Single Database, Multiple Benefits: San Gabriel Valley Diagnostic Center

San Gabriel Valley Diagnostic Center (SGVDC) of West Covina, Calif., made its transition to digital imaging comparatively early, installing a PowerServer PACS from RamSoft in January of 2006. “Our Founder and Medical Director, Dr. Bharath Kumar, was quick to see and understand the potential efficiencies,” recalls Asha Kumar, MBA, MP, vice president of SGVDC. “We were spending a fortune on offsite storage, chemicals, film and processing time, and we were one of the first imaging centers in the country to make the move from analog to digital.”

By 2009, the digital revolution was well underway, and SGVDC implemented a radiology information system from another vendor to further enhance its efficiency. The two systems worked with one another, but while the integration was functional, it had its disadvantages. “We had to develop a lot of workarounds,” Kumar says. “It was a unidirectional system—everything went through the RIS and interfaced to the PACS. That meant that if you noticed a mistake in the PACS, any corrections made wouldn’t go in the opposite direction to the RIS. Soon we were having to deal with duplicate records and other workflow problems.”

Single Database Advantage

It was evident to the team at SGVDC that a unified RIS/PACS operating off a single database would solve these problems. “I was an advocate of the concept because I knew how much easier it would make our workflow,” says Velvet Canez, CRT, ARRT, associate administrator of technical and clinical operations. As both a licensed technologist and an IT professional, Canez was ideally positioned to understand the host of operational and IT efficiencies a single database solution would offer. “With one platform, everything is cleaner and clearer.”

Canez cites multiple examples of improvements that can be attained through the use of a single-database solution. “Mistakes are only corrected once, instead of having to be addressed on both sides,” she says. “The worklists RamSoft offers make everything easier because all of our staff members can see what everyone is doing and where patients are at any given time in the workflow, meaning there aren’t a lot of phone calls going back and forth between the technologists and the doctors, the front office and the back.”

There also were advantages for the Center’s radiologists, Canez says. “Radiologists were reading off the RIS and doing the dictation there, and they’d have three screens open as well as paperwork in front of them to go through,” she explains. They needed the PACS running to view the images and also have to fill out the coordinating paperwork for each patient. “With the unified RIS/PACS, everything would be right on the screen—it takes one click to call up the patient’s current study along with prior studies and reports.  Additionally, front office staff are saving time by using templates prepopulated with patients’ demographic data with only check-boxes and fill-ins for patients to complete. This helps to make the workflow as smooth and efficient as possible.”

Economic Justification

Knowing the single-database approach would improve the Center’s workflow and efficiency was one thing. Justifying the new RamSoft PowerServer RIS/PACS from an economic perspective was another. “We demo-ed the RIS in 2011, but didn’t move forward at that time because we were functioning with the RIS we had at the time,” Kumar explains. “Although it would have been more efficient to have the RamSoft RIS, we couldn’t make the dollars ‘make sense’ at that time.”

Then, the Meaningful Use (MU) program was announced by CMS, and suddenly the budgetary picture looked better. “RamSoft was the first product in the mid-level market to be certified for Meaningful Use, and that’s when implementing their RIS-PACS platform truly became plausible for us,” Kumar says. “I would have been uncomfortable doing MU with a separate RIS and PACS—I wanted a unified product.” The financial incentives associated with achieving Meaningful Use only sweetened the pot. “The rebates are great,” she points out, “but the penalties alone are what makes attesting a no-brainer.”

The increasing competitiveness of the imaging market also played a role in Kumar and Canez’s decision. With PowerServer RIS/PACS, SGVDC would be able to offer such conveniences as online scheduling to their patients, and a web portal for referring physicians to view results and images. “We’re all vying for the same market share,” Kumar notes. “[That] makes it critical to differentiate yourself on service, convenience, and accessibility.”

Implementation and Utilization

Implementing the new RIS was a process the SGVC team was dreading. “It’s a huge undertaking to switch to a different RIS for anyone, and because we had already switched to digital in 2006, we had an unusual amount of data—eight years’ worth, over 150,000 patients,” Kumar recalls. “The beauty of this decision, however, was that all the data could stay in RamSoft’s single database application, and since we were already running Ramsoft’s PowerReader PACS system, our integration was even easier.”

In the summer of 2013, the Center pulled the trigger on the new RamSoft RIS and began the implementation process. “RamSoft’s Implementation Manager, Greg Weiner, became like a member of my staff,” she notes. “He was a part of our team from the day I signed the contract, migrating hundreds of thousands of patient records for us – and held our hand throughout the process.”

Staff were trained using five- to 10-minute e-learning modules that they could complete online at their leisure, followed by three days of pre-implementation onsite training and two days of post-implementation on-site training. “The rollout is only as successful as the implementation team the software vendor gives you,” Kumar notes. “The RamSoft team found out what the pain points were in our workflow, and matched the implementation and training to that. Even technologists who weren’t especially computer-savvy found this process easier than our previous RIS implementation.”

SGVDC went live on the single-database PowerServer platform in November 2013. Following their first quarter using the system, Kumar and Canez report nothing but high marks for Ramsoft’s PowerServer RIS/PACS from themselves, their technologists and their radiologists. “It’s important that your software vendor be a true partner to you, and that’s the experience we’ve had,” Kumar says. “Overall, everyone is quite happy with our decision to implement a new system, and the benefits of going unified.”