Summit Radiology CEO Mark Schaefer: The Role of IT in Building the Practice

The story of Summit Radiology is in some respects archetypal: the story of the modern radiology practice. Responding to changes in the health care regulatory and reimbursement environment in the late 1960s, staff radiologists at St Joseph and Lutheran Hospitals in Fort Wayne, Ind, formed Allen County Radiology Associates, Inc, and CFB Radiology, Inc. In 1995, those two groups merged to form Summit Radiology, PC, again in response to the challenges of the health care marketplace. Currently a 39-radiologist group, Summit services 13 area hospitals and 14 outpatient imaging facilities (none are owned by the group). Summit owns and operates a dedicated interventional-radiology outpatient clinic. All sites collectively generate more than 700,000 procedures annually. The glue that holds the workflow together is a practice-owned PACS, RIS, and voice-recognition system, maintained by an internal IT department. Mark Schaefer, who has been associated with the practice in various capacities since 1987, became the CEO in June 2007. He agreed to discuss the role of IT in building the practice with ImagingBiz.com ImagingBiz.com: At what point did the practice see the value of IT? Schaefer: We began seeing value in 1999–2000 with our own PACS, which consisted of several stand-alone RadWorks workstations and one PACS at a major hospital. In 2005, we upgraded our PACS to eMed to handle increasing volumes from some of our contracts that did not have PACS (but were digital), and to give us a platform to consolidate some of our after-hours work. Now, we are replacing the eMed system with FUJIFILM Synapse, which we feel will allow us to go to the next level with our practice. ImagingBiz.com: How did you approach the challenge of wiring the practice? Was there a master plan initially, or did one project lead to another? Schaefer: Summit built this network solving one problem at a time, initially. As we obtained new reading contracts, we needed to be able to give them 24-hour interpretations, while at the same time using our resources, the radiologists, in the most efficient manner. In order to do this, we established links using dedicated T1 lines and, depending on the site, either funneled the studies into our eMed system for off-hours reading or had a PACS station for that hospital located in our central reading room. As we've continued to grow, the number of PACS stations and dictation microphones in our reading room has increased tremendously. Now, it is at the point where, at times, the radiologist can get confused as to which PACS to use to read a particular case. At many of the hot reading stations dedicated to emergency-department or subspecialty work, the radiologists may have upwards of four different PACS to choose from, anywhere from six to eight monitors on their desk to work with, and four or five dictation microphones that they have to use. We've feel we've hit the threshold of what a practice can do in this manner, and we may have even gone beyond it. Now, we are educated enough to have a plan and are taking our practice to the next level by integrating all of the sites we read for onto a common platform of our own to improve our efficiencies. To accomplish this, we've hired a CIO with years of PACS and project-management experience to plan, coordinate, implement, and integrate all of our sites. We've built an entire new server room from the ground up with this project in mind, using the latest in hardware redundancy, virtualization, backup power, and network redundancy to make sure that our new system will be up and running 24/7, 365 days a year. ImagingBiz: Would you provide some examples of how IT is affecting the clinical, operational, and management arms of the practice? Schaefer: Prior to PACS, we had radiologists who would be unproductive due to the fluctuation of cases at any particular site. The radiologist was scheduled at a site and interpreted all cases. If it was a light day, there was nonproductive downtime because the radiologist had no way to get to other work. In addition, difficult cases had no way to get to our subspecialists. Today, we are able to manage the workload more evenly by dispersing the work across many sites and directing cases to subspecialty radiologists for improved patient care. As a group, we like to identify a radiologist’s sweet spot. With our latest business model, radiologists will be fed the cases according to where they are most productive and most knowledgeable. This makes for a better work environment for the radiologists, highest-quality interpretations for the referring physicians, and overall better care for the patients. ImagingBiz.com: What have you committed in resources, including people, money, and time? Where does IT stand as a line item in the budget, and how has that changed over time? Schaefer: We have gone from one employee and our initial PACS to a department of five, including a CIO. Approximately 26% of our overhead goes toward IT today. The return has been well worth the investment. ImagingBiz.com: In these difficult economic times, many practices and departments are taking a hard look at their FTEs and considering what can be outsourced. Are you outsourcing any of your IT functions? Schaefer: We prefer to have as much control of our infrastructure as possible so that we are not dependant on others. By hiring in-house talent, we do not have to rely on outsourced vendors. We have found that we are able to get better response times when issues arise because our people know the systems and entire enterprise infrastructure—as well as our radiologist workflow—much better than an outside firm could. We still outsource some of our higher-end networking with a local company that we have developed a good working relationship with; it has more experience in dealing with the telecommunications side of things than we do, and we've found it to be an extremely valuable partner. Next year, we also plan to work with it to develop a disaster-recovery plan, using its data center to mirror our servers. This will allow us, in the event of a massive catastrophe, to make a few minor network changes and have our entire infrastructure back up and running, at a different site, within minutes. ImagingBiz.com: Some practices that have made considerable investments in their IT capability are finding that there is a market for providing these services to practices and hospitals without this expertise. Is Summit leveraging its IT investment in this way? Schaefer: Yes, our IT team has years of experience in managing PACS, integrating disparate systems, and managing workflow. For many years, we have provided this service out of the necessity to move images and to help our radiologists to become more efficient; today, we are creating revenue opportunities with our IT investments. We are providing consulting services to other local imaging centers and physician groups to help them set up better imaging workflow within their practices. We are providing desktop support to our major customers. We are looking at providing PACS administrator services to clients on the Fuji system. ImagingBiz.com: You have a sophisticated Web site, including the ability for patients to pay their bills online. Tell me more about the site (including the protected area for referrers) and what role the Web plays, and will play, in practice development? Schaefer: Summit has recently revamped the Web site and, in the future, plans to augment the site with links to our PACS for referrers, as well as for expanded document access to our sites. Image access for referrers provides a wonderful opportunity to communicate via technology with our referral base; maintaining and educating this referral base is vital to our practice. In the future, such image access will allow us to achieve the same close relationship with referrers physically distant to our practice as we have always been able to maintain on a regional level. Keeping sites up to date with constantly evolving protocols and new procedures is always a challenge, but a challenge we find easy to diminish by providing ready access to these documents on our Web site. ImagingBiz.com: Ultimately, how will IT and the Internet shape Summit specifically, and radiology in general, over the next five years? Schaefer: The radiology industry has seen many changes over the past decade. We feel the successful future radiology groups will be those that can swiftly integrate multiple sites and that have the ability to move images and provide subspecialty interpretations from and to any location, with optimal workflow efficiencies.