Hill Country practice is PACS-flavored success story

Nine years ago, when radiologist Kevin Barker, MD, joined the solo practice of Dr. Anson Cone, Community Radiology Associates (CRA) covered one imaging center and one rural hospital, and enjoyed high regard from referring physicians in the Texas Hill Country, a vast, 25-county region marked by rugged hills separating Austin from San Antonio.

Today, the practice employs 13 radiologists for a total of 15 and covers 70-plus sites, including rural hospitals, imaging centers and physician offices, interpreting close to 300,000 images annually. It is a success story that came to be thanks to choosing just the right web-enabled PACS for CRA’s needs.

“In the past, where you sat is what you read,” Barker says. “Your income/revenue stream was based solely on how busy the site was where you were working. Now, we as a group would be handcuffing ourselves if we still worked off of that model. To maximize efficiency, productivity and thus income, a radiologist/group MUST have the ability to move studies from one site to another and from one radiologist to another in an attempt to place the appropriate type and number of studies in the hands of the most qualified and capable radiologist.”

As Barker explains, two years into the partnership, the radiologists acquired what he called a pseudo-PACS so that they could read stat images from home in the middle of the night. They soon tired of the slow download times and upgraded to a better system.  By the time they had grown to between approximately 20 sites, including four rural hospitals, they knew they needed a more robust solution and again went shopping.

“About five years ago, I looked at multiple different PACS, and Viztek was the perfect solution for my practice,” Barker says. “I could buy my server, house it where I chose, and with the web-based platform, my partner and I, wherever we were, could divide and sort the studies between the two of us so that we could optimize workflow and report turnaround times.  For instance, I would put four or five sites on my "to be read" list and he would do the same on his, and we were very quickly able construct not only our workflow but also out entire workday in the most efficient way possible.”

Prior to implementing Viztek’s Opal-RAD, Barker spent at least an hour each day logging onto a multitude of different hospital or doctor’s office PACS, reading a handful of studies from each site, and logging off only to log back on to the next site's PACS, over and over, all day long.

“When I went to Viztek, my productivity improved 40 to 50 percent just by reading all of my sites studies on one PACS,” he recalls. “I went from being super busy every day to where I was done by 1 o’clock in the afternoon. I then realized, ‘We’ve got to find more sites!  There is so much more I can do in a day with this new PACS platform.’”

A growth path

With time on their hands, the partners hired a Business Development Director Michael Cox. “He started pounding the pavement and spreading the word, and we picked up more hospitals, more imaging centers and more doctor’s offices,” Barker says. “Today, we have 70-plus sites, all across Texas.”

CRA’s clients are diverse, ranging from a 110-bed hospital down to a doctor’s office that sends three x-rays a day. “We are a perfect hybrid,” Barker says of the business model. “We have 15 radiologists, some full time, some part time, but we have eight different radiologists working on any given day, in locations around Austin and San Antonio. Those eight FTEs are not reading only the hospital where they are located, but we are shipping in via teleradiology from hospitals and sites all over the state to each radiologist.”

Almost all sites—with the exception of the large hospital clients—are read off of the Opal-RAD PACS, providing efficiency previously not enjoyed. At 5 p.m., the night shift comes on, and all studies are sent to Viztek and consolidated on one worklist. “Evenings and weekends, each radiologist reads from home,” Barker says. “All have the same workstation at home that is onsite at the hospitals.”

Throughout the five years that CRA has had the Viztek PACS, the practice has grown along with the solution, Barker says. “Viztek has made it very efficient over the years by listening to what radiologists want,” he explains. For instance, Barker, a diagnostic radiologist, as well as all other group members, have the ability to customize their toolset.

Consolidating onto one worklist turned out to be the growth engine the practice sought. “We had to figure out how to buy that first server and the Viztek platform,” Barker recalls. “Once we did that, that took us to the next level.” Now, when Barker contracts with a new hospital that wants an onsite presence, he asks Cox to find two to four teleradiology accounts to supplement additional volume thus justifying hiring another FTE radiologist.  The entire model is now based on and runs on optimizing efficiency.

Bringing new sites onto the system has become quite straightforward, says Cox. If the client has a capable IT person, what used to take a day or two literally takes 30 minutes. “It’s not so much VPN connections anymore," Cox says. "We are able to use Opal Forwarder, which acts as a VPN, maintaining our security integrity exactly like a VPN. We do not have a need to coordinate several people from several departments or incur all of the man hours it normally takes to create and support a connection like a VPN."

Once the software is downloaded, automation, encryption and compression are started automatically and the site is ready to send.

Efficient and user-friendly for all

Barker says the Viztek platform works as well for the referring physicians as it does for the radiologist, cutting down on distractions that are not patient-care related. “Viztek has allowed the group to streamline workflow and report distribution so that our radiologists are getting study- and patient-related questions and not, ‘Where’s my report?’ and ‘Why can’t I find it?’”  The ease of use of my PACS for my referrers has drastically reduced the number of non-patient care related calls and questions and has again allowed my radiologists to do what they do best, which is review and interpret studies.

Referring physicians are given a password and permitted to log onto the PACS to view the study and final report if they choose, and many of them prefer using the CRA PACS to accessing their own.

Some 60 percent of CRA radiologists live in Austin and 40 percent live in San Antonio, and all of them have high-quality workstations and high-speed Internet connections in their homes.  CRA employs all radiological subspecialties, allowing the ability to move any study to the appropriate subspecialist as needed.

“We are able to make more clients happier, because we can supply not just the efficiency, but the subspecialization,” he says. “I don’t need four neuroradiologists in Austin, four in Dallas, and four in San Antonio. I just need four, because I can direct studies to the correct radiologist when warranted.”

A recent move to voice recognition, native to the Viztek platform, also enabled a big step forward in service and efficiency, much to Barker’s surprise. “We are moving well through our studies,” he says. Barker did not adopt the VR when it first became available on Opal-RAD, because there was a lag of several seconds between the time a study was opened and the VR launched—just the excuse he needed to stay with an excellent transcription service that he was loathe to abandon.

“I trained on VR and the biggest frustration of any radiologist is to be a typist, not a radiologist,” he says. However, now four months into his recent voice recognition implementation, Barker says the recent money spent on voice recognition was well worth it.  "The newest software has such amazing recognition that my overall error and correction rate on my dictations is nearly zero.  I truly am spending my time as a radiologist and not a typist these days."

Two things happened: Viztek eliminated the aforementioned lag time, but more importantly, turnaround time became a competitive issue. “You are going to lose accounts when everyone else has [VR], and they can turn reports around in a few hours and it takes us a day,” he notes.

Barker describes the VR reporting process as “almost stream of consciousness—what I am seeing right now is what I am saying,” versus the old process of looking through all of the images, then going back to try and remember what you saw when you decide to dictate the exam.   “The Dragon platform that Viztek implemented and the way that it works is just short of unbelievable,” he reports. “I can dictate a whole report and only need to change a few words.”

Since he joined the practice nine years ago, Barker estimates that today CRA is generating 12 times the volume it did the year he joined the practice. “We have really high quality and respected radiologists,” he says. “But I attribute a lot of our growth to how we have maximized our efficiency and our PACS—Viztek really has been the backbone of that.”

Future plans

Ironically, for a radiologist who has enjoyed the described productivity enhancements that imaging informatics can provide, Barker is not overly focused on tracking radiologist productivity. “I am not as focused on the numbers for my radiologists, I am more focused on hiring the right ones,” Barker says. “Radiology is such a service industry. If all you are chasing is efficiency, then you have lost sight of what referring physicians and patients want, which is exceptional care.  When you can deliver the level of care that is wanted, that is, when one starts losing accounts.  Administrators, physicians, and ultimately the patients want excellent service and high quality care, and always will.  We are now able to provide that level of care yet at the same time we now supply that care as efficiently and timely as anyone else in the marketplace.”

“I look more for smart radiologists who are willing to open the door, talk to people, answer the phone and then, when they are at their workstation reading studies, I’ve tried to give them the platform and means necessary to be as efficient and focused as possible.  Happy radiologists lead to happy referring doctors which leads to continued growth.”

To pave the way for future growth, CRA is upgrading its billing capability and its PACS platform. Barker purchased two new servers from Viztek in the past six months with the goal of expanding the platform’s capability from the roughly 300,000 studies the practice currently reads to 700,000 to 800,000 studies in the next couple of years, without further investments.

“That’s the plan, he says. “With the way healthcare is changing, if we can continue to offer the service we do with this platform and the easy connectivity that we have, I think there is real growth ahead everywhere, but for us, specifically in the smaller Texas towns. With the geographic scope of Texas, if we can give the physicians here quality of care they can get in larger cities then I think they appreciate that, and that it where business can take off.”