Case Study: Internal Medicine Associates

After struggling with a PACS solution that was difficult to maintain and manage, Internal Medicine Associates (IMA) adopted a complete approach to their radiology workflow by implementing Avreo interWORKS. This RIS/PACS solution supports IMA’s multi-site radiology operations and facilitates off-site diagnostic reading, while contributing to a reduction in overall report turnaround time.

Getting to Know Internal Medicine Associates

Internal Medicine Associates (IMA) is a multi-specialty medical practice with physicians specializing in Internal Medicine, Endocrinology, Pulmonary Medicine, Rheumatology, and Infectious Disease. To provide convenient radiology services to their patients in southwest Florida, IMA offers a variety of imaging services at their offices in Ft. Myers and Cape Coral, Florida. These services include CT, digital x-ray, echocardiograms, lung screenings, MRI/MRA, nuclear medicine, ultrasound, and mammography.

IMA opened its doors in 2003 and immediately began using a Kodak PACS system that was not interfaced with a RIS. After using this system for approximately three years, IMA found the system difficult to manage without heavy dependence on support. For this reason, they began searching for a PACS solution that better met their needs. IMA required a solution that allowed them to retain their studies on site, while supporting a workflow that offered an off-site reading solution for radiologists.

Choosing a Replacement PACS

Sherry Spinella, Radiology Manager for IMA, developed a list of requirements for their new solution and visited vendors at the 2006 SCAR annual meeting to identify a short list of vendors who met her requirements. These requirements included:

• Limited interfaces to minimize hassles
• Scalable from their current environment of teleradiology to a possible transition to on-site radiologists in the future
• Software application easy for the referring physicians and their staff to maneuver
• Top of the line support system
• Easy to learn and understand

After visiting Avreo’s booth and participating in a demonstration of the interWORKS RIS/PACS solution with John Sloan, Avreo’s CEO, Sherry felt the Avreo solution was a good match to their needs because it provided:

• All in one solution that incorporated RIS, PACS, Dictation, Transcription, and Archiving
• Scalability for growth and features (Originally, IMA was looking for PACS, but the Avreo solution gave them the option to easily expand into a RIS/PACS)
• Master Folder organization of orders, studies, and reports
• Scheduling features incorporated into the PACS

IMA selected the Avreo ASP interWORKS solution, which offers fixed fee per study pricing so healthcare organizations can manage their expenses. Unlike the ASP solutions offered by many imaging vendors, Avreo’s ASP solution provides a server and local storage on-site to maximize image access speed. In addition, this solution also provides convenient off-site archiving via InSite One. When IMA selected Avreo, they experienced a seasonal fluctuation in the study volume and estimated upcoming change in their annual study volume. With the ASP solution, IMA could archive as much data as needed without concern for managing this storage volume. Sherry indicated this storage and archive model was very helpful because they did not have to place a limit on the data that they are able to archive.

Streamlining Radiology Workflow

Determined to maximize efficiency, IMA designed their workflow to connect their EMR with Avreo’s interWORKS RIS/PACS and drastically reduced report turnaround time by incorporating new reading partner, Tower Imaging, who also uses an Avreo solution.

Ordering, Scheduling, and Performing Radiology Procedures

Physicians at IMA use electronic medical records system (EMR) Allscripts TouchWorks in their day-to-day practice. This system maintains a unique number that identifies each patient. When a physician determines a patient needs a radiology procedure, the physician creates a task on the Radiology Schedule Task List in the EMR. The schedulers then arrange this procedure with the patient using the scheduling features in interWORKS. The order in interWORKS is linked to the patient’s record in the EMR using the patient’s EMR identification number. When IMA receives radiology orders from outside physicians, IMA chooses to retain the information in interWORKS only.

When the patient arrives for their procedure whether it is scheduled in advance or as a walk-in, the scheduler registers the patient in Avreo and sets the appointment status to Arrived. This process places the order on the technologists’ worklist and notifies the technologist that the patient is ready to be seen. After performing the study, the technologist completes the order in the Avreo system and enters any notes for the radiologist.

Reading Studies

IMA partnered with Radiology Associates of Tampa, Florida (Tower Radiology Centers) to provide reading services for their 45,000 annual studies. Tower also adopted Avreo’s interPRISE solution after seeing the Avreo system in action at IMA. In this notable partnership, Tower’s radiologists connect to IMA’s Avreo system directly from their own Avreo system to read studies and produce reports in real time.

When an IMA technologist completes a study, the study automatically displays on the reading worklist available to Tower. Tower radiologists then use Avreo’s digital dictation capabilities to dictate reports. This digital dictation automatically attaches the dictations as a .wav file to the corresponding orders in IMA’s Avreo system. Similarly, Tower’s transcriptionists transcribe the dictations in IMA’s Avreo system, then Tower’s radiologists review and electronically sign the reports. This reading workflow creates an enormous amount of efficiency as IMA can check the reading status of any study easily within their Avreo system. IMA was unable to do this with their prior PACS and reading provider, and were forced to wait for reports to be sent back into their system. In addition to rapid report turnaround, IMA’s physicians can also listen to the radiologist’s digital dictation prior to transcription, which can be very helpful for STAT patients.

Communicating the Report to Ordering Physicians

Once a Tower radiologist electronically signs the report associated with a study, the electronic report automatically displays in IMA’s Avreo system as well as their EMR system. The EMR adds the study results to the patient’s chart and creates a task for the original ordering physician to sign off on the report. For reports associated with outside physicians, IMA staff fax the final report to the ordering physician. Although Avreo includes automated faxing capabilities to distribute reports, IMA selected not to implement this feature due to the low ordering volume for outside physicians.

The efficient reading workflow between Tower and IMA offers rapid report turnaround time. On average, IMA receives a final report in less than 24 hours after submitting the study to Tower for reading. With their previous PACS and reading provider, IMA reported waiting 72 hours or more to receive final reports. When they pushed studies to their previous radiology provider, IMA could not access intermediate reading status information and were not sure when the final report would be available. In addition, once IMA received the report, it did not automatically display in their PACS. They had to scan it to make it available to physicians.

Communication between IMA and Tower

Better than a phone call or an email, Tower and IMA communicate as needed through Barracuda Instant Messaging and Archiving, giving both parties the ability to communicate throughout the day. IMA physicians and staff primarily use instant messaging for questions that arise throughout the day, and to discuss STAT exams needed by IMA. IMA also communicates with Tower using a toll-free telephone number that is specific for IMA for important questions.

Avreo Customer Support

Since IMA’s implementation, Avreo has initiated both a customer call center and web-based support via IssueTrak to streamline the support process. Sherry reported the web-based support was very efficient because she simply writes an email to submit support requests. She then automatically receives email updates and can review the status of support requests online at any time. Call center staff provide quick response to her requests. If an issue arises, Sherry can use the Avreo Admin capabilities to perform basic troubleshooting instead of contacting Avreo support to mend the problem. This gives Sherry not only a tremendous amount of freedom, but also confidence in knowing her system well enough to perform administration actions herself.

Realizing Workflow Efficiencies

After implementing Avreo interWORKS and partnering with Tower, IMA has experienced substantial efficiency improvements. Sherry reports that the scheduling process is much faster and more reliable. In addition, technologists can easily view the current status of scheduled patients. Administrative reports available in Avreo based on real-time system data are accurate and helpful.

The personnel at IMA enjoy the usability of the system and find it easy and efficient to access the information they need. Because of the tight integration with Avreo and IMA’s EMR, many physicians access the report directly from the EMR.

How Can Avreo Help Your Healthcare Organization?

Would you like to learn more about how Avreo can help your healthcare organization achieve its goals?  Request a free personal demonstration with an Avreo Clinical Applications Specialist.