A tradition of Excellence in Patient Care


December 5, 2013

Live From RSNA: Rethinking Teleradiology in Houston

Randall A. Stenoien, M.D. is leading a group of radiologists forward on the frontiers of teleradiology

When most people hear the word "teleradiology", they imagine a radiologist working in a teaching hospital speaking via videophone with a rural primary care physician about a patient living in a remote area. In fact, the term is now being used to describe some very advanced concepts these days. That certainly is true for Randall A. Stenoien, M.D., and his colleagues at Innovative Radiology, a 15-radiology medical group in Houston, and Houston Medical Imaging, a freestanding imaging center with three local locations that is operated by Innovative Radiology, which also provides radiological services to providers at two local hospitals, Conroe Regional Medical center (in nearby Conroe) and Houston Spine & Sports Medicine Center.

Innovative Radiology provides teleradiology services to 36 facilities. But now, in an advance on the concept of teleradiology, Dr. Stenoien, CEO of Houston Medical Imaging, and his colleagues, have partnered with the folks from the Atlanta-based Carestream, to develop what Carestream executives describe as "interface-less teleradiology" - teleradiology that no longer relies on operational support from any individual organization's radiology information system (RIS) in order to facilitate ordering, documentation, requests for information, or clinician-to-clinician communications. Thus, the PACS (picture archiving and communications system)-based reporting and viewing capability have been made RIS-independent, or, put another way, the RIS interface has been eliminated. On Dec. 3, while participating in RSNA 2013 at Chicago's McCormick Place Convention Center, Dr. Stenoien spoke with HCI Editor-in-Chief Mark Hagland regarding his organization's strategy and vision around teleradiology and the evolving role of radiologists. Below are excerpts from that interview:

What led you and your colleagues to move forward with this initiative?

Until recently, we had always been RIS-driven, and the workflow consisted of remotely registering your patient in the RIS, doing the study, sending the study, and then we'd pull the workflow from the RIS. But the folks from Carestream met with us, and shared that they had been working on a teleradiology project with people at the University of Virginia. And I proposed to them that we might also be a good co-development partner in creating advances in teleradiology.

And what we've created is a type of teleradiology with native PACS-based reporting. We divorced ourselves officially from the RIS on October 1, and converted everything within two or three days. So we have native PACS reporting; 100-percent voice recognition; and the ability to drop bookmarks into reports, among other functionalities. The whole idea is to get the communication starting again between the referring docs and the radiologists, and get us away from just being a commodity.

December 5, 2013

There are numerous new functionalities with this new solution, this upgrade to Carestream's ViewMotion that's being called View for Teleradiology. The distribution is extremely tight; it's MPI (master patient index)-/physician-based. And what's great for the referring physicians is this: all of a sudden, the physicians at the orthopedic group sending cases to Houston Medical Imaging and to two other imaging centers don't need to concern themselves about where specifically their patients go, because they're working with unified worklists. We also have a patient-merge capability, so they can see the entire list of patients, and it's become very easy for them to look at their data. This is making ViewMotion, which had already existed, more attractive to referring physicians. I couldn't get them to use the portal before, because I didn't have a way to lock down distribution. We couldn't tightly control the distribution. But now we can do that, and connect with all the providers. So for the orthopedic surgeons, we're their preferred reading group.

And the advantages are even greater now in the context of accountable care organizations and health information exchange, right?

Yes, very much so. We're now working with an ACO that sends their patients everywhere within the region. We're going to tie together these referring docs in the ACO, by allowing them to pick 10-15 imaging centers of their choice. The workflow will be that they'll order a study, will be able to choose from 15-20 imaging centers across Houston, those studies will be sent to our group to read, and they'll be able to see all the reports in ViewMotion, independently of where the study was sent. So we'll have that relationship; they'll have easy access to images and reports. And from the standpoint of the ACO, it's easier to track utilization when you can pull up the data.

What should other radiology leaders think about this initiative, strategically?

There was a nice article in the ACR Journal recently about the changing role of radiologists. We're trying to define ourselves and our roles in radiology, because with the advent of PACS, we really became isolated from our colleagues, and really became commoditized. And a lot of us have become disenchanted, and have been trying to maintain our incomes at all costs. But now with teleradiology, I'm getting excited again about getting our physicians engaged again; and getting them engaged in ACOs. So I'm excited about seeing myself as a leader and us radiologists as leaders, again. Radiologists are hungry for change, in terms of how they work with other doctors. And the bonus in all this is that we're regaining that sense of community.