Merge imaging solutions help one practice establish lean, mean radiology process

Radiology has been hit hard by reimbursement cuts and regulations but the cutting-edge tools available are helping practices stay ahead of all the changes impacting the market.

Radiology Associates of San Luis Obispo, CA, uses the Merge Unity PACS™ to focus its efforts on high-quality reporting and workflow efficiency. “If you’re willing to put in the time and effort, you’re going to have a huge return on your investment,” says Stephen Holtzman, MD.

After using another system that wasn’t meeting the practices’ needs, the 13 radiologists of Radiology Associates of San Luis Obispo were attracted to Merge because the system was designed by a radiologist for radiologists, says Holtzman.

Once they made the decision to switch, implementation was a “delight” because the picture archiving & communication system (PACS) was so much better than the system they replaced, he says.

Focus on efficiency

After installation, the radiologists learned how to use Merge Unity PACS to view images as efficiently as possible. “Merge offers a lot of efficiency tools beyond simple review and analysis of images,” he says.

There are three steps to the process: gather the clinical information, read the images, and generate a report. “We can make efficiency strides in each aspect of the process.”

The practice first worked on improving the information gathering phase. Most technologists talk to their patients before the study and get key information, says Holtzman, so they created a form to help gather and organize those data. The data are directly sent to and included in the report. Important questions include whether the patient had any relevant prior exams, whether he or she has had cancer or surgery, and whether this study is a result of an injury. Having the answers to those questions “really helps us create a value-added report,” Holtzman states.

The report templates available through Merge allow for efficient report generation. Plus, users have the option to create their own customized templates for even greater efficiency. And every minute counts. If a radiologist produces 100 reports a day and can save one minute on each report, that’s 100 saved minutes, Holtzman notes. “That’s a tremendous amount of time. You can see more patients, spend more time with the patients you see, or you could spend time with your family. There’s a lot you can do with that time.”

Despite its gains, the practice has yet to hit a plateau when it comes to improving its efficiency, thanks to the Merge solution. “The more we improve, the more we realize we can improve further. It’s an incredible product. We’ve had improvements on every single step of the process,” Holtzman says.

Value-added details

The practice also created templates that prompt the clinician to give the exact information the surgeon needs. “Before, it was difficult to pass along the things you learn when you talk to your surgeons. Now, we simply rebuilt our templates so everyone is reminded of key information that needs to be included in the report. This saves a great deal of repeat dictation time.”

Radiology Associates also uses Merge technology for web-based clinical review to facilitate information exchange. Any device or computer can be used with this secure viewer to access images and reports.

Merge’s product upgrades have “definitely been worthwhile,” Holtzman says, with pretty significant improvements to efficiency and quality. “They keep listening to their customers. They’ve really pushed the improvement process.”

Aside from improvements related to traditional image viewing and analysis, the PACS solution also allows Radiology Associates to perform breast tomosynthesis. Without Merge Unity PACS, “we would have had to purchase an expensive, separate stand-alone workstation,” he says. “Merge allows you see tomosynthesis in the regular PACS.”

Merge Unity PACS also has an EHR built in that helps the practice collect the data required for Meaningful Use—a government mandate that has a significant impact on the practice’s bottom line.

Another issue at top-of-mind is the transition to ICD-10 coding. Most radiologists are scared of ICD-10, Holtzman acknowledges, because the “reporting requirements are more detailed and this is likely to slow reimbursement while we figure out what needs to be included in the reports.”

Holtzman and his colleagues, however, are using the change as an opportunity to learn what’s necessary to properly code. The system can allow you to prompt technologists to gather the details required for accurate payment. While they could call physician offices to get that information, that would be time-consuming. Having their own technologists acquire the specifics and link directly to them in the report is more efficient and convenient.

Radiology Associates have long been proponents of efficiency, using Lean technology practices to drive improvements. They made a commitment to Lean in 2013 to streamline processes and eliminate waste. Borrowing from manufacturing processes, the practice has improved its team reading pace from 12.3 cases per hour to 14.3 cases per hour over a one-year period, which represents about $500,000 in cost savings, Holtzman says. The focus is on practice-wide improvements, not individual competition because they work as a team. They hope to get to 16 cases per hour. It takes time and effort to get there, he admits, but making that commitment means “the system can pay for itself.”

On the horizon

Looking ahead, the practice is focused on making sure its templates are ICD-10-compliant. Radiology Associates also wants to incorporate national care quality guidelines into their templates.

Holtzman looks forward to version 11 of Merge Unity PACS which will offer significant improvements to the scheduling process. With 200 cases a day at three outpatient imaging centers, “to quickly and efficiently schedule patients is huge.”

It is possible to improve efficiency and quality at the same time, but you have to work really hard, Holtzman says. Focusing on the Lean concept of continuous improvement means that the whole team can achieve greater efficiency.

“The government isn’t asking us to take care of more people,” Holtzman says. “They’re forcing us to. Luckily, technology supports us. Good systems are critical for success.”

About Merge

Merge is a leading provider of innovative enterprise imaging, interoperability and clinical systems that seek to advance healthcare. Merge’s enterprise and cloud-based technologies for image intensive specialties provide access to any image, anywhere, any time. Merge also provides clinical trials software with end-to-end study support in a single platform and other intelligent health data and analytics solutions. With solutions that have been used by providers for more than 25 years, Merge is helping to reduce costs, improve efficiencies and enhance the quality of healthcare worldwide. For more information, visit and follow us @MergeHealthcare.