Download Competing for Medical Imaging Success

COMPETING FOR
MEDICAL IMAGING
SUCCESS:
Using Information Technology
(IT) as a Competitive Advantage
By Murray A. Reicher, M.D.
DR Systems Chairman and Co-founder
Competing for Medical Imaging Success: 2
Using Information Technology (IT) as a Competitive Advantage
Contents
Introduction............................................................................................. 3
Why Information Technology is Your Principal Weapon ...................................... 3
Key features ..................................................................................3
Lesson of Business Automation ..................................................................... 4
What if better functionality costs a fraction of the price?............................4
Challenge to historical cost assumptions in the RIS/PACS field......................5
The RIS/PACS Exam Index (RPEI) ................................................................... 5
The Human Element .................................................................................. 6
1 - Make a Commitment ....................................................................6
2 - Designate and Empower Leaders......................................................6
3 - Prepare Your Customers for the Change.............................................6
4 - Require Full Utilization from the Beginning .........................................7
5 - Train Your Staff How to Communicate the Change ................................7
6 - Change the Work Flow ..................................................................7
7 - Measure, Reap, and Market the Benefits ............................................7
Staying Focused on the Customer ................................................................. 7
Conclusion............................................................................................... 8
Background.............................................................................................. 8
About the Author ...................................................................................... 9
About Murray A. Reicher, M.D. ............................................................9
About DR Systems, Inc. .....................................................................9
Competing for Medical Imaging Success: 3
Using Information Technology (IT) as a Competitive Advantage
Introduction
Competition among medical imaging providers continues to heat up, driven by
fundamental social and economic forces. The two main forces increasing the use of
medical imaging are:
ƒ
Our aging population.
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The emergence of new imaging technologies and benefits.
Yet resources are constrained. Simply stated, society now demands more healthcare
for less cost, with better, more accurate, timely, and caring services. What the market
wants, the market gets. How can providers use these insights to successfully compete?
Why Information Technology is Your Principal Weapon
In healthcare, as in most businesses, the overwhelming cost of operation is the cost of
human resources.
ƒ
Want to accomplish more with fewer people? Use tools, a fact well
understood by stone-age man.
ƒ
Want to work more accurately? Use tools that reduce error-prone processes. In
today’s world, information technology is the principal tool that multiplies human
productivity and reduces human error.
ƒ
Want to communicate better with your customer? Develop a superior
communication channel to reach your customers efficiently. In medical imaging,
this same line of reasoning can be applied to selecting the most effective RIS/PACS
competitive weapons.
Key features
Key features of a RIS/PACS system include:
ƒ
Automated output of images, audio, and structured text reports that cater
to the individual preferences of referring doctors. Store referring physician
preferences in a database.
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Automated delivery of images, audio, and text via a software application.
Include the following features:
ƒ
•
Free to referring doctors.
•
Ability to download via the Web.
•
Ability to automatically harvesting information from your RIS/PACS Web
server.
•
Provides a complete image management tool set.
Automated, Web-based, resource-constrained scheduling at the referring
doctor’s finger tips, so that your referral sources can reward your great work with
more referrals.
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Using Information Technology (IT) as a Competitive Advantage
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Automated structured text reports that are faster, easier, and more costeffective to both read and produce, with individual user’s choice of utilizing voice
recognition or transcription services.
ƒ
Automated hanging protocols and worklist protocols for reading radiologists
and cardiologists, with support for multi-site reading, remote reading, and remote
reporting.
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Automated concurrency management, so that different users and readers can
be simultaneously working on a LAN, on a WAN, or across the Web without
colliding or interfering with each other.
ƒ
Automated tracking of all events, including exams, reports, patient flow, supply
use, patient demographic data, worker productivity, referring doctor data,
transcription/reporting data, payments, insurance information, and security data,
with associated management reporting of this data. Keep in mind the adage, “If
you measure it, it will improve.”
Note:
The same application should present a “referring doctor-centric Web page,” so
that every time referring doctors access their patient records from their
homes or offices, you passively provide them a marketing or educational
message. With this feature, you can provide great service and establish a
preferred communication channel.
Lesson of Business Automation
The following lessons are especially important to learn when automating your
business:
1.
Build all your systems the same. Develop and document a systematic
operational approach that achieves the highest efficiency and lowest operational
expense.
2.
Eliminate all practices that don’t add value. In medical imaging, this means
your RIS/PACS solution must eliminate film, paper, unnecessary interfaces,
third-party brokers, separate reporting systems, separate mammography PACS,
separate cardiology PACS, separate fax servers, separate service contracts,
separate user-group meetings, and separate training.
3.
Mass customize. Apply mass production methods to serve a diversity of
customers, by providing them tailored services that meet each of their needs. In
medical imaging, this means providing output for each referring doctor - the way
they want it. It also means Web-based scheduling that allows referring doctors
and staff to input information that travels directly to both the technologist who
performs the exam, and the radiologist who interprets it.
What if better functionality costs a fraction of the price?
History shows that companies that ask and answer this question find tremendous
success. For example, a VCR or DVD player provides most of the functionality of a
greater than $10,000 recording studio in a less than $500 box. Most everyone has to
have a VCR or DVD player, yet very few people ever needed a recording studio!
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Using Information Technology (IT) as a Competitive Advantage
Perhaps a more subtle analogy is that:
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The $600 knee MRI provides basically all of the information of a $5,000 knee
arthroscopy.
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CT of the abdomen provides essentially all of the information of a much more
expensive exploratory laparotomy.
No wonder the less expensive and less invasive procedures have experienced explosive
growth. In fact, over the next 50 years, one can reasonably predict that, because of
technology-based automation, medical imaging will replace physical examination.
Labor-intensive physical exams simply won’t be cost-effective relative to more accurate
and labor-leveraging medical imaging.
Challenge to historical cost assumptions in the RIS/PACS field
In the RIS/PACS field, historical cost assumptions are now being radically challenged
as well. While the industry has historically treated RIS, PACS, and reporting, as
separate items, we now see installed sites where RIS-PACS-Reporting-Dictation-Voice
recognition-Faxing-Reporting-Teleradiology-Cardiology-Mammography-Archive-Backup-Web Distribution-Scheduling-Management Reporting are all one single integrated
application from one vendor. A vendor that adheres to industry standards, provides
one set of training manuals, one online Help tool, and one service provider. Industry
research indicates that this type of product unity radically reduces costs below previous
assumptions. Competition among RIS/PACS vendors is now driving the entire market
toward far-reaching, unified medical imaging IT solutions.
What would it mean to your practice to have a higher operational efficiency and a
better marketing channel to your referring doctors, compared to your local competitor?
The answer − happier referring doctors, more business, and wider profit margins.
The RIS/PACS Exam Index (RPEI)
The RPEI refers to the total costs sunk into a RIS/PACS vendor per exam. It’s a metric
that can be used to measure imaging IT costs and to compare vendors, “apples to
apples.”
To calculate RPEI:
1.
Add all invested costs in capital, interest, upgrades, and service paid to a
particular vendor.
2.
Subtract the depreciated value of the existing technology.
3.
Divide by the number of exams performed during the time period of this vendor
relationship.
You now have a simple metric of the costs paid to a particular vendor per exam.
This method allows comparison of vendor costs, even when one vendor charges a fee
per exam, one rents equipment, and one provides long-term capital leases. By taking
into account the depreciated value of the existing equipment, RPEI also factors in the
financial value of a continuous upgrade pathway.
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Using Information Technology (IT) as a Competitive Advantage
In addition, if you are considering separate RIS and PACS vendors, it may be useful to
sum the RPEI of two vendors compared to a single RIS/PACS solution in evaluating
your alternatives. If one vendor provides hardware and another doesn’t, simply add
your own anticipated hardware costs to the software-only vendor’s costs to create your
RPEI forecast.
Thus, RPEI can help compare vendors with different product scopes and different
financing models. And you can check the RPEI of a vendor’s installed customer base
when checking references!
In a review of 30 long-term single-vendor customers (over 5 years) evaluating this
metric, RPEIs have varied from approximately $1.10 to $4.10 per exam. These
measurements are qualified with “approximately” because of variations in the
reporting of exam volumes (for example, some consider a CT of the abdomen and pelvis
one exam, and some consider it two) and estimates of depreciated value.
These costs suggest that by eliminating forklift upgrades and by combining
technologies in one application, RIS/PACS costs can be radically reduced below the $812 per exam commonly incurred in our industry.
The Human Element
While selecting the right IT tools is important, managing your staff is equally or more
important to enhance your competitive position in the healthcare marketplace. The
following steps are very useful in re-engineering a hospital or imaging center:
1 - Make a Commitment
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Commit to cost savings with your top managers and physicians.
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Set tangible goals.
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Write a mission statement and have constituents sign it.
2 - Designate and Empower Leaders
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Designate the following leaders:
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Physician champion.
•
Technology champion.
•
Administrative champion.
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Assign accountability for training, quality assurance, and communication.
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Keep in mind that in smaller operations, one person can fill multiple roles.
3 - Prepare Your Customers for the Change
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Begin selling the changes early to hospital administration and referring staff.
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Emphasize improved access to images.
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Send letters of introduction to your referrers.
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Send letters to referring physicians who now receive film copies.
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Using Information Technology (IT) as a Competitive Advantage
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Present to hospital staff committees.
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Survey your referring physicians to get the “before installation” data.
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Institute telecommunication capability early to key referrers.
4 - Require Full Utilization from the Beginning
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Jettison the old system early.
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Begin “training drills” immediately.
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Make staff changes unambiguously and as early as possible.
5 - Train Your Staff How to Communicate the Change
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Create urgency, not anxiety.
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Channel problem calls to “champions.”
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Script your employees response.
6 - Change the Work Flow
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Diagram current work flow.
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Eliminate all tasks that do not add value.
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Rewrite job descriptions and performance standards.
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Continuously reassess and re-streamline.
7 - Measure, Reap, and Market the Benefits
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Build your network from the ground up.
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Exploit your reputation for information management.
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Market quality benefits to payers and other referrers.
Staying Focused on the Customer
Medical imaging providers serve multiple constituents, including patients, referring
doctors, IPAs, employers, and insurers. Of all of these constituents, referring doctors
may require the greatest focus. Maintaining great relationships with referring doctors
provides the greatest financial and professional rewards. If your practice or hospital
describes its competitive advantage as “excellent radiologists, good technology, and
reasonably prompt report faxing,” you are not providing any differentiation from your
competition, because every radiology practice claims these advantages.
So what do referring doctors want that the average practice is not yet providing? It’s
simple—complete, hassle-free, accurate medical imaging services, including:
ƒ
Scheduling exams via a Web-based exam appointment tool.
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Using Information Technology (IT) as a Competitive Advantage
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Receiving automated output and Web-based delivery per individual radiology
preference.
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Receiving structured reports with instant turnaround.
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Access to complete print formatter software for printing images or entire exams in
referring doctor’s offices.
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Workflow management in the referring doctor office. (“Which exam have I looked
at?”)
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Access to viewing tools such as image insets and 3-D interactive cross-referencing.
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Playing audio conclusions immediately.
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Viewing key selected images preferentially.
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Ability to locally store cases, save exams, save images for slides, marketing, and
other purposes.
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Ability to add recorded audio input for emergency room and other doctors.
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Ability to create and view multiple notes and flags for exam tracking, research, and
quality assurance.
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Access to great operating room and conference solutions.
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Providing CDs to go containing the exam.
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Printing based on individual preferences per exam type.
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Ability to forward DICOM data to other software, like therapy planning.
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Multiple office support for referring doctors with multiple facilities.
Conclusion
In an ever-demanding world with constrained resources, information technology can
truly be your main competitive weapon. As with any weapon, to be effective,
information technology must be carefully planned, cost-efficient, and implemented in
an organized manner.
Background
Murray A. Reicher, M.D., originally presented the ideas in this white paper in a session
Using Information Technology as a Competitive Advantage at the RBMA 2005
Radiology Summit.
Competing for Medical Imaging Success: 9
Using Information Technology (IT) as a Competitive Advantage
About the Author
About Murray A. Reicher, M.D.
Dr. Reicher is a Board certified diagnostic radiologist with subspecialty CAQ in
Neuroradiology. Dr. Reicher joined Radiology Medical Group in 1986 and continued to
make numerous significant contributions of teaching, scientific publications, and
research in the area of neuroradiology, musculoskeletal MRI, and related MRI
technologies. In 1992, he founded one of the world’s most successful PACS companies,
DR Systems, Inc. He is the past President of Radiology Medical Group, Inc. and
currently serves as Co-Chairman of Imaging Healthcare Specialists, LLC.
About DR Systems, Inc.
DR Systems, Inc. is a leading provider of film-free medical image and paperless
information systems with integrated RIS/PACS that includes dictation, reporting and
Internet-based distribution solution for hospitals and medical imaging centers.
DR Systems’ DICOM-compliant system includes the Dominator Diagnostic Reading
Station with available DR Instant Reporter (automated voice recognition, dictation,
and report distribution), the Catapult Technologist QC Workstation, the RIS Admin
Station, the DR Central Server and Communicator Web Server, the Ambassador
Clinical Review Station, the Messenger Diagnostic Portal, and the Guardian Archive
System. DR Systems’ ease of implementation and user training allows customers to
rapidly achieve financial and clinical success. With a modular design scalable for
growth, DR Systems RIS/PACS can handle current and future medical image and
information management needs.
DR Systems, Inc.
10140 Mesa Rim Road
San Diego, CA 92121
Toll Free: (800) 794-5955
Tel: (858) 625-3344
Fax: (858) 625-3334
Email: [email protected]
Web: www.dominator.com
Copyright © 1997-2006 DR Systems, Inc. All rights reserved.
Specifications are subject to change without notice. Ambassador, Catapult, CD Ambassador, Communicator, Dominator,
DR Scheduler, DR Systems, Guardian, Instant Reporter, Messenger, Report Manager, Universal Manager, Web Ambassador, and
Web Dominator are trademarks of DR Systems, Inc., San Diego, CA. Other trademarks used herein are the property of their
respective owners. Products and equipment by DR Systems described herein are manufactured under one or more patents,
including U.S. Patent #5,452,416.
60-76-00-1634-A