Reporting Whitepaper - Section 6.2

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6.2 Imaging Center

<Need Author/Input> <John and Kevin will look for more details>

<The Imaging Center is in some ways similar to a Radiology Department and in other ways similar to a Reading Service>

<The middle part of the workflow looks like a Department - internal RIS/PACS/Reporting, but the front end and back end of the workflows have to integrate "ad hoc" like the Reading Service does>

<there may be more variability between sites with Imaging Center workflows compared to Departments and Reading Service>

<<The Veterans Administration case of outsourcing Acquisitions should also be covered in this section.>>

• primarily acquisitions and reading (and outsourced radiology department)
• Hospital would like it to be transparent, simply place an order on the hospital system and get a report associated with it some time later.
• need to also consider a reading service for studies sent to it
• usually provide public service and also affiliated with hospitals
• hospital services include - acq only, acq and reading, reading only
• sometimes have RIS funcitons in their Practice Management system
• ADT/Orders is ambiguous.
• ADT/Order feed from the hospital is weak
• Accession numbers are problematic too (multiple sources)
• need ways to return the reports with a way for them to be associated with the hospital order
• Report submission/delivery is also a big fuzzy issue
  • Referring Doc base may be given access to the PACS/Report Repository, or the Docs EMR may be given access to pull/receive results, or the Referring Doc may go through the Hospital access
  • Accession number
• Rad workflow works internally fine. the question is the relationship to external orders
• Patient ID compatibility is an issue
• Status would be nice in the hospital
• Keeping image data in sync between the two is a challenge
• Hospitals should be sending priors to the Imaging Center (need to coordinate/trigger from the order)
• Hospital PACS is already pressing to receive the full study back with the report
• Sometimes handled in the contract that the Imaging Center holds it but if they part ways, IC has to do a bulk transfer of data to the hospital
• Hospital should hold copy to provide full priors
• If RHIO in the future then we are distributed management (XDS) there is less need to keep copies/minimize duplication

• Billing - MANY different arrangements
  • Hospital refers patient to IC and is read by Rad who works for both entities (doc may be at IC but work for hospital)
  • IC might be paid for Tech, and prof fee is split
  • in simplest case IC is self-contained billing
  • hospital would like to get more than just report (medically relevant or scheduling data like presence of metal, new allergy, reason for discontinuation
  • it exists where the IC is a pure subcontract, (ie the IC never bills the payor, the hospital pays the IC directly) - direct billing

• Could have the OP in hospital and OF in IC, but you would want to keep the ADT messages to the OF to a minimum?
• this is especially true if the IC is the master copy of the patient data.
• PIX helps but doesn't handle the updated demographics or merges
• may be useful to differentiate between the operational archive (where to get priors) and the legal archive
• hard when one hospital updates a patient but the other hospital you serve hasn't

• Germany has recently started large private radiology practices that fish for customers, but fewer stable relationships right now
  • Hospitals use it for overflow currently
  • It is mostly paper and film, little digital infrastructure

• Infoway is waiting for the infastructure to use distributed workflow.
  • they don't have ways to notify that there is a result waiting in the XDS
  • primarily hospital based Rad, almost no imaging centers, but growing number of modality only rad depts.

• Differences are based on the IT Topology (how separate or integrated) and frequency (regular relationship vs completely ad hoc)

• For external referring physicians, sending a patient to an IC or to a outpatient Rad Dept, it's about the same

• Referrings will have light infrastructure, so they will more likely login to the Order Filler instead of having an OP which transmits
• Same with review, they will login to the local system to view/download report and view images
• ICs compete by having better portals, Docs don't have the outlay to have a functional partner system to hold their end and be the master data (unlike the hospital which does)

• Is the pattern of specialists doing acq but being unable to read going to be common in the future?
• Links from the referring to the hospital may be paid by hospital to keep their referral base
  • if they have the data they're a preferred place for the surgery
• Imaging Centers (and Rad Depts) should have a digital receipt mechanism (per Nagy) for critical results (much easier when the doc is using a web portal)
  • Other items from Paul