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Image-sharing improves patient care, if hospitals listen

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From the April 2014 issue of Columbus CEO
  • Photo by Tim Johnson
    Peter Lafferty, MD (at left) and Ron Hosenfeld
  • ©2014 Thinkstock.com

Technology and discovery go hand in hand, and a local company is using technology in a cooperative way to give individuals greater control over their medical care. The system gets rave reviews from those who use it within their own networks. However, hospital systems are proving slow to share patient information with one another.

The system is RadAssist, a cloud-based information sharing system developed by Lucid Radiology Solutions. RadAssist allows doctors to pull up all of a patient’s past tests, provided that the facilities where they were performed have shared them with the system.

The results of diagnostic tests like X-rays, MRIs and CT scans can be made instantly available to any credentialed professional. This takes the burden off the patient’s memory and helps doctors provide more complete and accurate diagnoses. Central Ohio is home to a number of world-class medical facilities, but patients and doctors still struggle with barriers in information sharing.

“It is about allowing the patients control of their healthcare,” says Ron Hosenfeld, chief information officer of Lucid Radiology Solutions, developers of RadAssist. He says many people don’t know they have rights to their past test results. “When you ask patients who owns those images, most of them don’t know that it’s the patient.”

Ownership rights aside, it makes good medical sense to share as much information as possible, doctors say. Radiologists at Riverside Radiology and Interventional Associates saw such a need and enlisted Hosenfeld to develop an IT division for the practice in the early 2000s. RRIA is based in Columbus but provides diagnostic services to 26 hospitals around the state, so information sharing within that practice is a huge advantage.

Over the years, Hosenfeld and his team developed software that allowed instant access to shared files, with no download time or physical delivery of electronic storage media. With continual input from the doctors who use the system daily, it was tweaked and improved to provide a streamlined workspace for doctors that increases productivity, eliminates wasted time and automatically prioritizes patients based on severity of their complaint.

“It is a filtering system for prioritizing patients based on their need through the emergency room or through emergent imaging studies,” says Dr. Mark Alfonso, president of RRIA. “It does it in a non-biased, very efficient, objective manner so that you’re not picking and choosing which patients get priority. Every patient is treated the same, regardless of where the examination is performed.”

He says RadAssist has been invaluable to the practice. The system allows doctors to assess wait times, turnaround time, referral patterns and staffing models to make the most of the hours in their day.

“It’s a great data mining tool which basically allows you to pull information from across an entire radiology enterprise,” he says.

The system is being refined on an ongoing basis, so doctors don’t have to wait ages for major upgrades. Also, developers are responsive to what doctors in the field say they actually need. But the real benefit is to the patient, who receives a more rapid, more complete diagnosis because of the efficiency and access to past records. Alfonso calls the system “patient-centric.”

Form and Function

Hosenfeld developed the product on behalf of RRIA, but in 2011, he established Lucid as an independent entity. Lucid is in the process of rolling out its radiology solutions to imaging groups, hospitals and health systems across the nation. The platform continues to be refined for ease of use and increased productivity, but the chief focus is on patient care. Hosenfeld says such an approach has a measurable impact on all people involved, improving the experience in a very tangible way both for doctors and for patients.

“We are focused on developing the software that gets the right patient to the right doctor at the right time,” Hosenfeld says. “Before, it was much more about the efficiency of the group. Now, it has become much more about the groups working in partnership with the hospitals and facilities that they serve, adding value, becoming part of the complete care continuum, from when the patient enters the hospital to when that patient is discharged. That’s a different focus. Now it is a wholistic approach to what is happening.”

The platform helps efficiency on both ends. Prior to testing, doctors can view a history of what other tests the patient has had, perhaps preventing unnecessary retesting and repeated exposure to radiation. Post-test, the imaging specialist can pull up related comparison studies that may help to create a more complete diagnosis.

“That changes the course of the patient’s care,” Hosenfeld says. “It reduces costs, it reduces radiation, it reduces stress and it provides a more definitive result at the time of service.”

Hosenfeld says, like Amazon revolutionized shopping and Google revolutionized our access to information, technologies like the ones Lucid is employing will fundamentally change the way doctors compare and share images.

“You’re going to move to cloud-based services that provide easier connection points,” he says. “The integrations are going to become easier and faster, and groups that are prepared to respond to that are going to be the ones that benefit.”

Hosenfeld says his goal is to make the process so easy that doctors won’t think about the technology, but will be able to focus solely on the patient.

“We are removing the barriers of technology,” he says. “Where they used to be focused on digging through the information to find the right piece, it’s presented to them in a seamless manner so they can focus on the clinical care. Our goal is to make them forget what technology they are using. The technology does not need to be part of the patient care.”

Accolades from Doctors

Dr. Peter Lafferty, a body imaging specialist with RRIA, says RadAssist accomplishes that goal, and has proven to be effective in a practice spread over a large geographic area.

“It’s really about putting the patient at the top of the pyramid,” he says. “We’re giving the highest level of imaging interpretation to all of our patients regardless of facility size.”

Lafferty says such efficiency is good for everyone, because if patients are happy, the business will naturally grow and thrive.

“If we take care of the patient in the most timely and efficient fashion, with the highest level of expertise, the rest of it kind of takes care of itself,” he says.

Lafferty says the technology provides a level of transparency that, while not disregarding the necessary profit of the hospital or health system, addresses the needs of the person being treated.

“I guess the simplest way to put it is that it puts imaging data into a patient-centric framework instead of an institutional-centric framework,” he says.

Taking the patient’s thorough history into account, doctors can eliminate unnecessary testing.

“You’re reading an image taken at Riverside Hospital that shows a mass in the kidney, and you also have instant access to an image taken at Knox Community Hospital two years ago,” he says. “If you see there has been no change, you can render a report that is meaningful and that prevents unnecessary follow up and interventional procedures like a biopsy.”

A technological record is immensely helpful, since the human memory in times of stress or illness is sketchy at best.

“The memory is incredibly unreliable,” Lafferty says. “Not only don’t patients know where they had a test, but they don’t remember what test they had or when they had it.”

“If you use manual inputs, you get a lot of garbage in both directions,” he says. “But this system is kind of like a patient Google. It knows what’s out there and it helps you find it.”

In one respect, this can protect patients from themselves.

“Drug seekers may not want the doctor at ER X to know they’ve just been to ER Y complaining about the same kidney stone pain,” Lafferty says. “If patients are receiving 10 or 12 scans a month, this is valuable information for the doctors.” Not only can this knowledge lessen instances of drug abuse, but it also keeps these patients from absorbing unsafe doses of radiation.

As a doctor, Lafferty finds the system beneficial, but he also appreciates it from a patient’s perspective. “As a patient, I want access to my data and my medical record wherever I go. I don’t want to feel like I’m tied down to a particular facility just because they have my imaging data.”

Problems with Implementation

And therein lies the rub. Health systems and stand-alone radiology practices have embraced the technology within their own institutions, but hospitals have proven to be reluctant to get on board when it comes to sharing information freely with competitors.

“There has been very little incentive for this to happen, because hospitals don’t want to make it easier for patients to go to another hospital,” Lafferty says.

Keeping patients within the same system protects profits, but may not always be the best option for those receiving treatment. Currently, hospitals share information with one another, but not always in an easy or timely fashion.

“We’ve come up with a low-cost and genius system that would allow patients to move around seamlessly, but until there is a massive change in medical economics, it won’t happen,” Lafferty says. “There’s no incentive. Why would they decide to cooperate and play nice in the sandbox?”

In 2012, a number of radiology professionals joined in talks to get an imaging-sharing initiative off the ground. Called the Ohio Medical Corridor Cloud Initiative, the effort would have promoted the use of the information cloud concept, along with other improvements to the face of medical treatment in Ohio, including collaboration on clinical trials and promotion of medical products developed in Ohio.

“The initiative came from the governor’s office, and we talked to some people at the state government level,” Lafferty says. “But the idea just wasn’t appealing to the health care systems. The only compelling business argument would be that they could save money on the archive, and beyond that, there was no reason to do it.” Lafferty says the initiative fizzled out in 2013.

Hosenfeld says the idea could still work for hospital systems if the approach is slightly different.

“It died because there was a very specific set of goals,” he says. Hosenfeld says he would still like to see an initiative with a broader set of goals in which hospitals not only assess the one solution being offered, but also look at the possibilities that could make a solution work for everyone.

So professionals in the field will keep pushing for information sharing using a system they’ve used to streamline their own practices.

“Human nature is always to resist change, and that’s understandable,” says Dr. David Zadvinskis, a body imaging specialist with RRIA. “That being said, RadAssist makes it so easy, once you start using it, you don’t want to go back. From day one, once I saw what it did, I was sold hook, line and sinker. RadAssist simplifies a complicated practice.”

Alfonso agrees. “Being able to access imaging information from other health care systems is something we are going to have to do whether we like it or not,” he says. “But to be able to be proactive is sending a tremendous message to physicians and patients.”

Kristin Campbell is a freelance writer.