Reno Diagnostic Center
Radiology workstations and the bottom line
February 28, 2018
By Ronald J. Milbank
It has been said that every company is a technology company, no matter what product or service it provides.
Leaders of hospitals, radiology departments and imaging services providers need to look at their businesses as IT companies that deliver radiology services.
The implementation of technology to ensure quality, reduce regulatory administrative burdens, manage the education of employees and increase overall facility/employee efficiency is not only in your best interest, but is imperative to your survival. Topping this list of mission-critical tasks is ensuring your radiology services are as efficient as possible to offset continuing annual reductions in reimbursements from government and private providers for imaging services.
In any organization there are dozens of opportunities to invest in technology to improve overall performance and shorten the exam cycle. In radiology these include activities such as patient scheduling and sending reports to the referring physicians. But one of the highest returns on investment is making the radiologist as efficient as possible, which requires innovative workstation design.
Impressive productivity gains
Reno Diagnostic Centers has been in operation for 33 years. We had three of our most productive years during the last five years. We went from seeing 185 to 200 patients a day to between 280 and 300 patients a day with the addition of one modality. Making radiologists more productive with up-to-date technology and focusing on efficient scheduling for all modalities has generated a dramatic counterbalance to continuing drops in reimbursement.
A critical question is how many additional exams can be processed by using updated technology and procedures to reduce delays in radiologists’ workflow. Important factors that can boost overall profitability include minimizing the time radiologists spend: opening and closing exams; loading prior exams for comparison; taking their hands off the microphone, mouse, keyboard or auxiliary keypad device; reviewing and signing reports; physically adjusting their position to maintain a physical comfort level that reduces fatigue; and relocating between modality-centric reading workstations.
Redesigning the workstations at our facility improves productivity and reduces fatigue. It also eliminates delays of a few seconds to a dozen seconds or more that can occur every few minutes when the radiologist is reading a single exam. The new workstations allow radiologists to read 90 percent of exams without taking their hands off the mouse and the microphone. That creates substantive savings.
Let’s use five cents per second as an average radiologist’s cost ($400,000 annually). How many seconds a day do you need to save to pay for a $27,000 to $40,000 workstation? Moreover, how many more exams do you have to read to recover your workstation investment? This is a calculation that all administrators must face, but the bottom line is you can easily save multiple seconds per minute and save multiple minutes per hour if you implement the right technology at the radiologist’s workstation.
Saving just two minutes per hour of a radiologist’s time over 2,080 work hours per year provides an additional 69.3 hours of reading. The efficiency gain creates a substantial increase in throughput for both radiologists and the practice. As a result, we achieved an ROI of 25 months on technology that we will use for five years.
What technology solutions can ensure the greatest productivity for radiologists? Here are a few suggestions:
• Understand how EMR, HIS, RIS and PACS systems are programmed. Are they programmed to take advantage of multicore (8-16 core) processors, or are you better off with a four-core processor? Ask your solution provider. Select the fastest possible processor with the fewest number of cores to exploit the software that is running.
• Find the right diagnostic monitor and the right graphics card for your radiologists’ workstations. Use 4k/5k monitors where diagnostic monitors are not absolutely required by law or recommended by the American College of Radiology (ACR) guidelines. Use 6MP and 8MP monitors wherever possible. Seek monitor vendors that specify high-performance, off-the-shelf, third-party graphics cards.
• Workstations that can be used for all modalities reduce cost, and increased use of these workstations lowers overall ROI time frames and increases exam throughput.
• Consider M.2 interface NVMe (Non-Volatile Memory) over spinning hard drives or 3.5”/2.5” solid-state drives (SSDs).
• Consider gaming keyboards, mice and auxiliary controllers from the same manufacturer. A unified device controller software can manage all the devices (mouse button and shortcut key programming) to reduce conflicts and increase reliability.
• Explore tabletop microphones or headsets to allow both hands to be placed on the mouse and keyboard or auxiliary controller. This reduces hand fatigue and hand movement.
• Ensure dual network ports (1GB/10GB) as appropriate for the underlying network infrastructure.
Maximizing the patient schedule
In the face of continued deceases in reimbursement, imaging providers must fully utilize all modalities. When a patient cancels their appointment the day of the scheduled exam, our staff contacts other patients who are on an “early appointment requested” list to see if they are willing to fill the slot. Then we move patients into the schedule to ensure each appointment is booked. This process minimizes the costs of having staff with no patient to scan, which represents full cost with no revenue. Some facilities book patient appointments, and if the patient cancels, they do not try to fill it. Striving every day for maximum utilization is essential to ensure the lowest cost per exam possible.
Making our patients feel welcome and valued is very important. We have streamlined our procedures to ensure we process and image each patient quickly and efficiently. Our patients respect and appreciate that we value their time as much as we do our own.
It’s time for imaging services providers to stop worrying about their IT budgets and start investing in technology that can increase profitability and throughput in radiology services. Well-designed and implemented technology allows health care providers to achieve greater efficiency, which benefits both patients and providers.
About the author: Ronald J. Milbank is director of information technology for Reno Diagnostic Centers in Reno, Nevada. He is also one of the owners of R&C Consulting, providing national information systems and operational excellence advisory services.
It has been said that every company is a technology company, no matter what product or service it provides.
Leaders of hospitals, radiology departments and imaging services providers need to look at their businesses as IT companies that deliver radiology services.
The implementation of technology to ensure quality, reduce regulatory administrative burdens, manage the education of employees and increase overall facility/employee efficiency is not only in your best interest, but is imperative to your survival. Topping this list of mission-critical tasks is ensuring your radiology services are as efficient as possible to offset continuing annual reductions in reimbursements from government and private providers for imaging services.
In any organization there are dozens of opportunities to invest in technology to improve overall performance and shorten the exam cycle. In radiology these include activities such as patient scheduling and sending reports to the referring physicians. But one of the highest returns on investment is making the radiologist as efficient as possible, which requires innovative workstation design.
Impressive productivity gains
Reno Diagnostic Centers has been in operation for 33 years. We had three of our most productive years during the last five years. We went from seeing 185 to 200 patients a day to between 280 and 300 patients a day with the addition of one modality. Making radiologists more productive with up-to-date technology and focusing on efficient scheduling for all modalities has generated a dramatic counterbalance to continuing drops in reimbursement.
A critical question is how many additional exams can be processed by using updated technology and procedures to reduce delays in radiologists’ workflow. Important factors that can boost overall profitability include minimizing the time radiologists spend: opening and closing exams; loading prior exams for comparison; taking their hands off the microphone, mouse, keyboard or auxiliary keypad device; reviewing and signing reports; physically adjusting their position to maintain a physical comfort level that reduces fatigue; and relocating between modality-centric reading workstations.
Redesigning the workstations at our facility improves productivity and reduces fatigue. It also eliminates delays of a few seconds to a dozen seconds or more that can occur every few minutes when the radiologist is reading a single exam. The new workstations allow radiologists to read 90 percent of exams without taking their hands off the mouse and the microphone. That creates substantive savings.
Let’s use five cents per second as an average radiologist’s cost ($400,000 annually). How many seconds a day do you need to save to pay for a $27,000 to $40,000 workstation? Moreover, how many more exams do you have to read to recover your workstation investment? This is a calculation that all administrators must face, but the bottom line is you can easily save multiple seconds per minute and save multiple minutes per hour if you implement the right technology at the radiologist’s workstation.
Reno Diagnostic reading workstation
Saving just two minutes per hour of a radiologist’s time over 2,080 work hours per year provides an additional 69.3 hours of reading. The efficiency gain creates a substantial increase in throughput for both radiologists and the practice. As a result, we achieved an ROI of 25 months on technology that we will use for five years.
What technology solutions can ensure the greatest productivity for radiologists? Here are a few suggestions:
• Understand how EMR, HIS, RIS and PACS systems are programmed. Are they programmed to take advantage of multicore (8-16 core) processors, or are you better off with a four-core processor? Ask your solution provider. Select the fastest possible processor with the fewest number of cores to exploit the software that is running.
• Find the right diagnostic monitor and the right graphics card for your radiologists’ workstations. Use 4k/5k monitors where diagnostic monitors are not absolutely required by law or recommended by the American College of Radiology (ACR) guidelines. Use 6MP and 8MP monitors wherever possible. Seek monitor vendors that specify high-performance, off-the-shelf, third-party graphics cards.
• Workstations that can be used for all modalities reduce cost, and increased use of these workstations lowers overall ROI time frames and increases exam throughput.
• Consider M.2 interface NVMe (Non-Volatile Memory) over spinning hard drives or 3.5”/2.5” solid-state drives (SSDs).
• Consider gaming keyboards, mice and auxiliary controllers from the same manufacturer. A unified device controller software can manage all the devices (mouse button and shortcut key programming) to reduce conflicts and increase reliability.
• Explore tabletop microphones or headsets to allow both hands to be placed on the mouse and keyboard or auxiliary controller. This reduces hand fatigue and hand movement.
• Ensure dual network ports (1GB/10GB) as appropriate for the underlying network infrastructure.
Maximizing the patient schedule
In the face of continued deceases in reimbursement, imaging providers must fully utilize all modalities. When a patient cancels their appointment the day of the scheduled exam, our staff contacts other patients who are on an “early appointment requested” list to see if they are willing to fill the slot. Then we move patients into the schedule to ensure each appointment is booked. This process minimizes the costs of having staff with no patient to scan, which represents full cost with no revenue. Some facilities book patient appointments, and if the patient cancels, they do not try to fill it. Striving every day for maximum utilization is essential to ensure the lowest cost per exam possible.
Making our patients feel welcome and valued is very important. We have streamlined our procedures to ensure we process and image each patient quickly and efficiently. Our patients respect and appreciate that we value their time as much as we do our own.
It’s time for imaging services providers to stop worrying about their IT budgets and start investing in technology that can increase profitability and throughput in radiology services. Well-designed and implemented technology allows health care providers to achieve greater efficiency, which benefits both patients and providers.
Ronald J. Milbank
About the author: Ronald J. Milbank is director of information technology for Reno Diagnostic Centers in Reno, Nevada. He is also one of the owners of R&C Consulting, providing national information systems and operational excellence advisory services.