Recent technological innovations have made it possible for standalone imaging centers such as Diagnostic Centers of America (DCA) to deploy picture archiving and communications systems (PACS) that used to be found only in hospitals. The Web-based PACS we currently use enables us to give referring physicians an unprecedented level of access to data and images, and our adoption of an advanced radiology information system (RIS), coupled with improvements in RIS/PACS integration, has greatly increased our operational efficiency and the productivity of our radiologists.

DCA has offices in Boynton Beach and Delray Beach, Fla. (with a third site opening later this year) and performs approximately 60,000 studies per year. DCA has earned a national reputation for quality and excellence in providing superb diagnostic imaging, thoughtful patient care and radiological interpretations that are second to none. Our radiology group, Boca Radiology Group (BRG), conducts approximately 300,000 procedures yearly in a multi-site practice. All of our radiologists are board certified by the American Board of Radiology.

Our state-of-the art facilities perform MRI/MRA, CT/CTA, PET Scan, ultrasound, general radiology, nuclear medicine, digital mammography, bone density, breast ultrasound, breast MRI, echocardiography, breast biopsy and endovenous laser treatment.

The Dark Ages

Until we introduced our first PACS in 2004, our operation, like many imaging centers, was totally paper- and film-based. The radiologists had light boards on the walls of their rooms and they’d hang up the films to examine them. This was very time-consuming and made comparisons difficult. If a physician was reading an MRI study, for example, with multiple years of prior exams, he had to hang up six to seven sheets of film for each study. The films were stored in multiple warehouses and it often took more than a day to retrieve and send them to the center by courier. Reports were manually faxed to physician offices. All of this resulted in a lot of unnecessary expense and long delays in result reporting.

Our office operations were also in the Dark Ages. We scheduled visits on paper or by using simple calendar programs. Technologists checked off codes on charge slips and staff had to manually enter CPT and diagnosis codes and charges into our billing system. Errors were frequent and billers had to spend hours at the end of each day reconciling charges with the studies that had been performed. Bills were typically submitted three days after the date of service; and, when insurers rejected claims, our collection people had to pull charts to check photocopies of insurance and ID cards. In some cases, they had to have film “jackets” retrieved from storage.

Much of this changed when we acquired our first RIS/PACS. We eliminated printing film on a daily basis and have been chartless and paperless ever since. We also introduced voice recognition software, which eliminated transcription and made reports available sooner. But this was only the beginning.

The introduction of our current RIS/PACS in mid-2007 boosted our productivity to the next level and transformed our operation in many other ways. The Sage Intergy RIS and Sage Intergy PACS (powered by GE Centricity PACS-IW) are much more robust and more tightly integrated than the systems we were using before. The Sage Intergy PACS is Web-based. This means that, for the first time, referring physicians have direct, instantaneous access to online reports and images. While we still computer-fax reports to doctors to ensure they see them, the clinicians also have the option of viewing them on a secure physician portal.

None of this would have been possible just a few years ago. Before the advent of new compression techniques and the availability of very fast, inexpensive computers with large memories, it simply took too long to load Web-based radiology images. For our previous PACS, we had a server in each of our centers, tied together by a T-1 line. When a study entered the PACS in one location, it was automatically sent to the other office, as well as to a backup server. But the data could be retrieved on only one dedicated workstation in each center. As you can imagine, that posed problems for our radiologists.

Today, all of the radiologists have anywhere, anytime access to the entire system on any computer that has a high-speed Internet connection. This means they can view images and reports in the hospital, at home, or when they’re traveling. And, if a patient visits one of our centers after having tests done in the other office, the prior studies are instantly accessible to our radiologists. Most studies load in seconds and comparisons are easy. Because we were able to migrate all of our data from our former PACS, we have studies online going back to 2004.

Our productivity improvements are surprising: Back when we used film, a radiologist could read approximately 50 cases a day. Today, many of them are reading 100 to 125 cases a day, because all of the data is instantly available. Radiologists are also providing better patient care because they can review and manipulate studies in greater detail using software tools within the PACS.

The New World

The RIS has increased the efficiency of our offices. First, instead of storing copies of insurance and ID cards and patient-completed forms containing demographic and other data in large file jackets, we scan-in the cards and script/referral, patient questionnaires and enter the demographic and insurance data in the RIS.

When the type of study is entered into the system, our charges and CPT codes are captured invisibly. If we’re conducting an MRI of the lumbar spine, for example, the RIS already “knows” the code and the charge, and it populates the appropriate time slot. Instead of painstakingly inputting and checking data, our billing staff is simply reviewing charge details and patient information. All details are accounted for and all charges are captured. Best of all, we submit bills electronically on the day of service.

Our claims are rarely denied, because the RIS verifies that all of the data has been correctly entered before the bills are sent to the clearinghouse. But when we do receive a denial, the staff can easily find the information they need to work the claim, because we scan-in all of the relevant documents every day. If there’s a need to check a study report, they can review the report within the patient’s electronic medical record, so they don’t have to retrieve jackets out of storage.

Throughout the organization, data is entered only once. When someone is scheduled for a test in the RIS, an HL7 message containing the patient’s demographic information, ID number, accession number and many other fields is automatically sent to the PACS and other third party applications. As a result, none of the data has to be re-keyed. Single data entry largely eliminates the possibility that the wrong name, patient ID or accession number might be attached to a particular imaging test. All images are stored in DICOM format in the PACS.

Return on Investment

A RIS/PACS system is not inexpensive. But the improvement in patient care and our finances has fully justified our investment. First, we’ve reduced our cost of additional warehouses each year and are in the process of eliminating old warehouses. We’ve reduced FTEs that used to courier films and file film jackets. Our supply costs for film and processor materials have virtually been eliminated. Second, without automation to handle our current volume of business, we would need at least 30 percent more full-time administrative employees. The RIS/PACS saves us $150,000 to $200,000 each year on labor alone.

To put this in perspective, we’ve doubled our volume in the past three years, yet we have not had to hire additional front-desk staff. The RIS has also made it possible to conduct centralized scheduling for the two sites, allowing collaboration and fewer employees as compared to a decentralized department. When you’re implementing a RIS/PACS, these savings are not immediately realized. Considerable staff time must be devoted to scanning-in patient charts, and users will still be retrieving film jackets frequently until they have a fair number of studies online. But once the new operation is humming along, the rise in efficiency is remarkable.

Savings from the RIS/PACS are not the only factor that has enhanced our financial position. The improvement in our billing and collection operations has also made a major contribution. Our days in A/R have dropped, our collection ratio has increased, and we send bills out within 24 hours after services are rendered. Coupled with a significant drop in claims denials, all of this has increased our cash flow substantially.

The PACS has not only increased our radiologists’ productivity — and consequently, our revenues — but also has pleased our referring physicians. We can schedule their patients without redundantly asking their staff for information that we now have online, and their patients are seen right away. The turnaround time for reports is now just a few hours; it used to be two or three days.

If a study is ordered stat, our staff or radiologist is on the phone with the referring doctor before the patient even walks out our door and that doctor can also view our images online. And if the patient needs to go to the hospital, they walk out with a CD and/or a report in their hand to take with them.

Considering all of these factors, implementing our current RIS/PACS system was the right step for our business. By improving patient care, solidifying our finances and pleasing our referring doctors, this technology has truly proved its value.