Customer Solution Case Study
Antelope Valley Outpatient
Imaging Center / Radiology Group Cuts Diagnostic Report Turnaround Time from Hours to Minutes
Overview
Country or Region: United States
Industry: Healthcare
Customer Profile
Located in Lancaster, California, Antelope Valley Outpatient Imaging Center provides radiology diagnostic services for healthcare providers. The company employs eight radiologists and a support staff.
Business Situation
Heavy workload, high transcription fees, and slow turnaround of diagnostic reports prevented the imaging center from expanding its business.
Solution
Using a structured reporting solution built on the Microsoft® .NET Framework, the staff of radiologists produces more reports and finishes them faster, without additional transcription costs.
Benefits
n Robust security
n Immediate and long-term cost savings
n Improved worker productivity
n Faster work turnaround and better patient care
n More resources for business expansion / “Clinicians are raving. They used to have to wait days for reports. Now they’re getting reports within minutes …. Improving our turnaround time also increases customer satisfaction and patient care.”
Dr. Jennifer Hill, Medical Director, Antelope Valley Outpatient Imaging Center
Antelope Valley Outpatient Imaging Center analyzes radiology images to diagnose medical conditions and wanted to expand its staff of radiologists to handle more cases. The competitive diagnostic marketplace demanded not only cost containment but also faster turnaround of radiology reports. However, the high cost of transcribing the radiologists’ dictations and the time required to review the transcriptions posed difficult challenges. Working with StructuRad, a Microsoft® Gold Certified Partner that develops solutions on the Microsoft .NET Framework, the imaging center implemented a structured reporting system called FastFindings Reporter. With this program, the radiologists interpret images and complete their diagnostic reports at the same time. Results include increased productivity, speedier diagnostic reports, improved patient care, and significant cost savings.
Situation
Located in Lancaster, California, Antelope Valley Outpatient Imaging Center is a radiology group providing an imaging clinic and diagnostic services for nearby healthcare facilities, including Antelope Valley Hospital. The imaging center has a staff of eight radiologists plus support personnel including five transcriptionists.
Radiologists at the center create diagnostic reports of illnesses or conditions based on their analyses of images—x-rays, sonograms, and electronic scans. An experienced radiologist can review images and dictate diagnostic reports for about 100 cases per day. After a transcriptionist generates a text report from the dictation, the radiologist reviews, finalizes, and approves it, and then sends the report to the referring physician.
The transcription phase for a single report can take from several hours to more than a day, especially during peak periods, resulting in unwanted delays for physicians and patients as they wait for test results. If the delay persists, the referring physician may call the radiologist for a status report. This interruption—as the radiologist researches the previously examined case—further impedes his or her productivity. Transcriptions also are costly; the imaging center pays U.S.$45,000 to $55,000 per transcriptionist per year. And finding qualified medical transcriptionists can be difficult.
As demand for its services rose and the radiology field became more competitive, Antelope Valley Outpatient Imaging Center wanted to expand its staff of radiologists so that it could handle a larger caseload and increase revenue. However, the imaging center faced two particular challenges. First,the cost of transcribing diagnostic reports was already high, and adding more reports would increase that burden. Second, many referring healthcare providers were demanding faster turnaround for imaging test results, so continuing to use the dictation and transcription method exclusively would put the imaging center at a competitive disadvantage.
“Reviewing the images isn’t enough,” says Dr. Jennifer Hill, Medical Director of the Antelope Valley Outpatient Imaging Center. “The referring clinicians need to have our results and interpretations as soon as possible so that they can make crucial decisions about patient care. There’s a higher and higher demand for fast turnaround.”
The imaging center needed a solution that would increase the speed and efficiency of generating diagnostic reports without sacrificing quality. Plus, the solution would have to work with the imaging center’s existing radiology information system (RIS), IDX Imagecast. Radiologists use the RIS to store, display, and track digital images and patient information.
Solution
Antelope Valley Outpatient Imaging Center learned of a possible solution from one of its radiologists, Dr. Jerry Berman. While working for a previous employer, Berman used a structured reporting system from StructuRad, a technology company based in Los Angeles.
Founded by radiologists, StructuRad offers workstation and enterprise solutions to help radiology groups improve their reporting processes. With a comprehensive knowledge base of more than 7,000 radiology templates, the StructuRad workstation solution—FastFindings™ Reporter—reduces the delays associated with traditional dictation and transcription. “We help the radiologist build the initial report as the final report,” says William Tulloss, Vice President of Marketing and Sales at StructuRad. “Once the report issaved, it never has to go off and be transcribed. It’s immediately available to the referring physician.”
StructuRad is a Microsoft® Gold Certified Partner that develops its solutions on the Microsoft .NET Framework, an integral component of the Windows® operating system that provides a programming model and runtime for Web services, Web applications, and smart client applications. The company builds applications using the Microsoft Visual Studio® .NET 2003 development system, including the Visual C#® development tool.
“We use the .NET Framework for a lot of our internal architecture, and we expose our .NET Framework–based interfaces for external integration,” Tulloss says. “That’s the primary benefit of .NET from our perspective—easy integration on our part and easy integration on the customer's part.”
StructuRad enterprise solutions integrate with radiology information systems, picture archiving and communication systems (PACS), and hospital information systems using healthcare industry standards such as the Health Level 7 (HL7) data exchange protocol. “We use Message Queuing technology to queue up the radiology reports. Then we have an interface—a .NET-connected application—that connects our system to an external system and lets us hand off the reports,” says Tulloss. “From there, we can push the reports to whatever system needs to receive them, including older systems that many hospitals still use. It works great because, with .NET, we don’t have to worry about the details of network infrastructure.”
StructuRad worked with Antelope Valley Outpatient Imaging Center to analyze its reporting processes and implement a more efficient, structured reporting system. With FastFindings Reporter, radiologists can display and inspect images while creating diagnostic reports. The radiologists author reports by assembling and customizing partially prewritten and interconnected reports from a library of templates and macros.
“But it’s more than just blocks of text,” explains Tulloss. “The underlying format and the storage model are based on XML. Every word on our report is clickable and hyperlinked to the medical knowledge base. In addition, we use patent-pending technology based on natural language processing that works with the user to convert radiology words and phrases into natural-sounding English prose.”
In the first phase of the implementation, radiologists copied their finished reports from FastFindings Reporter and pasted them into the RIS for electronic or print delivery to the referring physician. Later, StructuRad expanded the reporting system by setting up two server computers running the Microsoft Windows Server™ 2003 Standard Edition operating system, the foundation of Windows Server System™ integrated server software. The first was an application server running Microsoft SQL Server™ 2000. The second provided a custom HL7 interface to IDX Imagecast.
With these improvements, reports go directly into the RIS. Also, radiologists can share their report macros across the organization, and the system can expand easily to accommodate new radiologists as they are hired.
To complete the interface between FastFindings Reporter and IDX Imagecast, StructuRad worked with an IDX engineer. “Because we were using .NET, we could do itall remotely,” says Tulloss. “We had the engineer and the RIS administrator from Antelope Valley Outpatient Imaging Center onone side and the interface engine on our side. All we had to do was some interface configuration and minor debugging.”
StructuRad set up its server computers so that they could communicate through virtual private networking for testing purposes. As a result, StructuRad didn’t have to bring all its hardware or personnel to the imaging center’s site.
The HL7 interface also connected the imaging center’s RIS to the information system used by Antelope Valley Hospital to facilitate workflow between the two. Web services were a critical component of the successful integration of the two facilities’ systems. “With Web services, we could do the integration without a lot of extra heavy lifting on the hospital’s side,” says Tulloss.
The “heavy lifting” would have doubled the workload for StructuRad. Both phases of the project—integrating the imaging center’s RIS with FastFindings Reporter and then connecting the imaging center to the hospital—required significant development. However, Tulloss estimates that StructuRad saved as much as 50 percent on development time by using the .NET Framework instead of Java 2 Platform Enterprise Edition.
The radiologists required little training on the new reporting system. “It’s structured in a way that’s very intuitive and easy to use. It helps you along the way to get the reports finished quickly,” says Dr. Hill. FastFindings Reporter enabled the radiologists to combine diagnostic and report-writing functions into one activity, but provided the option of using the previous dictation and transcription method if a particular case required it.
Benefits
Antelope Valley Outpatient Imaging Center started reaping the advantages of its new reporting system as soon as it was up and running. Dr. Berman began using the system right away, and other radiologists followed. “Turnaround time is phenomenal, within minutes,” says Dr. Hill. “Now we can get reports to clinicians right away, and that’s a real improvement in patient care.”
For example, a diagnostic report that used to take eight hours to be completed might now require as little as 15 minutes, a dramatic increase in productivity. Given these positive results, the imaging center is developing a marketing strategy to emphasize its rapid service as it expands to meet a larger workload.
Robust Security
Security is a major reason that StructuRad uses the .NET Framework for its healthcare solutions, and support for security is a major reason that the imaging center chose FastFindings Reporter. “Hospitals have very stringent IT management requirements,” Tulloss says. “They’re governed by many regulations, and they’re very security conscious. A big advantage of .NET technology is that it lets us focus on developing the interface for our customer without having to worry so much about the security implementation and the network management of the customer’s IT system. With Web services built using the .NET Framework and Visual Studio .NET, one system can easily talk to another, and it’s secure.”
Hospitals typically do not like making major changes to their security processes in order to permit communications with a third party, but it’s much easier with .NET, according to Tulloss. “Now we can go to a hospital and say, ‘Just install this application on a server and make sure a particular port is open, and then we can talk to you and it’s secure.’”
Immediate and Long-Term Cost Savings
With the new structured reporting solution, one radiologist can generate up to 160 reports a day without a transcriptionist. That represents a potential savings of $45,000 to $55,000 per year. Although transcriptionists still are needed for many cases, the imaging center hopes to avoid hiring new transcriptionists as its staff and workload expand.
Initially, only one radiologist is using the structured reporting solution regularly; a few others use it occasionally. As more radiologists learn to use FastFindings Reporter and apply it to more of their daily work, the savings are expected to grow.
Improved Worker Productivity
Because a radiologist’s diagnostic report is finished at the same time as the diagnosis itself, no transcription is required, and the radiologist’s review of the transcription is eliminated. Omitting the review frees the radiologist to diagnose up to 60 more cases per day.
Also, because referring physicians receive their patients’ test results faster, the physicians interrupt the radiologists less frequently with requests for status reports. “That increases our productivity because clinicians don’t have to ask us about their reports—they already have them,” says Hill.
Faster Report Turnaround and Better PatientCare
With the total time for completion of a diagnostic report cut from many hours to just a few minutes, referring physicians get their patients’ test results that much sooner. The result is a more satisfying experience for the physicians and more prompt care for the patients.
“Clinicians are raving,” says Hill. “They used to have to wait days for reports. Now they’re getting reports within minutes after the exam is done. It has really helped them very much. Improving our turnaround time also increases customer satisfaction and patient care.”
More Resources for Business Expansion
“We’re in a transition phase now,” says Hill. “We’ve just hired a new radiologist, but we haven’t had to hire more transcriptionists.” By reducing the overhead and transcription costs that normally accompany adding radiologists to its staff, Antelope Valley Outpatient Imaging Center is free to consider expansion opportunities that were previously out of reach.
Microsoft .NET
Microsoft .NET is software that connects people, information, systems, and devices through the use of Web services. Web services are a combination of protocols that enable computers to work together by exchanging messages. Web services are based on the standard protocols of XML, SOAP, and WSDL, which allow them to interoperate across platforms and programming languages.
.NET is integrated across Microsoft products and services, providing the ability to quickly build, deploy, manage, and use connected, secure solutions with Web services. These solutions provide agile business integration and the promise of information anytime, anywhere, on any device.
For more information about Microsoft .NET and Web services, please visit these Web sites:
www.microsoft.com/net
msdn.microsoft.com/webservices