Mecklenburg Radiology Associates (MRA), Charlotte, North Carolina, is the oldest continually operating radiology group in the state; its 40 radiologists and 10 physician assistants serve Novant Health’s four hospitals and nine imaging centers in the Southern Piedmont region of the state, as well as a number of other imaging centers, physician practices, and Lake Norman Regional Medical Center in Mooresville. “We’re very geographically diverse,” says Robert Barr, MD, president of the practice. “We have studies coming in from a wide area, and making sure the right people are reading the right studies at the right time is a complicated endeavor.”
The Novant facilities for which MRA reads include imaging centers that the health system purchased from MedQuest in a 2007 acquisition. That transition required special attention to the enterprise PACS, ensuring that prior studies from the MedQuest facilities were available in its archive so that patients of the imaging centers in question could be assured continuity of care. “We made a big priority out of making sure that the patient imaging history was seamless,” Barr says. “We needed it to have the same look and feel as if it were part of the long-standing integrated entity.”
Integration Paradigm
The term “integrated” is key to Barr, whose experience in his local market has made him hopeful about the patient care potential of more fully integrated health care networks. In Charlotte, he explains, two health systems have long shared the market. “There are two big entities, and they are very competitive with one another—we are very cognizant of what the other entity across town is doing, and that drives quality,” he says. “Patients here get a very high level of care.”
The integration in MRA’s market makes image sharing a comparatively easy task. Network physicians can reach Novant’s PACS through a web-based portal, giving them immediate access to both completed reports and images. In the future, Barr predicts, “Images will reside with the institutions where the exams were done, but patients will direct when those images can be shared across some sort of cloud-based system. As the changing reimbursement landscape and the push toward more integrated care accelerate the growth of these complex, integrated entities, you’ll see less and less need for sharing.
“Novant has grown rapidly through organic growth and acquisitions, and we have put a tremendous amount of energy into having one seamless archive so that we can meet the same standard for all patients, no matter where they have been,” Barr says. “If they have been to any facility related to Novant, their images are available to any Novant physician right away.”
Practice Perspective
For Barr and his colleagues, enterprise-wide image distribution has enabled the kind of subspecialization that referrers are demanding. “We have neuroradiologists, MSK radiologists, body radiologists, cardiovascular radiologists, women’s imagers, interventionalists, pediatric radiologists, and more,” he says to illustrate MRA’s high degree of subspecialization. “We are constantly rotating subspecialist coverage to a number of different hospitals and imaging centers, which is only possible with a robust solution for image distribution. We’ve worked very hard to become a highly subspecialized group and to make sure the right exams are read by the right people, wherever they are.”
He adds that this demand for subspecialized care is increasingly coming from patients as well, but that increased patient access to medical records—including radiology reports—comes with challenges and considerations of its own. “Patients can now follow along with all the care their doctors are orchestrating through a log-on to the EMR,” Barr says. “Radiologists who are used to providing reports only to the referring physician will need to be aware of the change. We tend to point out a lot of incidental findings, which can cause unnecessary concern or panic. Patients having access to reports is already beginning to change practice.”
If enterprise distribution of images can be viewed primarily as a function of increased demand for access—increased demand from referrers whose specialties become more imaging-intensive each day, and increased demand from patients seeking ownership of their medical data—then Barr is optimistic about what he calls the “institutionalization of medicine” to provide this access.
“We are going to see more and more growth of these complex, integrated entities like Novant,” he predicts. “I have seen ever more growth and integration of large institutions, and I see all kinds of incentives for that to continue in the future. Our challenge will be how to leverage the size and scope of these large entities to provide the best subspecialized care to our patients without losing the personalized focus critical to patient care.”
Cat Vasko is editor of HealthIT Executive Forum.