Customer Stories
Metro Imaging, LLC - (PDF Version)
Situation
Metro Imaging is a full-service, multi-modality imaging center with five locations in the greater St. Louis area. Established in 1994, this physician-owned and operated outpatient facility performs over 98,000 procedures per year.
In 2002, it became clear to Metro officials that its burgeoning practice was putting a strain on their existing RIS, a competent solution that had served Metro Imaging well for years. The problem was that there was no single centralized RIS database; each of the five locations had to operate dedicated databases.
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Christine M. Keefe, CPA
Chief Financial Officer
Metro Imaging, LLC
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“If we had to run a practice report, we had to go to every site,” says Chris Keefe, Metro’s Chief Financial Officer. “Plus, it had an outdated DOS operating system. Since we couldn’t upgrade it, we determined we needed to replace it either with the current RIS vendor’s product or that of a different provider.”
In addition to Metro Imaging’s RIS needs, the fact that each of the five Metro locations maintained its own image archive was looming on the horizon as a liability. The study volume at one of the five Metro sites exceeded the capabilities of a single radiologist, yet wasn’t high enough to justify the expense of hiring another radiologist; both high-salary employees would end up being underutilized if they split the workload. A centralized PACS archive that networked all locations would better distribute Metro’s entire case volume.
Ultimately, Metro Imaging embarked on a three-year process that involved sequential acquisitions of RIS, PACS and digital mammography solutions.
Requirements
Metro Imaging officials had intended to stick with their current RIS provider out of loyalty and an assumption that it would address the center’s growth requirements. Unfortunately, they discovered late that replacing or upgrading the RIS simply would not work, and the timeline for implementing a new system was growing perilously short.
The RIS that Metro envisioned would need powerful scheduling and reporting systems, particularly to satisfy referring physicians. Accordingly, a referring physician web portal also was a key requirement to provide reports, at least until integrating a PACS solution would permit referring physician access to both reports as well as images.
To satisfy the imaging center’s need for an image archiving solution that would unify Metro’s locations, officials emphasized a low maintenance PACS to account for the complete absence of an IT staff in 2004, the year they began evaluating PACS options.
“We wanted a PACS that was easy to maintain and did not take a lot of internal effort,” Keefe says. “The implementation would have to be a turn-key event and, above, all our radiologists were very insistent that the PACS and RIS be integrated, so that performing case review would be easier and more streamlined.”
Metro staff also was interested in tools to further streamline workflow, including integrated document management and digital dictation.
Since Metro Imaging was investigating the acquisition of digital mammography in 2006, a key radiologist necessity was that it did not require adding a second workstation. “They would not accept another workstation,” she notes. “Digital mammography would have to be on our existing workstation.”
Solution
Merge representatives had taken a keen interest in Metro Imaging as the type of center that could benefit significantly with its RIS and PACS solutions, and were in the habit of checking in with Keefe periodically by telephone. By coincidence, a Merge salesperson called Keefe the day after she and her colleagues had concluded that their existing RIS would not address their expansion challenges, particularly the aggressive RIS implementation schedule.
“Merge was able to meet our timeline for installing the Fusion RIS, which was huge,” she remarked. “We knew from RSNA trips that the RIS’s reporting capabilities were excellent.”
The Fusion RIS, installed in August 2003, included Merge’s Practice Analysis™ module, an interactive tool for data mining that enables a practice to proactively analyze referral, staffing, modality and productivity trends with user-friendly reports and multi-dimensional graphics.
With the successful implementation of Fusion RIS, Merge’s Fusion PACS was “our natural choice,” when timing became critical for PACS, Keefe notes. Fusion PACS and Referring Practice Portal went live in October 2005, concurrent with RIS upgrades, including digital dictation and integrated document management.
Acquiring the RIS and PACS from the same vendor enabled seamless integration, Keefe adds. “Integration of the RIS and PACS – to create the Fusion RIS/PACS – was terrific, better than we had ever imagined.”
The latest addition a year later was Merge Mammo, which provided Metro with digital mammography capabilities without adding another piece of workstation hardware.
Results
From the start, Fusion RIS unified Metro Imaging’s five locations in a way not possible before, facilitating reporting capabilities for all sites concurrently – in a new RIS solution that streamlined and integrated information workflow. But this was just the beginning of Metro’s journey.
In October 2005, Metro Imaging went live with Fusion PACS, integrating the PACS with the Fusion RIS seamlessly. “Implementation was a breeze,” Keefe recalls. “Ongoing administration has been pretty simple; we have one IT person, but he is doing everything, not just PACS. For a small company that doesn’t have a lot of IT resources, this has been a great solution for us.”
The centralized PACS archive immediately obviated hiring an additional radiologist, as studies could be accessed instantly from any of Metro’s locations, she adds. The PACS also enabled Metro to introduce a new service called OnSite Results (OSR), which provides patients with preliminary findings of their imaging examination presented in lay terms and handwritten on a specially designed card (below) – all before patients leave Metro Imaging’s doors and at no additional charge.
“With OnSite Results, the radiologist evaluates the patient’s exam and, in most cases, can give patients the peace of mind they really want,” Keefe explains. “We can let patients know if the exam is ‘normal,’ or shows ‘no remarkable abnormality’ and many other informative descriptors. Referring physicians still get their usual report from our site. Metro couldn’t offer this service without our efficient RIS/PACS workflow, because if one of the radiologists was occupied, the case can immediately go to another radiologist via general or assigned RIS worklists.”
The concurrent RIS upgrades that added digital dictation and document management also contributed to better workflow, Keefe notes, particularly digital dictation.
“From a transcriptionist perspective, I’ve been amazed at how beneficial digital dictation is,” she says. “Now, if a transcriptionist calls in sick, it’s not a workflow issue anymore. We don’t have to shuttle people around the locations. The dictation wav files are all on the dictation worklist for any available transcriptionist to pick up the workload regardless of their physical location. Previously, it was strictly one transcriptionist minimum per site. Today, I think we saved hiring one to two additional transcriptionists.”
For the last several years, Metro Imaging officials have been using the Fusion RIS Practice Analysis™ module to gather operational data on their imaging organization. In fact, the practice analytics tool has yielded sufficient data to inform and plan Metro’s entire advertising strategy. “We broke out our patients by age, gender and ZIP Code to target the radio stations that we were advertising on,” Keefe remarks. “We love this capability and use it all the time to assess our referral patterns for the marketing staff to guide them to promotional opportunities.”
In one Practice Analysis exercise, Metro simply analyzed the gender ratio, finding – not too surprisingly for a center with a strong mammography service – that 66 percent of Metro Imaging’s patients are women. However, even when mammograms were extracted from the analysis, Metro’s patient breakdown still skews 60 percent female. “That was interesting,” Keefe recalls. “You would have thought the ratio would have been around 50/50.”
Finally, Metro harnessed the Practice Analysis tool to help evaluate which imaging services could be offered cost-effectively on Saturdays. In the past, CT and mammography had been dropped from Saturdays, but Practice Analysis indicated that those modalities should be re-added to the weekend, in large part due to the workflow advantages of integrating PACS.
The ability to launch their Merge Mammo digital mammography application directly from Fusion PACS was the main rationale for acquiring the solution in October 2006, she observes. Coincidentally, Merge Mammo also was the most cost-effective workstation application. “ Although Merge Mammo is a multi-modality workstation, we still saved money by avoiding the cumulative cost of purchasing several of the modality vendor's dedicated mammography workstations. By acquiring Merge Mammo and new monitors for our existing workstation, instead of five dedicated workstations at $37,000 per unit, we saved $185,000,” she says.
Merge Mammo’s multi-modality capabilities have contributed immensely to optimal patient care, adds Metro radiologist and CEO, Harley Hammerman, M.D. “On this single workstation, I can interpret mammograms and sonograms, so if I see a lesion on the mammogram, I can then read the ultrasound study to determine if it’s a solid lesion I can biopsy,” he says.
Merge Mammo integrated seamlessly with Metro Imaging’s digital mammography system, the Siemens MAMMOMAT. “The doctors can actually annotate on the images and then send them back to the Siemens machine, so that technologists could see the work(?) they need to spot,” Keefe notes. “The radiologists were shocked that they could do that.”
After a year of using Merge Mammo, clinicians now are starting to reference priors that have been accumulating in the PACS, and which also are available on the Referring Practice Portal along with current studies. “Merge Mammo has been an awesome product for us,” she says.
Although Metro Imaging never signed a long-term, multi-product contract with Merge Healthcare, each time the imaging center found itself ready to build upon its informatics capacity, Merge was ready to offer a solution, Keefe said. “From the Fusion RIS on, every time we needed something – whether it be PACS, digital dictation, document management or digital mammography – Merge was there with the perfect product for us.”
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