Mecklenburg Radiology Associates (MRA), is a key imaging services provider for Novant Health, a multi-state hospital system that primarily serves the mid-Atlantic region. Based in Charlotte, NC, MRA is a main provider of regional imaging services to healthcare consumers in the greater Charlotte region. Jay W. Patti, MD, radiologist and MRA’s chief radiology informatics officer since 2008, offers his perspective on forming a successful regional imaging strategy and servicing one of the largest hospital systems in the country. From growing and streamlining operations within the group to successfully collaborating with other radiology groups, MRA provides a great example of regional imaging best practices that can be shared across the industry.

Growing with your partners

Like MRA, which is the oldest radiology group in North Carolina, Novant Health Presbyterian Medical Center has a long history within the region. Over time, the facility underwent considerable expansion and growth, via mergers, acquisitions and new construction. Because MRA expanded with the growing hospital system, providing the desired subspecialty clinical and radiologic oversight, the relationship with the hospital system has strengthened continually. Novant Health was formed when Presbyterian Hospital based in Charlotte, NC, merged with a leading healthcare provider in Winston-Salem, and has continued to grow, now providing services in Virginia and Georgia.

Providing radiology services to meet the current and future needs of a hospital system such as Novant Health requires substantial strategic planning for necessary subspecialty coverage. Early on, radiology groups were challenged to provide subspecialty interpretations needed by large facilities due to the analog nature of film radiology. PACS created a means for groups to efficiently distribute studies for subspecialty interpretation and paved the way for MRA to assure that the appropriate subspecialist would interpret the examination best suited to their specific expertise.

“One of the first things a radiology group can do in a situation where its hospital system is experiencing that kind of growth is to fully understand the needs of that partner,” Patti explains. “Being able to strategically align your services to meet the needs of the hospital system is critically important. Proactive management in this situation also demonstrates additional value that your group brings to the hospital system.”

“Investing to meet the growing needs of our partner institutions is one of the reasons I was brought in to MRA in 2008—to help fulfill the growing demands for subspecialty musculoskeletal radiology interpretations,” Patti continues. “Having a PACS like McKesson Radiology that helps to deliver the appropriate study to the appropriate radiologist at the appropriate time, empowered us to grow with our growing partners.”

With operations in three states, Novant Health has relationships with other radiology groups, and MRA is working collaboratively with several of them to ensure that they collectively are meeting the needs of their partner. In doing so, MRA also has discovered, documented and implemented new strategies that will take those combined services to the next level.

“Again, a really important factor in servicing a large hospital system is to be proactive,” Patti says. “MRA is working with other radiology groups that service Novant Health because we know that, together, we can provide a seamless service in the region for Novant’s patients, and we can also streamline things such as workflows and reporting.”

Sharing with peers

A significant outcome of the groups’ collaboration was recognition of their ability to share, streamline and align certain protocols and reporting practices to increase consistency in the eyes of the hospital system and patients.

“Financially, there isn’t direct incentive to collaborate, but ultimately, both radiology groups want to provide a consistent service,” Patti adds. “We’ve been able to find and maximize efficiencies that align some of our protocols and reporting. While some protocols can’t be exactly the same, due to differences in equipment, for example, we can certainly find ways to make them as consistent as we can across the region.”

Technology investments also have helped MRA grow to meet its partner health system’s needs. While PACS definitely enables easy distribution of studies for subspecialty reading, other features of the system enabled efficiencies to be maximized among all radiology services providers

“MRA developed a creative way, using a McKesson Radiology worklist within our PACS, to prioritize STAT reads,” Patti explains. “It has been working well for us, and we offered the worklist design to our partner groups. Another great example of the benefits of our collaboration can be seen in our ultrasound protocols. One group had very robust ultrasound scanning protocols, and another had very good technologist worksheets. By combining the two, we have one standard ultrasound protocol and set of worksheets used across the Novant Health system.”

The radiology groups are now collaborating to ensure that Novant has a robust, state-of-the-art critical-results workflow that can be used across the enterprise. McKesson’s Qualitative Intelligence Communication System, known as QICS, is a tool that may be able to fit that need and will be evaluated collaboratively by radiology groups working with Novant. Ensuring consistency in a regional imaging strategy is important in terms of protocols, workflows and reporting, but is also important with respect to healthcare consumer expectations, according to Patti.

“Another good reason for MRA to collaborate with other Novant radiology providers in the region is that there shouldn’t be arbitrary differences in the types of services provided by different radiology groups in the same region. The expectation is that the service be identical or as near as possible.”

Reporting consistency

A major initiative that Patti is currently working on in his region is structured reporting. The use of structured reports in radiology will allow the uncomplicated retrieval of pertinent information for the report reader, by using a common structure for the report, or a template, that enables the reader to extract information quickly. The information could also be used to support monitoring for quality improvement, reducing errors of omission and improving patient safety.

“Our goal is to capture information in a consistent way and display it in an organized fashion,” explains Patti. “Structured reporting is already popular in academic institutions, and its importance is becoming more and more evident. It is definitely achievable within one radiology group, but considerably more challenging to standardize across groups.”

Either way, efforts to provide consistency of care across hospital systems will benefit not just the system, but referring physicians and patients as well. While MRA has met the needs of needs of Novant Health as it has grown in size over the last decade, the challenges of the next decade will undoubtedly be different.

Federal mandates to use electronic medical record technology meaningfully necessitate that radiology groups have a strong understanding of clinical and radiologic informatics. Prudent acquisition and implementation of technology, savvy infrastructure design and efficient physician workflows, as demonstrated by MRA, are among the must-have skillsets for future success.