Seizing the moment: How to set the stage for imaging practice growth

As reimbursement challenges grow for outpatient imaging, many practices are struggling to remain afloat. However, with the right technology, it’s very possible to stay ahead of the curve. One organization in particular is meeting the challenge head on—and is turning a difficult reimbursement landscape into a period of growth while also improving efficiency.

“There’s no end in sight for eroding reimbursement rates,” says Jeff Tumbleson, CIO at Outpatient Imaging Affiliates (OIA). “As a result, we’re continuously working to increase throughput and efficiency while maintaining a patient centric, high quality experience. Every patient encounter counts.”

OIA partners with providers large and small to offer outpatient imaging services. OIA’s customers range from large health systems, where the organization provides outpatient imaging solutions, to radiology groups that provide the professional reads while OIA supports with management, billing and infrastructure services.

Toss in a portfolio of wholly-owned imaging sites, and OIA has a total of 37 locations from the east coast to Colorado. Needless to say, having the right technology to manage this complex workflow is a must.

Time for an upgrade

Given a diverse set of offered services and wide geographic footprint, OIA recently set about upgrading its IT systems with an eye on improving workflow, explains Tumbleson. Legacy RIS and PACS products from Merge Healthcare, an IBM company, of whom OIA has been a client for a decade, needed to be updated with the latest functionality.

In early 2015, the upgrade conversion began. Tumbleson explains that OIA did a wholesale “forklift installation” of Merge’s ambulatory stack of solutions, including migrating data into the latest Merge RIS™ platform and transferring all images into Merge PACS™. At the same time, OIA began leveraging Merge’s cloud-based image archive, iConnect® Cloud Archive, for disaster recovery.

It was a lot to bite off at once, says Tumbleson, but Merge compartmentalized the project on the front end and taught OIA how to be more autonomous, including usage of Merge migration tools. “It speaks volumes about Merge’s comfort level with us and our ability to manage a project like this, but also speaks volumes of Merge’s ability to off-load that kind of product knowledge to our product team.”

Using a “train the trainer” approach, Merge helped staff and technologists get a handle on the new RIS while supporting OIA’s IT staff to keep things running on the back end. All told, over a 12 month period, the project went from pre-training to multiple successful go-lives in record time.

Diverse needs, diverse solutions

Part of what has made OIA so successful despite modern reimbursement woes is its referring physician engagement strategy. OIA staff make sure referrers are well connected and constantly work to meet them where they are. For some physician offices, this means HL7 bidirectional interfaces for orders and results. However, this level of integration is the highest and has costs for the referrers, so some providers may want options.

For those sites, OIA turns to Merge’s iConnect® Network, which allows results to be delivered to referrers’ EMRs through a secure direct message protocol and leverages iConnect® Access as the universal image viewer. If a particular physician’s office isn’t addressable through that protocol, another option is real-time HL7 interfaces from Merge RIS™, in which OIA uses its enterprise interface engine to broker connections to referring physicians’ EMRs.

There’s also the Merge Referral Portal™, which allows referrers to view images and reports and request studies. “From our perspective, access to a number of portal products, a true zero-client, multi-platform, multi-browser capable solution…makes it a really clean process and one that doesn’t require a lot of support,” says Tumbleson.

The goal for OIA is to be the “path of least resistance” for scheduling outpatient imaging, according to Tumbleson. This includes everything from efficiency of phone systems to scheduling, from patient check-in to payment and check-out.


Another area where OIA has recently made significant improvements is standardizing order sets. Tumbleson says it’s easy to wish that most imaging centers were the same in this regard, but as OIA kept acquiring centers, its staff found this wasn’t the case. Over time, the organization added up to 4,000 orderable procedures—many of which were essentially the same study with different areas of focus, such as CT of the head versus CT of the brain.

Using the updated Merge RIS, OIA sought to “get back to basics” and created a trimmed down, standard list of orderable studies across all imaging centers, which was a boon for centralized scheduling. “When you’re looking at rolling out something like patient reminders, it helps that you’ve got a standard set of orderable procedures,” says Tumbleson.

Looking ahead

Tumbleson says his organization isn’t done improving, and is eagerly awaiting additional upgrades on the horizon. The next version of Merge RIS, for example, will include an enhanced scheduling module to streamline processes and reduce clicks for the user. “It has to be a simple process that can be easily repeated. That’s what drives the business for us.”

OIA has been a user of Merge Financials™ for a number of years, and Tumbleson says it has allowed staff to be more efficient in processing claims. Merge Dashboards has helped accounting staff get a better handle on month-to-month operations, but Tumbleson says OIA is just scratching the surface here. The organization is looking to fully use these tools to examine throughput and the flow of patients through imaging centers. With the recent standardization efforts, OIA will be able to make the most efficient use of equipment and manipulate schedules to squeeze in those extra patients, eventually functioning in a highly-automated, electronic forms environment.

While reimbursement challenges will no doubt linger, OIA has found itself in a position to not only survive, but to thrive and expand. “Things have not slowed down for us,” says Tumbleson. “We’re going to have an extremely busy summer.”

This optimism stems from Merge’s dedication to understanding the needs of its ambulatory-focused customers. “There are many RIS and PACS solutions out there, but few of them take [ambulatory workflow] into consideration from the scheduling of a patient through precertification to checking patients in. Merge listens to customers and provides better integration for ambulatory markets,” he says. “It’s just that simple.”