Nassau Radiologic Group Improves Efficiency and Saves In Annual Film Costs By Using CD Technology

The Nassau Radiologic Group, of Garden City, NY, recently realized that, in order to survive in the unforgiving world of managed healthcare, the organization had to find a way to provide a more efficient, cost-effective imaging service to referring physicians and other clients. Under managed health care, the Group was guaranteed a fixed number of patients and a monthly payment of about $40,000 from insurance companies. Although it may have appeared to be an acceptable deal, the flip side was that the Group was only reimbursing $5.00 per patient, per visit—regardless of the patient's medical condition. Thus, if a patient required an expensive procedure and many visits, which was the case more often than not, the Group absorbed the heavy costs.

In addition, there existed a prevailing attitude among select administrators and primary care physicians that imaging costs were too high to warrant the practice of radiology, and there was nothing more primary care physicians wanted than to reduce radiology and other specialty costs using any means possible. The Group was at a crossroads and fighting a battle with two intimidating forces—a decision to fundamentally change their business practices was the only possible solution.

During these times, the Nassau Radiologic Group was using laser film as a means to archive ultrasounds, MRIs, CTs, and other body images, but film was outdated and inefficient, and the cost of maintaining and storing it was exorbitant. After researching various options, the Group decided to replace their film system with a CD-based PAC system made by DR Systems, Inc. of San Diego, CA.

The choice to move from the well-known radiology solution that prints images to film to one that is filmless, was a difficult one for the Nassau Radiologic Group to make. All but one of the radiologists in the Group favored the switch, but many of the referring physicians they served were reluctant. After all, these physicians were familiar with film, and it had been serving them well. Once the Group was able to convince referring physicians that the move from film to CD would be wise, the benefits of the technology became immediately apparent.

The radiologists and physicians found that the quality and clarity of electronic images is comparable, if not better, than film. Because patient information must be regulated and securely archived, CD-R media is ideal. And, CD offered a high-capacity storage solution for archiving data, images, and voice at a low cost.

DR Systems Solution Makes the Nassau Radiologic Group More Efficient and Cost-Effective
Because DR Systems' Picture Archiving and Communications system (PACS) was developed by radiologists, the company has understood from the beginning the needs of radiologists and how best to fulfill them. Says Charles Burke, C.O.O. of the Nassau Radiologic Group, "DR Systems is giving us the advantage over everybody else. The doctors are more efficient; we've increased throughput in ultrasound; we've reduced our film usage by 97%; and we are saving money in the process. For us, this is a win, win, win situation all around."

In brief, the PACS automated process involves the following steps: Technologists capture, crop, zoom, window/level and separate patient images by series on the DR Systems Catapult computer. Next, the patient images are sent to the main image server, where they are ready to be pulled up and interpreted by the Radiologist on a high-resolution, multi-monitor primary reading station. After images are interpreted, they are permanently archived on the DR Systems Guardian CD jukebox.

DR Systems' filmless system has improved operations at the Nassau Radiologic Group in many ways, one of which is by giving radiologists at the Group an imaging process that allows them to search for and retrieve patient images automatically through in-house networking. Digital images archived to CDs are stored in networked jukeboxes, where radiologists can access them directly from their workstations. Film, on the other hand, required them to physically locate and "check out" patient images from an archive room, which was often on a different floor. Physically retrieving patient film was not only inconvenient and time-consuming, but it increased the possibility of the film being misplaced or lost. Burke emphasizes that "the days of people running around the office searching for film jackets are over."

DR Systems' PACS also allows radiologists to deliver patient information electronically to referring physicians at other medical facilities. The previous film-based system required that film be delivered to the referring physicians via messengers, and there was no guarantee that the images would arrive on the same day. The film-less model only takes minutes to transmit images to physicians using a T1 line that links radiology facilities to other satellite offices in Nassau County. "This allows studies to be interpreted from any location, increasing the efficiency of our radiologists and thereby allowing us to instantly route a case to the appropriate expert for a final interpretation," says Burke. What's more, the PACS' feature that allows radiologists to include verbal and written diagnosis along with the images eliminates the need for radiologists and referring physicians to be present in the same room.

In addition to saving radiologists and referring physicians valuable time, DR Systems' PACS reduces costs of materials drastically by allowing radiologists to create high-resolution montages of the patient's key images on standard paper. Radiologists sort and select the images displayed on computer screens, and print only the images (12-15 per page) that are relevant to patient cases. Not only is the Group saving on the substantial costs of film by printing images on standard paper (which costs between three and five cents per page), referring physicians don't have to wade through sheets of film in trying to determine which images are vital to a particular case. And, on the rare occasion when film is required by physicians, radiologist still have the option to sort, select, and print high-resolution montages of patient images on film.

The montages have also contributed to slashing the Group's costs by significantly alleviating the need for physical storage space for film. In the days when film was used exclusively, the Group was required to produce a set of films for referring physicians and a duplicate for their own records. The practice of producing duplicates often resulted in patient files that grew to be as thick as eight inches and as heavy as 40 pounds. To make matters worse, referring physicians, who had no desire to store their film, would return it to the Group. "At the end of the year many referring physicians would return a package of film, and we'd have no where to put them. It became increasingly more difficult for us to store film," explains Burke. Another way the Group saves on storage space is by providing referring physicians with the Ambassador viewing stations.

SmartCD+DVD API Toolkits Enable DR Systems to Use CD Jukeboxes as "Image File Cabinets"
When DR Systems began their search for near-line archival storage to compliment their PACS, they had specific requirements in mind. The first requirement was a software solution that provided extensive device support, giving their customers a variety of jukeboxes from which to choose. "We were looking for a company that was a leader in the CD-R field and would insulate us from hardware differences. We wanted to focus our R&D on our application—not to develop device drivers for CD-R and jukebox devices," says Kent Curtis, VP of Development at DR Systems. DR Systems' main priority in developing the PACS was a cost-effective solution that would give customers affordable hardware and media. As such, the company wanted software that would support a variety of hardware—they knew the media would drop in price.

DR Systems also wanted an API solution that would be easy to integrate with their software. Says Curtis, "Smart Storage offered the best integration of all the software companies we saw." They didn't want their engineers spending a great deal of time and energy embedding an API into their software.

They also wanted to produce a product that was easy for the end-user to use, so tight integration was a requirement. SmartCD+DVD's tight integration with the DR Systems' PACS enabled their developers to produce a CD recording procedure that is as easy as clicking a button on a screen. The procedure is so easy that clerical personnel can record the images with ease, allowing radiologists to dedicate their energies to other important matters.

The Result: Significant Increase in Patient Visits, No Lost Film, and Huge Savings
Since the Nassau Radiologic Group has implemented DR Systems' PACS over three years ago their bottom line savings have increased dramatically. Enhanced diagnostic capabilities, such as an automated process, electronic transportation of images, and the ability to manipulate images in creating montages, has increased the number of patients that can be seen by radiologists and referring physicians. Burke believes that DR Systems' PACS with SmartCD+DVD API Toolkits has increased the Group's daily business by 30%.

The PACS' automated archiving and network access functionality has reduced waiting time for delivery, misfiling, and film loss. With film-based imaging departments, studies have shown that as many as 10% of film can be lost annually through transportation within a department. The PACS eliminates this problem, virtually making it impossible for patient images to get lost.

While the Nassau Radiologic Group has also seen a reduction in film storage by 25%, the most impressive benefit the Group receives from using the PACS is an overall savings in film cost and maintenance, which according to Burke is $500,000 annually. The Group still uses film when a few referring physicians demand it, but now the cost to maintain it is about $27,000 per year. Burke enthusiastically adds that the initial cost of the PACS has easily paid for itself with the amount the Group has saved on film maintenance and storage in the last three years.

Regarding the future, both DR Systems and the Nassau Radiologic Group are awaiting the arrival of low cost DVD-R, which will give them even more storage space, while also providing them with the outstanding features of CD, such as non-erasability and portability. Burke is also anticipating the day when an image will be automatically burned and compressed on DVD. He would like to see a total hands-off approach to archiving and accessing DVDs in hospitals and private practices.