Let’s face it. Today a PACS is a commodity …has been for quite a while.
Most PACS and for that matter RIS on the market can do most everything………..at least that is what the brochures claim!
For a Tele-radiology application, these are some of the important requirments:
What are the workflow features it supports?
How easy is it for a Radiologist to set up a practice for himself or herself?
How many reports can the Radiologist dictate in a day?
What is the cost of ownership?
Let’s take the last one first!
Today, reducing reimbursements from insurance companies, increasing competition across the globe, and the need to provide quality care in spite of all the above - are forcing owners of imaging centers to question the cost of ownership.
This is where the cloud based solution brings value to the table. With a cloud based solution, the vendor is responsible for the high end redundant servers housed in a class III or similar data center, disaster management solutions, archiving studies and reports for 7 years or more. This solution provides a very low or practically nil cost of ownership.
The Radiologist or the owner can focus on building the business, signing up new hospitals, and bringing the bacon home! The cloud based solution gives him lot more flexibility and freedom to go after new prospects even if they are not in the same state or even the same country.
The number of reports a Radiologist can generate in a day translates to profits. The system must be simple to use and the reporting engine and viewer must allow him to dictate as quickly as possible. Interface with a Voice recognition system, easy content (text and audio) exchange between the Radiologist and transcriptionist, peer review with ABR codes, QA, real time collaboration between different stakeholders are some of the features to look for in a system. The Radiologist must be the last link in the chain and studies / images must reach him only when they are complete in all respects, thereby saving his valuable time. Some systems have the reconciliation feature that handles this part of the assignment. The system must support all DICOM modalities which can be added any time later with ease and also support non DICOM for use with legacy modalities.
The system must be simple to use and more importantly easy to install. The Radiologist must be able to start his business or add a new hospital within hours thereby generating confidence in his business. If the hospital or clinic that is sending studies provides a VPN -then the issue of encrypting, security, and safe transmission are taken care of and there is no need for any hardware purchase by the Radiologist. If not, a simple PC that can house the DICOM router software and route the studies fast and efficiently to the central server, is sufficient. The system must also be universal such that it should not need any proprietary hardware for viewing and should be able to log in from any browser. Viewing and distributing images on a mobile device is becoming ubiquitous today and helps the Radiologist to take instant decisions from an airport or a coffee shop!
Last but not least the workflow features are very important. It is indeed an irony that when you mention workflow, most people have the “deer caught in the headlights look”. The workflow is the most important factor which contributes to the productivity and thereby to the bottom line of the enterprise. Some systems provide a “soup to nuts” solution for workflow from capture to archive while some provide certain modules. Here it is important to get a standard off-the-shelf software that can be customized -rather than develop one from scratch and make it proprietary , finding it difficult to change in the future. The workflow defines many conditions that improve the overall efficiency.
Assignment of studies to a Radiologist depending upon various conditions
Workflow parameters like TAT, number of reads, work load, QA score for Radiologist
Auto assignment or through manual intervention by an Administrator
Monitoring TAT (Turn Around Time) and reassigning studies if TAT is not met
Collaboration between various stakeholders through work-list
Customizable work-list which enables the user to see what they want to see and hide the extraneous information.
Monitoring QA, reconciliation, Peer review to help improve the quality of care to the patient
Integration with existing front end or back end solutions using HL7 or web links
Accessing PRIORS and showing patient demographics to the Radiologist while reporting to enable faster and more accurate reporting
Enabling the patient to get hold of the report and studies through a secure patient portal.
Use of mobile devices and maybe a QR code to make it easy for the patient to receive the information.
These are just some of the important workflow features to look for. It is best to ask the vendor what they provide - to help you improve the productivity of the Tele-radiology center. An important characteristic the software should provide is the flexibility to customize the features to get the best bang for your buck.
Many vendors who are in this business should be getting constant feedback from their valued users and keep improving their product.
Make sure they provide 24x7x365 support otherwise all the above is not as attractive as it sounds!