Radiologist Dr. Greg Bruno studies a patient¹s x-ray.

A radiology group may not seem to have a pressing need for an electronic medical record (EMR) and it may seem unlikely that radiology practices with ties to an acute care setting would embark on initiatives to obtain EMR systems, but when that practice includes interventional radiological procedures, the need is very real.

Although some independent radiological units are outside private hospitals, especially in large cities, most private radiological EMR is performed in the radiology departments of private hospitals. “Our practice is a hybrid of the two,” said John Crocker, MD, president of Jackson Radiology Associates, which is in the process of selecting an EMR system for its practice. “We not only have radiologists who practice in the hospital setting, we also have interventional radiologists, such as myself, who see patients at our clinic as well as in the hospital setting. This means some of our physicians generate records that are not tied into the hospital system, but due to the nature of our specialty, we have to be integrated with the hospital’s system as well as be able to be autonomous.”

Jackson Radiology Associates is a group of 16 board-certified radiologists in a hospital-based practice at Jackson-Madison County General Hospital (JMCGH). Jackson Radiology covers all imaging services at the hospital, as well as the West Tennessee Imaging Center and the West Tennessee Healthcare-affiliated hospitals throughout West Tennessee. All the radiologists are board certified, and the group has fellowship-trained radiologists in the subspecialty areas of musculoskeletal radiology, neuroradiology, and vascular and interventional radiology. The group has six vascular and interventional radiologists, physicians who use minimally invasive techniques to treat patients for a variety of conditions. This includes peripheral arterial disease (PAD), vertebral compression fractures, varicose veins and symptomatic uterine fibroids.

“We are aware of the incentives the ARRA act provides for implementing an EMR system as well as the implications of not having one,” said Crocker. “Both are highly motivating factors in our decision to undertake this project at this time. We also know that there are benefits to our patients and our practice to having an EMR system in place and operational.”

For a radiology practice, it is particularly important to consider the features and necessary interfaces required to link the Picture Archiving & Communications Systems/ Radiology Information System (PACS/RIS) meaningfully with EMRs. HL7 interfaces affect everything from the communication of results and follow-up recommendations to billing, coding and compliance. Fortunately, radiology is somewhat ahead of the curve; its growing experience with PACS and RIS position it well for its role of making images and RIS data available to the EMR.

“The vascular and interventional radiology portion of the practice is separate, and much of that work is performed in the clinic, which is housed in space leased in the West Tennessee Healthcare Imaging Center,” said Crocker. “Our situation may seem like it creates a difficulty in our being able to select a vendor for our EMR, but actually our needs are much the same as other specialties. Our biggest issue is technical in nature. Our system must interface with JMCGH due to our relationship with them. It is really a matter of the systems talking.”

An EMR system can address many issues inherent to a practice, such as informed consent, provider communications, patient history and work-up and medical-records documentation and provide enhanced means to improve performance. Among the most important direct benefits of the integration of radiology into the EMR, is the ability to use direct migration of radiology studies and reports. Reports have been readily available for years, but the ability to embed actual studies (including key images) is valuable to the physician and patient. A tight interface between the PACS and the EMR will provide many indirect additional benefits, including access to more meaningful information on patients (including patient history, current medical status and imaging results from prior studies performed at outside institutions).

“Radiology is image driven, but it boils down to the patient history and physical,” said Crocker. “The initial visit notes we generate are the core of the EMR chart; the images will be in our PAC system. The images become important when they are coming from somewhere else. For the majority of our patients, we generate those images, but for those that come in from outlying counties, having the ability to import their images into their EMR will be very beneficial.”

“We see two main benefits to having an EMR system,” said Crocker.  “On the local end being paperless will be more efficient for the clinic. We also see the benefits of having a complete record, both as patients are referred to us for service, as well as being able to send this information back to the referring physician. It is our hope that we will be able to have everything in one record, from reports to imaging studies, medications, allergies and lab results. We see the ability to send and receive electronic transfers of patient information with other physicians involved in a patient’s care as another step to providing the highest quality of care to our patients.”

Communication between the RIS and the EHR also has the potential to enhance revenue opportunities and improve collections. Some analysts estimate the costs of lost revenue and revenue-recovery efforts as three to five percent of annual collections. Electronic records, when closely integrated with the PACS and the RIS, provide greater accuracy and less uncertainty for diagnostic and interventional radiology. As interventional procedures have their own ICD-9 codes and reimbursement, carefully integrated systems should minimize the risks of over coding and under billing, improving compliance with federally funded programs (where the consequences of incorrect billing and claims submission can be time consuming and costly). 

“Two main issues have to be addressed due to the nature of our specialty and how our practice is run; the inherent issues of implementing a system such as this within our clinic and being able to interface with the hospital,” said Crocker. As we are wading through this process, we have been encouraged that these issues seem to not be as big of a deal as we thought. Receiving the maximum incentive funds for implementing an EMR system by the end of 2011 is a driving factor in undertaking this at this time. We would probably have put it off a bit longer if it were not for the incentives.”

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