexibility in provisioning data between local storage and the cloud, giving CIOs more control.

He says that there are many ways to protect and back up data in the event of a disaster. If a facility has only a single data center, it can include servers with dual power supplies, dual CPUs and dual net cards to maximize uptimes. Enterprises can use multiple storage area networks (SANs), with each performing different roles.

Prior planning is essential in creating disaster recovery plans. For example, with Hurricane Irene bearing down on the Northeast in August, Mohnk and his staff met daily to discuss preparations. They had previously established three remote geo-clustered data centers to back up data and minimize the risk of data loss, and in advance of Irene, they created a mini command center, where they could address any issues that might arise.

Healthcare IT departments should formulate a vision ahead of time, and know its limitations, Mohnk says. Budgets are a concern and small community hospitals may not be able to afford a high-availability, fully redundant, geo-clustered data center. Organizations should define their needs, says Mohnk. “Put the plan in place. Talk to the leadership. Get the board onboard.”

Beyond the cloud

Disaster planning also includes workflow and contingency plans for staff, says Pam Matthews, senior director of regional affairs for HIMSS. Everyone from radiologists to nursing assistants needs to know his or her role. A facility needs to know how it will transport patient data in the event of evacuations, and have a plan for all types of interruptions, even if it’s simply unscheduled downtime for email services.

Some organizations may leverage cloud technology to protect data, says Matthews, but she says decisions about budget and the amount an organization is willing to risk in protecting assets must be made well in advance of any unexpected shutdown.

“The challenge, especially for a CIO, is to develop an understanding within the organization of the importance of disaster recovery,” says Matthews.

Advanced planning, an organizational disaster plan and ongoing data protection strategies, including those that leverage cloud technology, can help healthcare providers fulfill Matthew’s personal mantra, which is that you can’t stop delivering care, even in a disaster.

View article here

vRad® Enterprise Connect, a product of Virtual Radiologic, is a web-based radiology reading system that allows for unprecedented speed in performing radiological studies and gives the ordering physicians a typed, final report within just a few hours.  Typically, these reports are not available for several days.

The addition of the Pittsburg, KS location further enhances Eagle Imaging’s presence in the Southern Plains region.  Eagle Imaging currently provides radiology services for numerous hospitals, imaging centers and ambulatory surgery centers (ASC) across Oklahoma and Texas.

For Eagle Imaging CEO and Kansas-native, Eric Slimmer, the addition of Open MRI of Pittsburg serves as a homecoming.  Slimmer was raised in Holton, KS and attended Washburn University in Topeka, KS.  He’s excited to bring Eagle Imaging’s advanced level of service and clinical excellence to residents and physicians throughout the state of Kansas.

“We’ve been looking at expanding into Kansas for some time and this was the perfect opportunity,” says Slimmer.  We think area physicians will truly enjoy the level of service and expertise our team will provide for them and their patients,” Slimmer says.  “Kansas is a special place to me personally and I look forward to our practice providing services in my home state.”

In addition to performing routine radiological studies, many of Eagle Imaging’s radiologists also perform interventional radiology procedures, something Slimmer hopes to provide in Kansas as Eagle Imaging expands its statewide presence.  “We’re actively looking for additional opportunities to serve Kansans.  Our goal is to provide greater access to quality care and specialized radiological services for both rural and metro areas of the state,” Slimmer says.

Dr. Griggs graduated from the University of Texas Southwestern Medical School in Dallas. He completed a surgical internship, radiology residency and vascular and interventional radiology fellowship at the University of Oklahoma Health Sciences Center. Dr. Griggs is board certified by the American Board of Radiology.

Dr. Griggs serves as the medical director for LakePointe Imaging Center in Oklahoma City and will also provide radiology coverage for Community Hospital in Oklahoma City. In addition, Dr. Griggs will provide radiology coverage and perform diagnostic and interventional radiology procedures at Duncan Regional Hospital in Duncan, OK.

imagingBiz

Saint Mary’s Regional Medical Center, Reno, Nevada, first considered a cloud-based platform when its 12–year-old PACS was on its last legs. Facing a significant capital expenditure to replace it with another traditional PACS, the team at Saint Mary’s Regional Medical Center wondered whether it would be possible to achieve similar or better clinical efficiency with a pay-as-you-go solution.

Dan Ferguson, MD, CMO, says, “We had been having a lot of technical issues with our PACS and needed expensive service contracts just to keep it running. Quite frankly, we needed another approach.”

Eagle Imaging Partners, an 11-radiologist practice based in Oklahoma City, Oklahoma, found itself considering a cloud-based PACS out of necessity. The group was covering 12 facilities across a large geographic area.

As Eric Slimmer, CEO, explains, “We’re an on-site teleradiology group, by which I mean that we provide on-site radiologists, but our practice operates like a collective teleradiology practice. We needed a solution that would allow our physicians to go to any of our locations and have the same access to our entire network of images, as well as the same workflow.”

New York Radiology Alliance (NYRA), formerly S&D Medical, Bedford Hills, New York, was experiencing a similar issue in a very different environment. The 60-radiologist practice (which serves the greater New York City metropolitan area) wanted to consolidate workflow across the diverse array of facilities that it serves. These range from large hospitals to small subspecialty practices, but the group couldn’t find a solution that fit its specific needs, which could include enabling one radiologist to read for 15 facilities in a day.

Jonathan Schwartz, COO of NYRA, recalls, “We had used a bunch of different systems, but they were all limited, one way or another, in the quality of their product. For a while, we were looking at building our own system, but the big vendors never quite understood our workflow requirements.”

Hesitations and Solutions

Today, all three organizations are managing their radiology workflow using the cloud-based vRad® Enterprise ConnectSM platform from Virtual Radiologic (vRad), Minneapolis, Minnesota, complemented by the company’s cloud-based vRad ResultsSM solution, which provides referring physicians with instant access to reports and images via mobile device or the Internet.

Schwartz says that for NYRA, which is an alliance partner of vRad, turning to the cloud was the smartest option. “Radiology has become very competitive,” he observes. “A high level of quality is expected, and turnaround needs to be fast. Everyone needs more throughput to keep up with the increasing financial pressures. Without a solution like this, it’s not practical, it’s not economical—you just can’t do it.”

Cloud computing is no longer in its infancy, but health care has traditionally been slow to place its trust in new technological solutions, Ferguson notes. “A cloud-based platform was a new idea for us,” he says. “It was something we had to get comfortable with—something that had to be proven.”

For Saint Mary’s Regional Medical Center, that proof came in the customization of the vRad solution that occurred in the months after the system went live, in July 2010. “We had to do some redesign to meet the needs of the inpatient acute-care radiologists,” he recalls. “I think some people hesitate because they think they’re giving up local control. We felt very connected and in control, however—the vendor (vRad) met and exceeded our expectations at every turn.”

He adds, “It took some effort for our radiologists to move to voice recognition over a period of several months. We’re very proud of them—they deserve a lot of credit for the success of this implementation.”

From the radiology group’s perspective, Slimmer says, “The general hesitation, in my opinion, with cloud-based technology is that physicians will be waiting on images—they’ll be waiting because of network limitations, which has not been our experience.”

Schwartz adds that uncertainty from hospitals can also play a role in a practice’s decision making. “There’s always the general reaction of, ‘We don’t want to use this software, it will be a nightmare for our IT department,’” he observes. “That’s where vRad’s technical and operations staff came in; our facilities found it was not intrusive, there was no heavy hardware, and there was minimal programming.”

Advantages of the Cloud

Ferguson says that the cost savings available using a cloud-based workflow solution were a deciding factor for Saint Mary’s Regional Medical Center. “We have capital constraints, as all health systems do,” he says. “The ability to pay as we go, rather than making a large capital investment, is absolutely preferable to us.”

Other opportunities for savings were available as well. With vRad Enterprise Connect, Saint Mary’s Regional Medical Center radiologists have access to voice-recognition software, which has remarkably decreased transcription costs without an upfront capital outlay, Ferguson says.

“We have no plans ever to return to a traditional PACS solution,” he says. “We don’t have to worry about growth now. We don’t have to buy any more servers. We’ll never have to worry about paying for upgrades. On many levels, it’s a very cost-effective solution, and it’s more efficient clinically.”

Slimmer says that for his group, being able to access a unified workflow was critical, both from an efficiency perspective and in terms of patient care. “It became a risk for our physicians to keep working on different systems: When you’re constantly changing workflow, it’s easier to make a mistake,” he says. “Now, our physicians can sit down and log into the system at any location and have the same workflow they would have anywhere else.”

Schwartz concurs. “Now, we have more effective workflow distribution and rules to route the right study to the right physician,” he says. “The increase in the quality of care is really the ultimate outcome of this. We’re able to offer fast turnaround on a high-quality final interpretation.”

All three organizations also offer their referring physicians cloud-based access to reports and key images through the vRad Results solution. “In the hospital environment, there’s no question use that feature,” Schwartz says. “The days of clinicians coming down to the radiology department are over. Now, clinicians can just hop onto the system to access the information they need.”

At Saint Mary’s Regional Medical Center, Ferguson says, Internet-enabled computer stations have been placed in physicians’ lounges and in operating rooms to take advantage of the easy access to reports and images offered by vRad Results. “Whether they’re in the acute care setting, in their offices, or even at home on call, it’s been highly helpful to them,” he says.

For Eagle Imaging Partners, implementing a cloud-based workflow solution enabled the group’s rapid growth; since going live with the vRad Enterprise Connect solution, Slimmer says, the practice has gone from covering 12 facilities to covering 30. “The physical location of the physician is not important anymore,” he notes. “It definitely improves my ability to staff. Our use of locum tenens staff has dropped to zero, even as we’ve added new clients.”

He reports that Eagle Imaging Partners managed to continue its operations during a February blizzard that crippled the state of Oklahoma. “It was two full days that most of the interstate highways were closed,” he says. “Had we not had this product in place, we would have been closed as well. It allowed us to provide continuity of care.”

Schwartz shares a similarly inspiring story. A struggling New York City hospital, which was still using plain-film imaging and had never implemented a PACS or RIS, came to NYRA seeking cost-effective radiology services. “Even though this hospital has been through some financial difficulty in recent years, it came to see that it needs to have this so it can keep the hospital economical,” he says. “It will be able to cut its payroll costs, see more patients, and spend more time on patient care.”

Schwartz concludes, “We can’t imagine doing business any other way. Anybody in the forefront of technology in the field can see that with the complex logistics of today’s radiology environment, the cloud-based approach is going to be necessary in the future.”

Effective October 1st, Eagle Imaging radiologists will provide radiology services for the clinic. The Southern Plains Medical Clinic serves the town of Chickasha, and Grady County, with a wide range of medical and radiology services.

Southern Plains Medical Center P.C.
2222 West Iowa Ave.
Chickasha, OK 73018

405-224-8111

http://www.spmcmed.com/

 ”It has been simply amazing to see the effect that implementing new technology has had on our doctor’s ability to supply reports more efficiently than ever before,” says Mr. Slimmer.  “I am looking forward to sharing our success with other radiology groups from around the country.” 

The 2010 RBMA Fall Education Conference represents the second such appearance for Eagle Imaging in 2010.  In May, Mr. Slimmer addressed the 2010 convention of the National Rural Hospital Association highlighting the benefits of new technology for rural healthcare facilities. 

Disparate technologies and multiple locations pose a challenge, but ultimately, Eagle Imaging soars with an integrated system.

After 3 years in a fast-growing practice providing 90,000 interpretations per year, Eagle Imaging Partners reached a critical juncture in the winter of 2009. We serve hospitals, imaging centers, and medical clinics in Oklahoma City, rural Oklahoma, and Texas, yet we could not take on additional business despite demand for our services.

We could not accept any new business without feeling like our hands were tied by inefficiency. Most of the 15 facilities we served had different technical workflows from each other, as many as five workstations to accommodate the various PACS our customers used, and different dictation systems. Space-wise alone, there was not room for an additional workstation for another customer. Time-wise and stress-wise, our radiologists could not train on another customer-specific PACS. The situation was nightmarish…

Click here to continue reading this article

Virtual Radiologic News Releases

Eagle Imaging Partners is proud to announce the addition of Michael Murphy M.D., to the Eagle Imaging team.  Dr. Murphy is a 2004 graduate of the University of Oklahoma College of Medicine, performed his residency in Diagnostic Radiology at Baptist Memorial Hospital in Memphis, Tennessee and is a diplomate of the American Board of Radiology.   He is currently completing a fellowship in Diagnostic Neuroradiology at the Baylor College of Medicine in Houston, Texas.

Dr. Murphy and his wife Kristen will return to Oklahoma City in July when his practice with Eagle Imaging begins.  The addition of Dr. Murphy to the Eagle Imaging team reaffirms our commitment to providing our clients with the highest quality radiology services available.

Eagle Imaging has a proud commitment to providing the highest quality and most cost effective radiology services.  That’s why we’re proud to announce a strategic alliance with Oklahoma’s leading women’s health imaging service provider, Breast Imaging of Oklahoma.

Breast Imaging of Oklahoma’s team of board certified, female breast radiologists, utilizes the most advanced imaging and diagnostic systems available.  Eagle Imaging is proud to work alongside this talented team, furthering our mission to bring unparalleled service and clinical excellence to our clients.

Together, Eagle Imaging and Breast Imaging of Oklahoma can provide facilities with a comprehensive and advanced solution for women’s health imaging.  Best of all, patients in rural areas can now receive a specialist consultation and review without having to leave their hometown.

For more information about Breast Imaging of Oklahoma visit their website.

http://www.breastimagingofoklahoma.com/

Eagle Imaging is your complete turnkey radiology service partner.  Let us work with you to enhance your facility’s service offerings and patient satisfaction.  Contact Eagle Imaging today for a complete consultation.