While radiology practices and imaging center operators spend heavily on marketing liaisons to help cement favorable referral patterns, few understand the role that hands-on PACS IT support can play.
John Griffith, CRA, CIIP, RT, and CIO of Epic Imaging, Portland, Ore, operates in a market that grew from three providers of outpatient imaging to dozens. Recognizing that referring physicians had multiple PACS viewers to use and a proliferating choice of imaging centers to send patients to, Epic Imaging implemented a tiered approach to IT support, and last year added an applications specialist to visit referring physician offices, install an application, and assist office staff in understanding its use.
One year later, the applications specialist has visited several hundred referring physicians’ offices—some of them multiple times, because of high staff turnover—to install the viewing software and offer user support and training. The total referring-provider login count now stands at more than 2,000. In addition to its IT help desk, WebEx™ remote access to physicians’ desktops, and vendor-supplied marketing collateral, Epic Imaging has recently closed the loop by rolling out electronic results communications.
“The referring physician will choose the path of least resistance.”
—John Griffith, CRA, CIIP, RT CIO, Epic Imaging
Epic Imaging, which employs 20 radiologists and operates two multimodality imaging centers with 190 employees in Portland and a nearby suburb, was an early PACS adopter in 2000, prompted by the practice’s purchase of full-field digital mammography (FFDM). “We jumped on digital mammography, and Dr [Gerald] Warnock wanted a PACS for the FFDM,” Griffith explained to an audience at the GE Healthcare Beyond Conference in Washington DC on July 24, 2008.
As soft-copy reading evolved, Epic moved to a Web viewer in 2002, and the practice’s marketing representatives assumed responsibility for installing the viewer in referring physicians’ offices. At the time, there was little PACS penetration, and the center continued to print a lot of film. There were also interoperability issues. A Java conflict associated with Epic’s former Web viewer resulted in the disabling of other vendors’ Web viewers.
Viewer Confusion
By 2004, the market had matured. PACS had penetrated Portland and was no longer a niche offering, with a total of seven different PACS vendors represented in the market. “We really had a market of viewer confusion,” Griffith reports.
Because the organization had distinguished itself as the market’s premier provider of white-glove service, Epic Imaging’s management knew that it had to up the ante in its IT support for referring physicians. When Epic rolled out its current full-function Web-based Centricity® PACS-IW (then called Dynamic Imaging IntegradWeb) in 2004, it did so with a tiered approach to support that included:
- an IT help desk phone line and email,
- remote access to physicians’ computers via WebEx,
- a Web-based full-function viewer,
- CDs loaded with same Web-based viewer, and
- vendor-provided marketing collateral.
- The applications specialist was added in 2007.
A key feature of the IT help desk is an internal/external IT line that rings to all IT support staff (currently six FTEs), including Griffith, the applications specialist, two desktop support people who service 200 computers, a network service manager, and a PACS assistant. Griffith also implemented Help Desk Outlook software, through which help-desk tickets can be created both manually (when IT personnel answer the phone) and automatically (through email and when a voice message is left with the answering service).
The support staff was given the ability to access referring physicians’ computers and control their desktops, enabling them to set up instant meetings for support and provide faster resolution to immediate problems. While Epic uses WebEx, other options mentioned by Griffith include GoToMeeting®, Techinline, Microsoft® Live Meeting, and Adobe® Connect™.
“With WebEx, you can start a session, have your referring physician sign in, and they can take control of your desktop,” Griffith explains, “or you can email them a link or ask them to go to epicimaging.webex.com.”
The Applications Specialist
Replacing the marketing representatives with an applications specialist to deploy the Web viewer in referring physicians’ offices turned out to have hidden benefits. While Griffith recognized that the marketing representatives did not have the expertise to demonstrate the diagnostic capabilities of the new Centricity-IW Web-based viewer, he did not foresee the good will that would be generated by sending an expert whose only perceived purpose was to support the referring physician.
In a visit that takes approximately from one to two hours, the applications specialist provides hands-on setup and training on the Centricity PACS-IW Web viewer, tailored to the referring-office type: family practice, orthopedics, neurology, chiropractic, or obstetrics/gynecology.
The Web viewer requires no configuration for the client, but provides full diagnostic capabilities, including access to advanced visualization tools. The settings can be configured to give referrers access to the entire database or limit viewing to a physician’s own patients. “Referring physicians can burn a full DICOM CD in their office to take into surgery and view on a hospital PACS,” Griffith adds.
The applications specialist also can provide knowledgeable on-site troubleshooting. Before leaving the office, the applications specialist gives the referring physician collateral material provided by the PACS vendor and customized with the Epic Imaging logo and brand. This Boost package includes print collateral promoting online results access, sample page prints and reports, and a quick-start guide for referring physicians. “We have had so many positive comments about having a dedicated applications specialist in the field,” Griffith says.
With more than 2,000 referring-physician sign-ons established for its PACS, the next step for Epic Imaging was delivering results electronically. While adoption of the electronic medical record (EMR) by physicians is relatively low nationwide, Portland physicians are estimated to have a higher EMR adoption rate of 33% to 36%, and autofax delivery of results is unsuitable for this population.
“When referring offices invest in an EMR, they want to take advantage of the efficiencies it offers,” Griffith acknowledges. Griffith also knew that HL7 messaging via Secure Sockets Layer presented the only viable option to automate fully the population of patient results into the referring physicians’ EMRs.
Epic Imaging, therefore, invested in an HL7 engine to develop low-cost interfaces with referring physicians’ EMRs, allowing the delivery of preliminary and final reports. Options to embed a link to images have yet to be implemented, but will be implemented with Epic’s new Web portal, to be launched this fall. This project was described in detail in an article that was featured in the February edition of RadInformatics.com.
In closing, Griffith summarizes the keys to leveraging IT support of referring physicians successfully: give them what they want; solve their problems quickly; hire and properly train an applications specialist; and buy a full-featured, easy-to-use, Web-based PACS.
