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What do you look for in a RIS/PACS for a Tele-radiology application

What do you look for in a RIS/PACS for a Tele-radiology application

Sep 24, 2020 | RIS/PACS, Teleradiology

Let’s face it. Today a PACS is a commodity has been for quite a while.
Most PACS and for that matter RIS on the market can do most everything… at least that is what the brochures claim!

For a Tele-radiology application, these are some of the important requirements

  • What are the workflow features it supports?
  •  How easy is it for a Radiologist to set up a practice for himself or herself?
  •  How many reports can the Radiologist dictate in a day?
  •  What is the cost of ownership?

Let’s take the last one first!

Today, reducing reimbursements from insurance companies, increasing competition across the globe, and the need to provide quality care in spite of all the above – are forcing owners of imaging centers to question the cost of ownership.

This is where the cloud-based solution brings value to the table. With a cloud-based solution, the vendor is responsible for the high end redundant servers housed in class III or similar data center, disaster management solutions, archiving studies and reports for 7 years or more. This solution provides a very low or practically nil cost of ownership.

The Radiologist or the owner can focus on building the business, signing up new hospitals, and bringing the bacon home! The cloud based solution gives him a lot more flexibility and freedom to go after new prospects even if they are not in the same state or even the same country.

The number of reports a Radiologist can generate in a day translates to profits. The system must be simple to use and the reporting engine and viewer must allow him to dictate as quickly as possible. Interface with a Voice recognition system, easy content (text and audio) exchange between the Radiologist and transcriptionist, peer review with ABR codes, QA, real time collaboration between different stakeholders are some of the features to look for in a system. The Radiologist must be the last link in the chain and studies/images must reach him only when they are complete in all respects, thereby saving his valuable time. Some systems have the reconciliation feature that handles this part of the assignment. The system must support all DICOM modalities which can be added any time later with ease and also support non DICOM for use with legacy modalities.

The system must be simple to use and more importantly easy to install. The Radiologist must be able to start his business or add a new hospital within hours thereby generating confidence in his business. If the hospital or clinic that is sending studies provides a VPN -then the issue of encrypting, security, and safe transmission are taken care of and there is no need for any hardware purchase by the Radiologist. If not, a simple PC that can house the DICOM router software and route the studies fast and efficiently to the central server, is sufficient. The system must also be universal such that it should not need any proprietary hardware for viewing and should be able to log in from any browser. Viewing and distributing images on a mobile device is becoming ubiquitous today and helps the Radiologist to take instant decisions from an airport or a coffee shop!

Last but not least the workflow features are very important. It is indeed an irony that when you mention workflow, most people have the “deer caught in the headlights look”. The workflow is the most important factor which contributes to the productivity and thereby to the bottom line of the enterprise. Some systems provide a “soup to nuts” solution for the workflow from capture to archive while some provide certain modules. Here it is important to get a standard off-the-shelf software that can be customized -rather than develop one from scratch and make it proprietary, finding it difficult to change in the future. The workflow defines many conditions that improve overall efficiency.

For example:

  • Assignment of studies to a Radiologist depending upon various conditions
  • Workflow parameters like TAT, number of reads, work load, QA score for Radiologist
  • Auto assignment or through manual intervention by an Administrator
  • Monitoring TAT (Turn Around Time) and reassigning studies if TAT is not met
  • Collaboration between various stakeholders through work-list
  • Customizable work-list which enables the user to see what they want to see and hide the extraneous information.
  • Monitoring QA, reconciliation, Peer review to help improve the quality of care to the patient
  • Integration with existing front end or back end solutions using HL7 or web links
  • Accessing PRIORS and showing patient demographics to the Radiologist while reporting to enable faster and more accurate reporting
  • Enabling the patient to get hold of the report and studies through a secure patient portal.
  • Use of mobile devices and maybe a QR code to make it easy for the patient to receive the information.

These are just some of the important workflow features to look for. It is best to ask the vendor what they provide – to help you improve the productivity of the Tele-radiology center. An important characteristic the software should provide is the flexibility to customize the features to get the best bang for your buck.

Many vendors who are in this business should be getting constant feedback from their valued users and keep improving their product.

Make sure they provide 24x7x365 support otherwise all the above is not as attractive as it sounds!

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Unlock productivity, quality and communication with radiology workflow orchestration

Unlock productivity, quality and communication with radiology workflow orchestration

Sep 9, 2020 | Radiology, RIS/PACS

Radiology exams are typically categorized as Stroke Cases, STAT cases, Trauma cases, Emergency Radiology, Inpatient, Outpatient and ICU cases etc. A radiologist’s workflow dashboard therefore must be organized in a manner that s/he has access to all vital information with the click of a button. But, it is easier said than done!

With increased accessibility and affordability of imaging modality machines and also due to incessant endeavors of modality manufacturers and PACS companies to provide precise imaging solution, there has been a quantum jump in the number of exams to be read. Further, the advent and availability of newer modality machines has also created the need for subspecialists readings.  A radiologist dashboard is now no less than a cross-word puzzle. What is most affected are the radiologist’s productivity, quality of work, communication between different stakeholders and the overall viability of running an imaging facility.

To overcome these challenges, companies are creating workflow orchestrators. Workflow Orchestrator is a mechanism for automatically matching imaging scans with a radiologist profile in the radiologist service provider environment. So, instead of radiologists spending their precious time figuring out which scan to read, the scans look for a perfect radiologist to read them.  Workflow Orchestrator further mines for exams in terms of priority or SLA (service level agreement), right sub-specialty and the best relationships and accordingly populates them in the worklist of the relevant radiologists for their appropriate response.

RIS-PACS with Workflow Orchestration lends itself in enhancing productivity, quality and communication.  With the implementation of intelligent tools such as Workflow Orchestration, the exams are exposed to a broader audience as time goes by. To begin with, the exams are exposed to the most suited radiologists, ones that have the best expertise and the best relationship to read that exam.

The Workflow Orchestrator also ensures that all available subspecialists are taken into the fold if a particular exam is not read or taken up quickly enough. The orchestrator delivers incalculable augmentation where quality KPI is concerned. The software also organizes exams not just by clinical but also by business priorities. The most crucial exams can be seen on top followed by the emergency and STAT exams, right after that comes inpatient exams, and then outpatient exams. Each exam is tagged by the intelligent software by the SLA so the time remaining to read each exam can be seen easily.

The productivity of the radiologists can be seen clearly from the personal radiologist dashboard. Apart from other features, there is also a break glass mechanism so that if a radiologist chooses to read out of order, the system will ask for a reason to do so. With integrated communication tools such as chat or instant messaging and more, the orchestrator’s software allows radiologists and referring physicians to easily share context of exams with each other and even ask for a specific exam to be reviewed.  The workflow orchestrator lets radiologists have the right tools to manage inaccurate exams and enhance productivity.

The Workflow Orchestrator helps direct imaging exams first to suitable clinical subspecialists, and then it makes sure that the exams are made available to other radiologists as needed to satisfy desired turnaround times. Exams also can be allocated to specific radiologists according to a referring physician’s preference and existing affiliations with hospitals or healthcare facilities. The platform’s workload balancing function can optimize reporting times.

RADSpa’s Workflow Orchestrator is one such value-added capability in the ever-evolving healthcare delivery paradigm.

  • It takes care of enhanced productivity by aligning demand with supply. Dynamic assignment automatically accelerates and assigns studies to the most appropriate, available radiologists. There is better communication through associated tools and automated notifications.
  • With a universal worklist, the orchestrator incorporates quality and interpretations tasks in one place. Efficiency is improved by contributing to quicker turnaround times and reduced length of stay.

When a study was conducted to see the impact of RADSpa’s Workflow Orchestrator feature, the results were overwhelmingly positive.

  • Almost 85% of the radiologists agreed that RADSpa’s Workflow Orchestrator helped them to reduce the TATs and increase productivity.
  • Statistical analysis of 180 days of logs before and after automation indicated 35% improvement in overall TAT for emergency cases.
  • Radiologist productivity per case improved by 25% as every case is auto-validated for images prior it is assigned.
  • Exam Coordinators or the Assigners reported a massive 98% reduction in effort which used to go in manually eliminating errors, and thereby more time in hand for handling greater workloads.

Radiology Workflow Automation has positively impacted timely patient care specifically in Reporting Emergency cases and thereby saving lives.

  • Manual errors and allocation time is reduced by 98%, TAT is improved 35% and RAD’s productivity by 25%.
  • Zero error in case assignment to radiologists by the coordinators (assigners).
  • Radiologists receiving advance alert regarding their work list.
  • Notification to assigners regarding un-attended cases. This helped assigners to follow-up with the respective Radiologists or re-assign them to equivalent Radiologists.

This value-based care has helped radiologists achieve more and do much more. This increased cooperation between healthcare providers as well as professionals benefits all participants in the care continuum. Workflow Orchestrator is therefore a great productivity and quality boosting tool and promises to be an excellent tool for collaboration and communication.

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7 Signs That Diagnostic Centers Should Invest In Tele-Radiology

7 Signs That Diagnostic Centers Should Invest In Tele-Radiology

Sep 7, 2020 | Teleradiology

In today’s competitive healthcare environment, running a diagnostic imaging center is not easy. Apart from the high equipment cost at startup, operational and ongoing financial challenges abound. A technology innovation that can assist owners of diagnostic centers in optimizing their center’s performance is teleradiology. This article lists the typical scenarios in which owners of diagnostic centers can benefit from this pathbreaking healthcare innovation.

  1. A chain of new diagnostic imaging centers is being opened.

    The best time to invest in teleradiology is at the time of expansion from a single center facility (either a diagnostic center or a nursing home or hospital) to a multicenter practice setup. This is when teleradiology will bring you maximum benefits, as it will allow you to utilize your existing radiologist staffing more efficiently. One radiologist at one of the sites can potentially report Xray and CT/MRI scans for all the centers. An onsite radiologist will be required at each site for performing ultrasounds and procedures.

  2. Scans are not getting reported on time and the patients and referring doctors are complaining.

    Implementing teleradiology is a highly effective way to improve your report turnaround time. It brings the images to your radiologist and allows him/her to report them instantly, instead of your having to wait for the radiologist to show up at work. Furthermore, using an efficient teleradiology workflow platform (Radspa developed by TeleradTech is one such example) can significantly improve your radiologists’ reporting efficiency and thereby further shorten the reporting times.

  3. The diagnostic imaging center has started receiving injury cases at night that need immediate reporting.

    Emergency Nighthawk/urgent care is where teleradiology makes its greatest impact. If your hospital or diagnostic center is open 24 hours and scans are being performed through the night then you can greatly benefit from teleradiology, either by allowing your own radiologist to report from his or her own home at night or if that is too taxing for them, by outsourcing your reporting to a teleradiology reporting center that provides 24 x 7 services. Remember though to check reporting quality standards and accreditations!

  4. The center is unable to find a radiologist to report the scans.

    In the current scenario of radiologist shortages, this is not an uncommon situation and the radiologist staffing at any site can suddenly become a problem. Teleradiology can help by either allowing your radiologist to report the scans from wherever he or she may be, or by allowing you to outsource your radiology reporting to a teleradiology reporting center.

  5. The reporting radiologist is getting frustrated and burnt out with the increasing workload.

    As your diagnostic center volumes increase it may become more difficult for your radiologist to cope with the workload. In such situations, teleradiology can be a helpful backup to direct your excess case workload to a teleradiology reporting service.

  6. The radiologist is excellent with reporting xrays and ultrasounds but not comfortable with CT and MRI.

    Advanced imaging techniques such as CT and MRI are rapidly evolving and becoming more and more complex, not all radiologists may be comfortable reporting all types of exams especially pediatric, musculoskeletal or cardiovascular. In such cases, referring such complex examinations to a teleradiology reporting center can improve the quality of reporting by gaining access to a subspecialist radiologist with expertise in the specific type of examination.

  7. The center requires a backup of all the scans done without the hassle of maintaining it on site.

    Using teleradiology allows one to maintain a remote archive of all of one’s scans and reports, on the cloud, with complete security. This can be a valuable backup archive for an imaging center, so that there is never any loss of patient information or images.

The above points are a brief synopsis of the many benefits that teleradiology can afford to the promoters of a diagnostic imaging center. To help unleash the full potential of an imaging center, teleradiology holds the key today.

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How To Pick The Best Teleradiology Solution For Your Practice?

How To Pick The Best Teleradiology Solution For Your Practice?

Sep 5, 2020 | Teleradiology

With a plethora of vendors offering a RIS/PACS solution and claiming to do everything under the sun, it is not surprising that most buyers are confused and overwhelmed. Even for a discerning user, it is difficult to separate the wheat from the chaff and arrive at a short list of vendors who meet both the technical and the financial criteria. If you are managing a radiology imaging facility, then you are probably walking a tightrope between investing in technology for your radiologists and improving the bottom line for the organization. This has become a lot easier with the advent of cloud technology. The right Teleradiology software for you depends on your needs and the size of your practice. It is the 80/20 rule. 80% of the features are nice to have, but the 20% features impact the bottom line and should be considered as must haves.

Some Teleradiology providers offer an extensive range of Teleradiology software solutions with many extra features that you might not need – and will end up paying more than you actually need. Do you really want an integrated billing system? Marketing services? Do you need a Teleradiology solution bundled with contracted radiologists?

On the other hand, if you are based in a bigger health ecosystem and you need a wide range of services, you will prefer a Teleradiology software that offers an all-in-one solution.

Minimal set-up

When it comes to adopting a new Teleradiology software and then training the staff it will require a ton of resources and time. If possible, look for a web-based solution, or opt for a user-friendly Teleradiology software and simple implementation. Consider a product which has no capital investments, no maintenance costs and you can still keep your Radiology reading team excited and productive!

RIS and EMR integration

If you want to archive any transmitted medical images and radiology consults, how will you? How will these files be incorporated into your patient records? Check with the teleradiology software provider whether they offer EMR integration or compatible radiology information systems (RIS). If you are looking to archive the studies and the reports you need to make sure that they are stored in a VNA. You must be able to get out of the relationship with the vendor and move out with all your data and take it elsewhere. You need to be assured that the data is not stored in any proprietary format and is stored in standard DICOM. Check if the vendor complies with HL7 standards and HIPAA guidelines.

Patient portal

Will you be sharing medical images with your patients? Check if the Teleradiology solution provides a patient portal that allows them to share images with the patients in a hassle free manner without the printing, and couriering the media costs.

Mobile solutions

Based on your need for mobile devices, in your practice, you may want to explore teleradiology software that is mobile compatible.

That way, providers can retrieve and enhance medical images and radiology consults on their devices while on the go.

Cost

A Teleradiology solution can be an effective way to expand radiology services while saving money. However, one has to evaluate all the associated costs. Ask the Teleradiology software provider for a detailed pricing quote, in writing. Consider the below questions when doing the ROI.

How can operational efficiency and the productivity of my team improve? Can I shoot for a goal of 30% improvement or more?
  • How can I reduce the maintenance cost of my system that I purchase?
  • How can I spend more time on my business rather than on the system related stuff?
  • How reliable and stable is the company who is offering this product?
  • Can I have a full feature trial of the system before I decide to buy?
  • What is my monthly cash outflow with this system? Can I get an obligation free consultancy with an expert and discuss my needs?
  • How can my team benefit from the use of the system?
Support: This is one of the important criteria for selection. Question to be asked are
  • Does your company provide 24x7x365 support?
  • Can I see your Service Level Agreement (SLA)?
  • Do you support multiple languages in your software?
  • Do you have local support people?
  • What happens when a feature of the system does not work? How soon can I expect a response? Is there a way to replace the system? If so how quickly can it be replaced? (This is a challenge especially in an ONSITE solution and a cloud-based solution has advantages here!)

Security

Teleradiology software needs to be HIPAA compliant. If you don’t have the IT resources to configure a secure virtual private network (VPN) and set-up a DICOM router, you may want to ask a Teleradiology provider if they will help get you set-up.

While the vendors are constantly working to improve their product offerings, the end user also has to do their due diligence before the purchase. All this happens all the time in the industry but it helps to have a check-list and go through it so you don’t lose track of any specific item! Teleradiology Solution can be an effective way for small to large health systems to expand their radiology services and offer 24/7 access. Find the right Teleradiology solution now.

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Replacing existing RIS-PACS? Or a first time RIS-PACS buyer?

Replacing existing RIS-PACS? Or a first time RIS-PACS buyer?

Sep 2, 2020 | Radiology, RIS/PACS

Struggling with what to do about an outdated RIS-PACS? Or, planning for RIS-PACS for the first time? In either case, it is not an easy and simple decision to take. But prolonging the decision will not help either. There will always be a dilemma, for an existing RIS-PACS user, regarding whether to pay the upgradation cost and stick to the same old vendor who ask for big bucks for each single support or whether to replace existing PACS
with a new system which also comes with value added features such as AI algorithms in-built into the RIS-PACS. Other factors which needs to be considered before switching to a new system include the data migration costs, training costs, opportunity costs, related hardware upgradations costs, regulatory environment., cost of upgradation versus going with a new system, all these questions have to be answered.  As per expert estimate, transition and migration to a new system may take from 30-90 days. The challenge is also therefore to identify a vendor which can fast track the transition to maximum 15 days while ensuring that the ongoing work is not affected.

Finding the appropriate RIS-PACS can be a big challenge. Few important questions that needs to be asked regarding a new RIS/PACS is that it must be affordable, faster, should have prior studies uploading feature, voice recording feature, ability to integrate with third part voice recognition system such as dragon application or PowerScribe, and ability to be integrated with the hospital information system amongst the few important pre-requisites. Growing number of RIS-PACS providers are placing emphasis on reporting on the cloud feature.

What is an Integrated Radiology Information System (RIS) PACS?

PACS, or picture archiving and communication system, is a medical imaging technology used for storing, retrieving, presenting and sharing images produced by various medical hardware modalities, such as X-ray, CT scan, MRI and ultrasound machines. While digital medical imaging has brought in enormous savings for the imaging centres in terms of archival, storing, retrieval and sharing. It is the Radiology Information System (RIS), which helps manage the radiology workflow and the business.

Older RIS/PACS consisted of disparate systems – one for archiving patient images and one for storing patient records. Often, it would be noticed that the patient data in the PACS database may not be same as the data entered in the RIS database. If there is a mismatch between patient’s name or other demographic details entered in the PACS and RIS databases, then the system will not be able to correctly access all relevant records.  Such discrepancies can cause unwanted inconvenience to patients and referring physicians while also expose the facilities to unwarranted risks and legal liabilities.

Functions of RIS

Some of the key functions of RIS includes order entry; patient scheduling, assigning studies; tracking number of exams; assistance in billing etc.  A combination of the two (PACS and RIS) is termed as an integrated RIS-PACS. An integrated RIS-PACS gives radiologists or the administrators access to evidence-based insights such as which modalities are being used the most, which referring physicians are sending maximum exams, radiologist productivity, turn-around time, busiest time, days or week of the month etc.

An imaging facility stands to make enormous gain in terms of patient and financial outcomes if they choose an integrated RIS-PACS. RADSpa is one of the best Integrated RIS-PACS available on the shelf and deployable in various situations and for different kinds of facilities.

Now, what is AI-enabled RIS-PACS?

AI -Enabled RIS PACS is a platform on which resides numerous AI algorithms developed by the RIS-PACS providers themselves or those provided by niche AI companies. For example, the RADSpa RIS-PACS platform is AI enabled. So, when you go with RADSpa, you also get access to a number of algorithms. What makes this system very interesting is the fact that there are no initial upfront investments on AI part. You pay for the algorithms, only when you use them. That, too, it is pay-per-use system.

To replace or retain?

There was a time when the average longevity of a RIS-PACS would be around 7-10 years. But now in the current fast developing diagnostic imaging space where not only the volume of imaging and its complexities are growing by leap and bound but also the regulatory and privacy requirements such as HIPAA and GDPR, which is forcing radiologists to be always hard pressed for time and for quality reporting.  Any delay or hesitation in decision making can be hazardous to imaging business.

But hesitation presents hazards

Imaging facilities need to appreciate that failing behind on modernization and working with an out-of-date RIS-PACS can have serious consequences for clinical efficiency and financial health of the centre.  In addition, sticking to system which has far outlived its lifespan can also make it tough for a facility to keep up with the expectations of referring physicians, affiliated organizations and patients.

Telerad Tech, the global health IT company and one of the leading providers of integrated RIS-PACS Workflow strongly recommends that while analyzing current RIS-PACS and its vendor, an imaging facility should do proper audit in the key areas of operations such as – administrative, clinical, information technology (IT), regulatory environment and the market.

Important points to consider

For instance, if your existing PACS or RIS-PACS chokes your competitiveness, is unable to give you important insights regarding productivity of manpower, modality machines, have a confusing user interface, or simply doesn’t give you the next generation workflow tools such as workflow orchestration that optimize your productivity, you should consider a new system. Also, you should take into account the regulatory environment such as HIPAA and GDPR and go with systems which is capable of anonymizing patient data and is able to give you patient security framework (PSF) gateway, if needed. Teleradiology companies who are either reporting or have an ambition to serve defense hospital establishments, should ideally look for RIS-PACS which comes with PSF Gateway feature. RADSpa, which comes with PSF feature, is deployed at multiple hospitals under the Navy establishment in Mexico.

Making the Switch

Finally, having decided to switchover to a new RIS-PACS, a facility should first clearly define its requirement. Talk to vendors who can help you assess your current and future growth requirements.

First Time RIS-PACS buyers

For a facility which is considering acquiring PACS for the first time, they should look for a solution which offers latest productivity tools, can integrate with the existing DICOM compliant modalities amongst other features which are explained below.

Listing the requirements

Begin your process for procuring RIS-PACS, like for any other product, by listing the requirements. If possible, involve the Radiologists, Technicians, IT Team, Operations Team, and Finance Team in the process. Your list of requirements can include:

  • RIS-PACS should easily and fast integrate with existing modality machines;
  • System should be able to integrate with existing Hospital Information System (HIS) through Health Level 7 (HL7) protocol;
  • Should be able to reduce the turn around time (TAT) and increase productivity;
  • Should be able to integrate with existing PACS, without requiring any major overhaul of the system;
  • For teleradiology companies which have complex workflow and QA requirements, the facility should look for systems which has multi-read workflow management features and whose QA and peer review module facilitates collaborations as per ACR guidelines;
  • The new system should have smart features like workflow orchestration, real-time work lists, CD burning feature, multi-monitor support;
  • The RIS-PACS should meet regulatory requirements of FDA and should be CE certified, HIPAA and GDPR compliant;
  • Should have advanced 3D DICOM Viewer Features such as Minimum Intensity Projection (MIP), Maximum Intensity Projection (MIP), Multi Planar Reconstruction (MPR), and sculpting tools;
  • Radiologists/facilities often want to customize layout in the viewport using custom feature which helps standardize the workflows as per their specific requirements. So, look for such features in the system proposed by your vendor;
  • Facilities should also look for RIS-PACS which offers hanging protocol features for each specific modality machine;
  • Vendor Neutral Archive(VNAs) technology is today a game changer. VNA is enabling imaging facilities to archive and retrieve millions of medical images generated by disparate modalities from many different vendors. So, look out for RIS-PACS which is VNA compliant;
  • If you are a new and starting small, look for solutions which will be able to grow with you, i.e., look for a solution which is scalable;
  • Depending upon your specific choice, you may go with a solution which is pure cloud so that you can jump start radiology without any major investments in IT infrastructure;
  • You may go with an on-premise solution, if your already have the IT infra and manpower in place or have the capital to invest in on-premise solutions;
  • Products like RADSpa also offers something called Hybrid solution that stores images on site in the local system, while RIS is available on cloud which gives the flexibility to report from anywhere. This type of systems can potentially reduce your investments and recurring bandwidth expenditure by up to 30%.

Timing

Regardless of the fact that whether you are switching to a new system or a first-time buyer of RIS-PACS, it is the timing which is most important. The transition should be such that the normal operations are not affected. You can also go for a trial run for about a month so that your team is well familiarized with the software. RADSpa offers free trial to most of its prospects after properly assessing the seriousness of the customer.  So, go on, and go for your new system to leapfrog your facility to an integrated and AI-Enabled RIS-PACS environment.

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