There are still a few simple strategies guaranteed to optimize workflow with the added benefit of delivering a positive return on investment.

Diagnostic imaging has revolutionized healthcare for millions of people and pushed quality of care to new limits. Modalities such as MRI and CT are extremely technical and expensive in nature, yet they have been leveraged by industry and providers to identify early-stage disease, enhance quality of care and facilitate lifesaving intervention. Each modality requires specialized buildings, safety precautions, ancillary components, expensive software, highly specialized training and more. All this advanced technology facilitates unmatched patient healthcare, but it also comes with a significant price tag that never seems to level off.

At some point every diagnostic imaging center needs to find some price relief. Any cut back, however, comes with other significant costs (job satisfaction, physician satisfaction, increased turnaround times, decreased competitive advantage, etc.)

There is one strategic area where cutbacks can have a positive impact on a busy diagnostic imaging center, outsourcing. Cutting back on third party software, licenses, training costs and hardware costs not only decreases the dollars going out the door, but it also has several positive effects on the department.

• Eliminate the expense of purchasing and maintaining expensive third-party software.
• Free up time for technologists to work more closely with patients.
• Avoid the need for physicians (cardiologists, neurologists) to do their own post processing work.
• Decrease / remove service gaps when technologists go on vacation.
• Enhance technologist job satisfaction.
• More efficient use of modality time increases throughput (and revenue).
• Increase patient satisfaction.

Diagnostic imaging centers that are currently outsourcing their CT and/or MRI exams for post processing tell this story best. These organizations have done the research, sat through the demonstrations provided by industry, discussed concerns with their providers and colleagues and they have done the math. These providers decided Precision Imaging Analysis, with their unique deployment of post processing services, is the best fit for their needs. After a few months of service, we sat down with clients and asked them several questions pertaining to overall cost, quality of service and physician acceptance. The following is a brief collection of endorsements from a physician and Directors of Diagnostic Imaging from variously sized imaging and health services.

“I like specialized software tools, but each vendor has a niche specialty, none do everything well. What I found of great value is PIA’s ability to use different best-of-breed software to accomplish the best analysis for each case.”

                                                            -Dinesh Kalra, M.D.

                                                            Chair, Cardiovascular Imaging

“We contracted with Precision Image Analysis in June of 2022 to perform post-processing for our cardiologists. The (PIA) service provides results back in a timely manner and our physicians are quite happy with the results. If we need to get in touch with an analyst, they are a quick phone call or email away. PIA is close to 150 miles away from our care center, but it feels like they are just down the hall.”

-Magdy Kandil

Ancillary Services Manager

Finally, another Director whose department is responsible for tens of thousands of patient exams per year has the following to say about Precision Image Analysis. In this scenario the Director was faced with the task of setting up a new 3-D laboratory or outsourcing. A thorough analysis of costs alone found initial year one savings of over $800K and allowance of a shift to operating budget vs capital expenditures.

“Software is the gift that keeps on giving. Avoiding the capital costs of software as well as its ongoing care and feeding enabled tremendous flexibility in our budgets. Our reading radiologists and cardiologists are demanding in their pursuit of optimal patient care. PIA has excellent analysts. Their cloud service also provides real time access to studies when needed. PIA’s level of customer service is among the best of our vendors.”

- Bernard Peculis

Director - Diagnostic Services

It is true that most things in diagnostic imaging are very expensive and require lots of overhead to manage. Outsourcing cannot solve all the issues related to tight budgets, but it can sure lighten the load carried on the shoulders of a busy imaging center.

A few things to consider before choosing a vendor and making the leap to outsourcing all or just a few of your CT and MRI exams for post processing.

Quality of Service

It seems obvious that a provider of such important services needs to be accurate and reproducible in their work, but not all vendors are created equal. There are service providers that put an emphasis on the quantity of work their technologists can complete and thus quality may suffer. Further, when the work takes place offshore there may be some confusion on post processing protocols and exactly what is to be measured, which leads to inaccuracies. What is more, when physicians have questions about specific studies, the technologist who performed the analysis can be nearly impossible to reach if they are offshore. When considering outsourcing make sure the service is in the US and has sufficient quality controls in place to ensure all protocols are followed without compromise.

Timeliness of Service

The necessity for on time delivery of results varies between study types. If you are submitting a routine Coronary CTA exam for reformats and measurements, there typically isn’t a problem getting results back in a timely manner. However, if you have a STAT patient exam you need the data back ASAP. Unless you are planning on sending only non-acute studies, expectations must be set, and your service provider must have a way of differentiating and prioritizing studies according to study type.

Direct Contact with the Analyst Doing the Work

Your vendor should provide a straightforward way for you to contact the analyst doing the post processing work for you. This is extremely important; if your post processing provider is using a pool of analysts working from a shared worklist you lose the ability to build a relationship with that analyst and they do not learn about the specific low-level needs of your physicians. A service-oriented provider of post processing services needs to allow for multiple methods (email, text, phone) to contact a primary and secondary analyst assigned to your account. If physicians have a question about post processing or are looking for an additional measurement or view, they should be able to contact that individual analyst within just a few minutes to request a modification.

Workflow Flexibility

Imaging centers typically employ multiple physicians, and it is highly likely many of them have preferred workflows depending upon the study type they are interpreting. Your outsourced image post processing vendor needs to be able to accommodate as many of these workflows and physician preferences as possible. For example, some providers may have multiple disciplines interacting with patient studies; surgeons, cardiologists, radiologists – they all have reason to be looking at images and they may have different requirements regarding measurements, reformats and more. If your post processing service provider is not able to generate views, measurements and reports based on study type, severity of disease, or customized reports per discipline, your satisfaction with that provider will suffer. Nominally a post processing service provider will provide a wide range of reports but will also provide internet based, real time, secure access to the patient study. In this scenario the physicians will have a comprehensive report but will also have the option of opening the study from a web-based browser window and making slight adjustments of their own. If desired, that physician will also be able to reach their outsourced analyst and discuss the case within the context of the software within minutes as well.

Complete Service Offering

Your preferred image post processing vendor should offer a full range of post processing services, using the most up to date, industry standard, FDA cleared software. Having to engage with more than one post processing vendor for specific study types would be extremely inconvenient and counterproductive to streamlining departmental workflow. When interviewing potential vendors be sure to ask questions about not only which type of analysis they can provide but also about their monthly volume of those study types. This will give you a good indication of not only the breadth of service but also their proficiency.

The Process of Choosing a Vendor

Be sure to look at a minimum of two service providers and ask lots of detailed questions as they relate to your specific situation. Ask about compatibility with PACS, modalities and modality manufacturers, network types (LAN, WAN, Cloud), acquisition protocols, software they use routinely and for niche applications and more. The right service provider will be able to accommodate your routine workflow within the context of your network infrastructure. That service provider should be able to answer your questions and provide you with a proposal that meets your needs within 12 hours of having a fact-finding demonstration of the service. The provider should provide 3 to 5 no charge analysis of sample studies and follow up quickly with your physicians to ensure their analysis protocol requirements are met. The process of selecting a vendor should take no more than a few weeks depending upon the availability of your resources (physician, radiology administrator, legal / procurement).

Sometimes it feels like the hardest part of selecting a vendor is making the decision to start the process; the reasons to make the move to outsourcing are obvious. My recommendation is to make a few phone calls, engage with a couple of vendors, talk with some reference accounts, select the vendor you trust and start outsourcing, you will be thrilled with the change.

About the author. Daniel D. Bickford (www.linkedin.com/in/daniel-bickford) is President of Pintail Strategic Consulting which provides sales and marketing services to the diagnostic imaging industry, including Precision Image Analysis. Daniel was co-founder of Confirma, Inc., the pioneer of the breast MRI CAD market and manufacturer of CADstream.