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Today, we’re going to discuss x-ray transportation codes. Portable diagnostic equipment is gaining popularity. These machines are reliable and affordable and they help businesses cut office service expenditures besides. Moreover, mobile diagnostic services are often more convenient for patients than scheduled visits and in some cases are the only way to reach patients. However, there is one issue – transportation costs.

Mobile imaging operators use vans or other vehicles to transport their imaging equipment. Sometimes they need to travel many miles and spend hours getting to a site. There are no problems if they can collect transportation fees directly from their patients, but when it comes to insurance reimbursement, issues may occur. Nevertheless, in some cases, the transportation costs of mobile imaging operators can be covered.

Medicare has contributed to solving this problem by the introduction of portable x-ray transportation HCPCS codes, intended for use by mobile providers when they travel to Skilled Nursing Facilities (SNFs). Generally, there are two codes, depending on the number of patients: R0070, for single-patient services, and R0075, when there are two or more patients. In addition, the R0075 code has five Level II modifiers: UN (two patients served); UP (three patients); UQ (four patients); UR (five patients); US (six or more patients). Imaging facilities are to report these codes to get their transportation costs covered, thereby making mobile x-ray services more accessible.

Still, there are some rules and considerations*:

•   X-ray transportation codes are to be used for Skilled Nursing Facilities only. Transportation costs for trips to other types of facilities, e.g., doctors’ offices, may not be covered. For detailed information, please refer to the official Medicare booklet.
•   Only portable x-ray procedures will be covered. Other diagnostic modalities (e.g., ultrasound or MRI) are not mentioned in coverage guidelines and Medicare only covers transportation to a different location, i.e., tests carried out in a facility with mobile x-ray equipment already on site will not be covered.
•   Medicare covers transportation under these codes, but private payers may have their own rules. However, Medicare is one of the largest insurance programs in the United States. In 2016 it covered 16.7% of the total population and spent $696.6 billion on medical needs, and these figures are continuing to grow.
•   The codes must be used correctly. Otherwise, insurance providers may deny claims. The R0070 code must be used for single-patient services, while R0075 requires one of the modifiers. Moreover, the transportation codes are to be combined with the Current Procedural Terminology (CPT) radiology codes (7000 series).
•   Billing software should support x-ray transportation codes. Typically, mobile imaging operators use specialized software for sharing diagnostic images, preparing reports, billing, and sending insurance claims. Today, there are a lot of affordable, reliable, and user-friendly applications, but not all of them allow the use of transportation codes. Before signing up, it’s worth asking the software providers if this option is available. Usually, they willingly contact their customers, consult them on billing issues, and even create features customized to their needs.

Many medical businesses that deal with portable x-rays have increased their profits by using x-ray transportation codes. On top of that, they have expanded their service area considerably since Medicare covers their transportation costs.

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*This article is intended for information purposes only, so before using x-ray transportation codes, imaging operators are recommended to study the Medicare Claims Processing Manual and other related documents. 

Links:

Medicare Coverage of Skilled Nursing Facility Care (official booklet): https://www.medicare.gov/Pubs/pdf/10153.pdf

Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf

Teleradiology is the transfer of medical images via information technologies. It has a long history (much older than the Internet). But before the 1990s it was not widely used because of the expense, inefficiency, and poor image quality. Today, the development of IT has reversed this trend. Now teleradiology guarantees an increase in imaging procedures by up to 6–12% annually.

If you deal with X-rays, ultrasounds, or CTs, you surely know about DICOM, PACS, and RIS, and utilize these tools in your practice. These means of image transfer are quite common. However, their convenience and security vary considerably depending on the choice of service.

Currently, more platforms are becoming web-based. This is essential when you are working with remote X-ray technicians and doctors; accessibility from any device with an internet connection and no installation guarantee greater flexibility.

But the main point is that a good teleradiology platform can offer imaging providers a decreased turnaround time and reduce costs.

Decreased turnaround time (TAT). Teleradiology platforms decrease the time spent on image transfer and viewing. Needless to say, processing speed is affected by internet speed, but also by the quality of the software used. To that end, advanced solutions can offer a powerful toolset for image interpretation.

Instant round-the-clock access. If you are outsourcing or looking for a second opinion in other states, time difference can be an issue. A cloud-based application solves this problem. You have access to images at any time after they have been uploaded.

Cost reduction. Teleradiology solutions are helpful in outsourcing, which decreases expenses for in-house specialists.

User-friendliness and functionality. Teleradiology platforms offer a lot of useful tools and boast stability and security, but a good platform is a user-friendly one and can be easily integrated into any IT infrastructure. Every practitioner wants to begin right away. Nobody likes dealing with bulky manuals or spending hours on initial program setup.

Security and HIPAA compliance. Whether you are sending X-ray images to a colleague for a second opinion or receiving a series of CT scans from a technologist, you need to be confident that the process meets HIPAA regulations. Any risk of violation must be avoided.

Today, the majority of X-ray providers are switching to teleradiology software, but the benefits will differ greatly depending on the chosen service.

Today, a growing number of patients wish to have access to their health information. There are several reasons for that. They may need to change a doctor, learn a second opinion or just want to get control of their health records and feel independent of their providers. Whatever the reason, the Right to be Informed and the Right to Information are provided by law and the norms of professional ethics. Therefore, medical businesses should give patients access to their info. However, there are some transferability and privacy issues.

So, what are the ways of sharing medical info with patients?

Addressing a doctor or a facility directly is traditional, and, probably, the most troublesome way. Imagine that you need to get your records from a doctor you haven’t seen for months or even years. You’ll have to visit the facility and ask the front desk officer to retrieve your history. Then you’ll need to find the needed items. Your doctor could help you, but if you want to see him or her, you will likely need to schedule a visit. Of course, nowadays patient info is frequently kept in digitized form as Word/Excel files or DICOM images. So why not ask the doctor to send the records via email or upload the DICOMs to some file sharing service? The problem is, most doctors would flatly refuse to do that because of HIPAA compliance issues, since all your charts, progress notes, and images are Electronic protected health information (ePHI), and violation penalties can reach up to $1.5 million. Therefore, direct addressing is challenging for both doctors and patients.

Electronic health records (EHRs) are a much more advanced digital solution, intended for entering, processing and sharing medical info. There are hundreds of vendors that offer reliable and HIPAA-compliant systems, which allow retrieving demographics, progress notes, images, insurance/billing information and much more. EHRs are a common and reliable way for sharing patient information, and, if properly used, they improve doctor-patient relations. Wherever patients go, their charts go with them. Still, there is one problem. The system is intended for use by healthcare professionals and typically does not provide direct patient access.

Instead, there are solutions designed specifically for patients and tailored to their needs. The architecture of such software applications varies, e.g. module-based solutions may have patient portals (or patient modules). A patient visits the portal, logs in and finds all the needed information – from progress notes and eligibility responses to bulky DICOMs. If the system is designed as a web application, it requires no installation and can be accessed at any time and from anywhere. This means that the patient can control his or her records and becomes physician-independent, which may be useful if the patient needs to change doctors. To ensure HIPAA compliance, vendors use various types of encrypted connections. Besides, the patient can by no means access unintended information, since he or she has access to only one module.

The system of patient portals or modules is secure for medical businesses and isn’t a challenge for the patients. And if the service is painless to the patients, it is profitable to the provider.

Previously, we discussed tools for staying HIPAA compliant when sharing electronic Protected Health Information (ePHI). Now let’s focus on Direct Messaging, also known as Secure Direct Messaging or merely Direct, because, unlike SFTP or VPNs, it is intended for the use by clinicians only.

Direct is a part of a federal project for medical information standardization, which started in 2010. Therefore, it is undoubtedly HIPAA compliant, which is crucial for practice. However, it is still in its development and has its pros and cons.

At first thought, Direct Messaging is quite similar to common email systems, but there are some key differences. First, it can be used only by its specific users. To connect with another Direct user, you must hold an address that looks like, for example, [username]@direct.[facility].com. Therefore, you will be unable to send a message from, say, yahoo.com (in this case you’ll get a notification). On the one hand, such “closeness” may seem inconvenient, because it considerably limits your ability to contact different users. On the other hand, this eliminates a lot of entry and delivery errors and ensures that the message will be sent to the intended user. Thus, Direct becomes a corporate network of healthcare specialists with trustful relationships.

This feature attracts criticism, because finding the needed contacts may turn out to be challenging. However, some vendors integrate a search option, which allows clinicians to find a user by name, address, facility or specialty. In this regard, Direct is now only in development; this function is far from perfection. But the number of users is growing and in the future Direct is likely to become a powerful tool for managing professional networks.

Besides a digital security certificate, Direct uses an encrypted connection, which significantly reduces unauthorized access. Moreover, Direct is provided by HISPs, specialized Health Information Service Providers. So, Direct appears to be more secure than common web messengers.

Another essential feature of Direct Messaging is its integration with EHRs. Patient records can be shared within your regular workflow. To get their license, all EHR vendors need to integrate their services with a Direct Messaging system, and this feature will likely promote Direct. However, it doesn’t mean that any EHR supports any Direct Messaging system. There are a lot of different EHR and Direct Messaging providers, and their applications do not always work together. As for the leading providers, they usually cooperate with each other, but anyway, it’s better to check if your EHR is integrated with the Direct Messaging system you are going to purchase (unlike many web-based email services, Direct Messaging systems are not free). Normally, you will need to pay $100–200 per year. Besides, some vendors offer extra features that are additionally charged, e.g. a C-CDA viewer or another special tool, which you might need, but is not everybody’s cup of tea.

Being a required element of EHRs, Direct itself is independent of the configuration or elements of your IT infrastructure. This means that it can be used without any additional software, directly from the web browser. However, some software providers manage to integrate Direct Messaging in their applications. Usually, they offer top-to-bottom solutions, covering all the processes of a diagnostic business. If you are using such an app, you can contact your provider and ask them about Direct Messaging capabilities.

HIPAA compliance is an existential issue for medical businesses, especially if they use special-purpose software and mobile applications (e.g. mobile imaging operators). HIPAA (Health Insurance Portability and Accountability Act), adopted in 1996, includes a set of legal requirements for protecting sensitive patient information from unauthorized access or leakage. Medical institutions, their staff, and software they use must meet the criteria of physical, network, and process security. Today we will review a few common security tools used to protect data exchange in imaging diagnostics.

TLS (Transport Layer Security) is an encryption protocol that provides secure data communication between network nodes. It is widely used in web-based applications, as well as email and instant messengers. The primary function of this protocol is to prevent unauthorized access and traffic analyzing via so-called “sniffers.” This protection feature can be used in teleradiology to ensure the secure transmission of sensitive patient data, such as medical images. The DICOM protocol commonly used in medical imaging does not originally use TLS, although the relations between DICOM and TLS are specified in DICOM standards. So, to provide secure communication, you can hire an IT expert to “stream” your DICOM connection through TLS or find a ready-made solution.

SFTP (Security File Transfer Protocol) is a file exchange protocol, which is more secure than basic FTP. The underlying technology, SSH (Secure Shell), is a reliable and secure way of connecting two remote systems to exchange commands and data. The linked systems use authorization to “recognize” each other before they start sharing any information. For example, if two facilities need to exchange medical data, such as reports, progress notes or images, then using SFTP is a reasonable and simple solution. If the two systems use different standards (e.g. HL7 and DICOM), it may require a lot of data mapping and format conversion work, but SFTP certainly does its job as a file exchange means.

Direct messaging (also known as Direct Exchange or simply Direct) is a special-purpose encrypted protocol for exchanging medical information in the form of text messages and attached files. It is similar to web-based email, however, there are some crucial differences. It is managed by specialized providers – HISP (Health Internet Service Providers), cannot be accessed by non-Direct users, and has some additional tools. Being an integrated feature of modern EHR systems, it is user-friendly, standardized, and HIPAA compliant.

VPN (Virtual Private Network) technology is widely used in various industries. As for imaging diagnostics, VPN can provide encrypted links between, for example, a PACS server and a remote client. Currently, a lot of providers claim that their services are secure enough and meet the requirements of the healthcare industry. Some experts consider such networks safe and entirely HIPAA compliant. However, VPN users stay provider dependent, even if the connection is encrypted strongly enough.

These are the most common tools for keeping protected patient information secure. We could also mention end-to-end encrypted messengers, PGP, and more. Besides, you can get the ultimate solution, which combines multiple protection features and helps you stay 100% HIPAA compliant.

And does HIPAA compliance guarantee complete security? Technically, it doesn’t, although the requirements are strict and sophisticated. However, the damage may be too severe if you ignore them and use open email networks instead. We use those every day for common communication, and the probability of leakage is relatively low. But when it comes to patient information, even a single case of unauthorized access may turn out to be a costly matter. The overall penalties for each violation amount up to $1.5 million per year (while fines typically range from $100 to $50,000). So, you can analyze the financial risks and compare them to the costs of security tools.

Reporting, retrieving, and communicating clinical findings are among the most important capabilities of any diagnostic information system. The conservative way of preparing and storing clinical reports is keeping them as free text. Such reports (digital or paper) are not exactly “unstructured,” as they typically include several mandatory sections: patient demographics, clinical findings, measurements etc. Still, they make it rather difficult to find specific details or compare records made by different specialists.

Imagine a situation where a patient needs to change a physician (say, he or she has moved to another town). The new doctor needs to review the patient’s medical history and retrieve their previous reports that were created by the previous specialist. If they were entered as free text, the search becomes challenging. Moreover, the previous physician might have used non-standard terminology, which adds ambiguity to the information. Thus, the new physician needs to spend extra time or even contact the doctor who prepared the previous reports.

A reasonable solution is using structured reporting (SR), which is integrated into modern software applications. Today, we will talk about the pros and cons of SR and try to answer the question: Does structured reporting limit the professional freedom of doctors?

Report templates make it possible to enforce a certain report structure and ensure the consistency and integrity of your reports. A stable report structure allows doctors, billing companies, medicolegal officers, and scholars to spend less time reading and comparing the reports and makes patient records more organized (which makes it easy for business owners to control the work of their employees). But that’s not the whole story.

DICOM-based SRs are supported by diagnostic equipment and allow for the transfer of diagnostic measurements in a standardized format. This makes it possible to have auto-populated report forms for typical medical studies (e.g. ultrasound). The equipment stores the needed measurements and displays them in the corresponding fields. Such a workflow optimizes the reporting process and reduces the incidence of human error.

However, as SR gets widespread, it attracts criticism. Some clinicians claim that they do not understand the meaning of structured reporting, while others consider that SR lacks objectivity, because the templates may be used “to reveal the needed results and hide the undesired findings.” Some are afraid that structured reporting attempts to impose a uniform structure for different types of studies and lacks detailed information. Finally, the most conservative physicians confess that they experience issues using the software.

Indeed, these problems may take place, but we consider them rather vendor-related than fundamental. First, let’s clarify that structured reporting has the same meaning and purposes as “traditional reporting”; in essence, it’s just an upgraded version of the same idea. But well-built SR eliminates a good deal of manual work and saves time. The templates are (or, at least, should be!) designed in response to the demands of medical specialists and thus reflect their vision.

As for report structure, it was never intended to be uniform for all types of studies. Otherwise, SR would be kind of a Procrustean bed, unsuitable for medical needs. Each diagnostic modality requires a specific approach and, thus, a specific reporting form. Moreover, sometimes one form for one modality is not enough, especially when a vast anatomic area is being examined (e.g. an abdominal sonogram). Software vendors understand it and make several report templates available for the same type of study. Due to this flexibility, structured reporting can contain as many details as the physician needs.

However, some practitioners are not willing to use SR, despite its advantages. In this case, they can create reports as free text and attach them to study records as PDF documents, because modern software allows such type of data exchange as well. This practice takes place, but the general trend is that free-text reports are being gradually replaced by SR.

So, does structured reporting limit professional freedom? In our opinion, that is not true. SR is a set of tools, and each of them should be adjusted to the user’s needs and utilized according to its intended purpose. If the SR functionality is used correctly, all your medical findings will be prepared easily, precisely, kept in order, and contain all the needed information. Besides, most healthcare information systems keep an open option, so that medical specialists could select the appropriate set of templates or follow the conservative path and record their findings manually.

Discovered in December 2019 in Wuhan (Central China), a new сoronavirus infection named COVID-19 has rapidly spread to the rest of the world and become the first global pandemic of the 21^st century. On January 30, 2020, the World Health Organization (WHO) declared the 2019 Novel сoronavirus (2019-nCoV) disease outbreak a public health emergency of international concern. The official name of the disease was announced on February 11, 2020.

As we write this article, there are about 500,000 confirmed cases; over 65,000 have occurred in the USA. Fatality rate has already exceeded 7% in Italy, and the situation is provoking worldwide panic and affecting businesses, the consumer goods market, and the healthcare industry.

This time we will try to look at the situation from the medical business point of view and discuss the coding and billing aspects of COVID-19. What are the ICD codes for the coronavirus, are they billable, and how can you improve your coding and billing processes in the current situation?

According to the 10^th revision of the International Classification of Diseases (ICD-10), there are two emergency codes for COVID-19: U07.1, which is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing, and U07.2, assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.

However, in the USA, there are currently no specific ICD-10 codes to use when billing for services related to COVID-19. The U07.1 code will be added to the U.S. ICD-10-CM list effective April 1. Starting on that day, U07.1 should be used to report a patient who has tested positive for COVID-19.

Until then, the CDC is giving the following guidance:

For a diagnosis of COVID-19, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.”

To make a long story short, U07.1 is considered for confirmed cases only, and is not available to bill until April 2020, while B97.29 is the diagnosis code providers should use for confirmed cases through March 31, 2020. However, healthcare providers who work with Medicaid should refer to the Medicaid billing guidance for COVID-19 Evaluation and Testing.

Please note that if the provider documents “suspected”, “possible” or “probable” COVID-19, you should not assign the B97.29 code.

As for ICD-11, which will come into effect on January 1, 2022, the confirmed diagnosis is coded as RA01.0 and the suspected or probable diagnosis as RA01.2.

The Centers for Medicare & Medicaid Services (CMS) introduced the first HCPCS code, U0001, to bill for tests and track new cases of the virus. Another HCPCS code, U0002, allows laboratories to bill for non-CDC laboratory tests for the coronavirus. CMS experts believe that specific codes will encourage testing and improve tracking. Medicare will be able to accept these codes on April 1 for dates of service starting from February 4.

COVID-19 puts forth organizational and institutional problems and dramatically affects the healthcare industry. Under the current conditions, coding, billing, and medical practice itself become more challenging than ever, but you can get some support from healthcare software. Here is a couple of ideas:

• Advanced EMR or billing solutions help you populate codes correctly. You can start entering the code or simply a keyword, and the system will give you a hint by displaying a dropdown menu.

You can also automate your claim generation process, which is quite possible with modern medical billing platforms. This can help you overcome the personnel shortage and considerably speed up your revenue cycle management.

• Telemedicine, including televisits and phone consultations can help you practice social distancing and avoid unnecessary personal contacts.

IT solutions designed for medical businesses can help you focus on the health of your patients, which should be the only challenge nowadays, whatever the situation turns out to be.

It is on you to take care of them, so take care of yourselves, too.

Today, rapidly developing healthcare technologies inspire more players to enter the market of diagnostic services. A lot of new solutions are now quite affordable – from wireless connections and secure PACS to compact portable machines. Some companies even create transducers which can be connected to a smartphone!

However, this encourages competition among medical businesses. The competition leads to an increase in quality-to-price ratio and makes physicians with vast experience reframe their views on management and reconsider their diagnostic methods. Innovations are no substitute for the medical expertise, and still, a lot of healthcare enterprises with decades of practice and spotless reputation become driven from the market by younger and smaller entrepreneurs, who have adopted new technologies.

As an example, we can mention modern ultrasound systems, which are currently gaining popularity. The overwhelming majority of such machines are digital and DICOM-friendly. But what are the benefits of ultrasound compared to, say, X-ray? First, US units produce no radiation. On the one hand, it allows physicians to cut their expenditures on radiation protection and dosimetry (not to mention ergonomic issues). On the other hand, the number of studies can be increased. This, in turn, leads to better understanding of the course of the disease and more successfully treated cases.

From the technical point of view, modern ultrasound systems have an extensive capability of structured and templated reporting. Some specific-purpose software allows doctors and technologists to combine these two features, providing them with a powerful diagnostic instrument.

Besides, the leading equipment providers market portable ultrasound units – some of them are laptop-sized, others can be easily held in one hand or even connected to a mobile device. Such machines are usually quite reliable and even more advantageous, especially for small businesses. They are less expensive than stationary equipment and allow the technologist to perform all the necessary procedures right at the patient’s bedside – rapidly and with no compromise in quality. A visiting technologist can cover multiple locations, which is way more convenient for elderly or urgent patients.

But mobility and comfort are not the only ways to increase patients’ satisfaction. Such devices increase transparency of healthcare. Quite often, the patients experience stress or anxiety when they do not understand the real situation. The new approach to diagnostics, based on the use of mobile devices, can eliminate these unfounded fears. For example, a doctor can immediately compare images of a cardiac patient’s heart to a normal organ or more severe pathologies, and explain the difference. This method does not always have a calming effect, and the physician should analyze each particular case before using it. However, together with professional comments, such visualization makes the patient follow the doctor’s orders more carefully.

Practices based on the use of mobile ultrasound systems sometimes attract controversy and evidence-based criticism, arising from misdiagnosing cases. Some claim that the problem lies in the training programs for ultrasound specialists. Others suggest that the major issues are caused by the misuse of the equipment. Without being experts in education, we cannot judge on the first problem, but as for the technical issues, it’s easy to overcome them.

Nowadays, software developers offer a lot of different applications for diagnostic imaging: from single-purpose billing services to A-Z solutions which can streamline all your business processes (including scheduling, reporting, equipment management and much more). Such applications can considerably simplify your operation of medical equipment. Besides, the developers of the most advanced software have understood the benefits of cooperation with equipment providers and medical specialists. Some of them can even send you manuals for your ultrasound machine and help you configure it – completely free of charge.

Electronic Health Records (EHRs) make it much easier to manage patient records by systematizing and making them more accessible, searchable and secure. Apparently, EHRs are not free from shortcomings. Some clinicians reveal user-unfriendliness or lack of interoperability. However, all these downsides are specific to particular systems, while the number of EHR vendors in the USA is over 1,100 as of today. The adoption rate also looks impressive. According to the National Electronic Health Records Survey (2015), 87% of physicians were using EHR. This suggests that at least the system has its advantages.

Originally, the electronic health record technology was designed for billing, but gradually practitioners revealed more and more of its features.

Now, EHRs are successfully used for administrative and clinical purposes. They are well-structured and still give you the necessary degree of professional freedom, which is essential for successful medical practice. Thus, EHRs include healthcare data variables (demographics, health behavior, allergies, chronic diseases etc.), as well as fields for free text (e.g. progress notes or comments for diagnostic images). We are not going to focus on these things. If you are a medical business owner, a doctor or a technologist, you surely know what EHR is about.

Let us think about not-so-obvious benefits, which can be achieved with the use of Electronic Health Records.

EHRs have become helpful to medical science. They are a rich and affordable (sometimes even free!) source of longitudinal health data associated with key socioeconomic and cultural indicators. Besides, being GIS-based, EHRs reveal state-specific situation. And since the system suits scholars, you might as well think of using it in, say, creating your business strategy, whether you are a prospective individualist or a nationwide hospital network. A good idea would be to plan your actions according to the local demographic and health situation.

Another way to benefit from EHR is to combine it with an advanced healthcare application. Imagine a common situation: diagnostics findings look controversial and need to be disambiguated. At the same time, the referring doctor is overloaded with work, and can overlook some vitally important tests, which may be a matter of the patient’s health. Luckily, nowadays such situations are avoidable. There are healthcare applications that use smart algorithms designed in cooperation with practicing physicians. Those algorithms automatically analyze the patient’s EHR and search for diagnoses that suggest specific medical tests. Normally, such software by no means pretends to be a substitute for a professional medical opinion. However, it is widely used as an efficient tool for preventive diagnostics, and that’s why interoperability is a substantial point. Besides, this combination can help medical businesses increase their revenue by recommending their patients more necessary medical tests.

Experience has shown that an electronic health record system can hardly be called a one-trick pony. It gives medical businesses multiple advantages in various fields, from market research to preventive diagnostics. Moreover, in the right hands, it becomes a powerful revenue booster.

To learn what your information system can do together with EHRs, contact your software provider. If you are going to purchase a healthcare application, make sure it is successfully integrated with the leading EHR systems.

Modern diagnostic imaging companies meet many challenges. One of them is image management, especially if you deal with X-ray films. On the one hand, federal and state laws require that images are kept long enough. On the other hand, films are usually fragile and can be easily damaged.

You probably know that image-keeping requirements are very state-specific. The legislation concerning retention periods and storing images of different modalities varies from state to state. Utilization of medical images is a separate issue. In some states (e.g., in Colorado) you should try to contact a patient before destroying his or her records – personally or even through mass media (if you fail to locate the patient). Besides, recycling of X-ray films should be HIPAA compliant (which means that normally you’ll have to call upon recycling agencies and receive a destruction certificate).

So, storing images as films is a somewhat conservative and troublesome way of image management. Therefore, more and more business owners choose to go digital. You would probably ask: “Is it worth going digital if I have been using films for quite a while?” It’s up to you to decide, but today there are plenty of opportunities for that. Some companies even provide services for creating a transformation strategy. But, no matter how individual such strategies might be, they always consist of two basic steps.

Step 1. Digitizing. If you have started your business before the “digital revolution”, you’ll have to convert your images. The most common format is DICOM. However, JPG and TIFF are also available. Here, there are two main ways of action. First, you can purchase or rent an X-ray digitizer and scan your images yourself. Second, you can outsource the task to a digitizing company.

We should note that the most crucial point here is image quality. So if you are going to purchase a digitizer, make sure it is designed especially for clinical needs, reliable, easy to use, and productive. As for productivity, it can be measured as films (usually of a particular format) per hour, or cycle time (in seconds). We would recommend using equipment from trusted manufacturers, such as Kodak, Carestream or GE. If you are going to outsource, it’s better to contact companies specializing in working with medical materials.

Step 2. Choosing storage. Now you’ve got to keep these massive archives somewhere. You will need not just to store the images, but to retrieve and communicate them easily and securely.  At this point, you have an alternative:

• Burning CDs. The simplest way—which, however, gradually becomes less popular—is keeping your medical info on CDs. One, and probably the only advantage of this method is that the CDs are way more compact than large-format films. However, you’ll need to purchase loads of CDs, because medical images are rather memory-consuming.
• Internal server. A more advanced solution is storing your medical info on an internal server in your office or hospital. Still, your expenditures will be significant, because, above all, you’ll need to hire an IT specialist to attend the server. Besides, if you choose storing sensitive patient information in your office, you will need to make sure it is secure enough, otherwise your business will face HIPAA compliance issues.
• And the third way is keeping your images in a digital cloud. Perhaps, such storage is even more secure than your server. Besides, you are not serviceman-dependent anymore, and your information is available 24/7 from anywhere. You do not need to download images to view them, as cloud solutions usually have a viewer tool built-in. Moreover, you do not need to install any software, except for a web browser.

We have already discussed the benefits of electronic image-keeping. To put it in a nutshell, such images are much easier to store and retrieve, than films. Digitalizing your business may hide some pitfalls, but there are plenty of ways to overcome them. One of such ways is to use a digital health platform with an integrated DICOM viewer and cloud storage. Such software can help you digitize, store and communicate your images, providing maximum convenience and security.

The integration of new technology solutions continues to reshape businesses, and healthcare is no exception. On our blog, we have already presented some features, which optimize a lot of processes for medical diagnostic businesses, such as web-based PACS. However, from time to time, they become subject to criticism.

The general objection is: “Productivity increase leads to quality loss.” This is usually explained by several points.

Firstly, modern software reduces discussion, which is vitally important for medical practice. For instance, in medical imaging, radiologists and referring physicians do not communicate directly anymore. Instead, they use a built-in list of medical findings, which lacks an individual approach and sometimes even misleads the doctors.

Another disputable point is the presentation of medical data. A clinician takes a rapid glance at a report, displayed on a computer screen right at a patient’s bed, and proceeds to the next patient. Thus, clinical findings become not only under-discussed but also under-studied.

These claims usually come from physicians with extensive practice, whose skills and experience are beyond any doubts. In their opinion, PACS, EHR and other software is a sort of Procrustean bed, i.e. it is unfit for medical examinations, limits professional freedom, lacks flexibility and an individual approach. Furthermore, those conservative doctors remark that such a state of affairs leads to deterioration of professional skills, which gives causes to more pressing concerns.

Well, all these arguments are based on practice and should be taken seriously. However, are they really caused by the functionality of the software in question?

It’s true that some medical software provides just a short drop-down menu to select clinical findings from. Does it mean that modern applications limit a physician’s thought or impose restrictions on patient treatment options? Definitely not! For example, if you are performing a diagnostic test and cannot find the needed assessment or plan on the built-in list, you can usually leave a free-text note in the corresponding section, so that the referring doctor could assign a treatment plan in compliance with your recommendations. But, best of all, contact your software providers, and they will add the missing element or make any other adjustment. These guys usually keep in touch with practicing physicians, because your comments help them improve their solutions and win the market.

Another myth is that diagnostic images cannot be appropriately studied via PACS software. The truth is that advanced solutions have a built-in viewer with an impressive set of tools, which would leave films far behind. Besides, web-based PACS services that use cloud storage help you securely store and quickly retrieve images from anywhere in the world.

And last but not at all least, there is a myth that PACS and EHR applications prevent physicians from staying in touch with each other. Healthcare applications offer many ways of communication: from simple chats (which are, however, HIPAA compliant) and message boards, where you can share your thoughts freely, to such special-purpose tools, as Direct Messaging. Moreover, some advanced applications offer a “second opinion” option, which means that you can consult physicians all around the world on disputable questions.

So, do PACS and EHR really reduce quality? We believe they do not. The main troubles caused by modern software tools seem to be rather a matter of habit than harmfulness or incompleteness of the product itself.

As for diagnostic imaging, the current push is for radiologists to sit at the table, taking part in overall patient care. So more and more systems are actually getting the radiologists more involved.

We are likely dealing with a psychological phenomenon of conservatism and mistrust in innovation. Not to mention that many software tools are sometimes just misused. The software ecosystem is yet far from perfect, and there is definitely much work to do, but it is constantly being improved by many software developers and medical specialists. More and more healthcare businesses become interested in getting efficient, flexible and easy-to-use IT-based tools. Today there are a lot of available PACS, EHR and other solutions, marketed as standalone applications or multi-purpose integrated software. So, if you have not yet tried a PACS to manage your diagnostic images or an EHR to organize your patient records (or if you have been disappointed with some solutions), it’s worth looking around. Maybe you’ll find a tool designed uniquely for your business.

DICOM offers a lot of capabilities for storing, transmitting and processing medical images and patient data. However, you must be aware that there are several other protocols, which causes interoperability problems. This time we’ll talk about interoperability and compare two common medical data standards – HL7 and DICOM, which are the most common protocols.

Interoperability issues may be illustrated in different ways. For example, a patient has to change hospitals (say, he is moving to another town). He expects that his EHR and all medical information would be transmitted successfully. But these two hospitals use different standards, and their information systems are unable to understand each other. So, the patient needs to retrieve his medical records on paper and perhaps even do some tests again. Imagine that he is seriously ill and needs treatment as soon as possible – then any delay means health deterioration.

Or suppose you run a medical business and transmit patient data to an imaging operator or a hospital. If you and your partner use the same standards, you’ll faсe no obstacles. Otherwise, your systems will encounter many errors or barely be unable to communicate. This can result in losing the partner because none of you want to abandon the system you are using as the switch is costly.

Now let’s focus on the protocols. What are the similarities and differences between HL7 and DICOM? HL7 can be used as an alternative to DICOM MWL, which is more imaging-oriented.

Herman Oosterwijk, the President of O Tech Inc., a company specializing in healthcare technology consulting and training, has been exploring the subject for years. In his judgment, the main points are as follows.

• HL7 is a transaction-based protocol. It is driven by events (e.g. the admission or discharge of a patient). According to these occurrences, an information system creates so-called “unsolicited events” and sends them to the other side of the connection, no matter who might be there. DICOM is a much more client-oriented protocol. For example, when using MWL, imaging equipment sends requests to an MWL server to receive a worklist.
• HL7 is a flexible standard, therefore it has become more of a guide than a standard for many healthcare facilities. HL7 is often customized on-site, while DICOM is much more rigid.
• HL7 files are somewhat larger in size because of character-based encoding, which implies conversion of pixel data to characters.
• Thanks to MPPS, the DICOM protocol can provide more timely and precise information about performed diagnostic studies.

We should also mention some institutional peculiarities. For example, HL7 offers several types of membership and regularly holds conferences and workgroups. As for DICOM, its use depends on the equipment or software you buy; sometimes you have to purchase this or that option separately. They also educate their customers, but to a lesser extent.

“While HL7 and DICOM have their own domains, they do definitely connect, however. The interface consists from a workflow perspective of two areas, i.e. where the ordering information for the imaging procedure is exchanged, and where the results, in the form of a diagnostic report and/or measurements are sent back to the information system.”

To the benefit of the end customer, both of the protocols do try to solve the compatibility issue. Besides, software developers have come up with customized medical applications that can link the two protocols. Even if you and your partner have taken different sides on the subject, you still can be fully compatible if you use one of those applications. Patient data can be rapidly transmitted, recognized, easily processed and managed.

• For more information, please refer to Herman Oosterwijk’s articles: https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=51105
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3453402/pdf/10278_2009_Article_BF03168256.pdf

Along with Modality Worklist, which enables your information system to send study inquiries to diagnostic equipment, you can use one more DICOM tool, Modality Performed Procedure Step (also known as MPPS). Conversely to Modality Worklist, it enables your machines to send feedback to your RIS, HIS, PACS or another system (for example, you may use an integrated IT solution which combines all these tools). Like many other DICOM tools, it is an optional feature, so you might need to pay extra for it. Today, we will talk about the features of Modality Performed Procedure Step, the basic principles of its function and the benefits it offers.

What is it for? When you order imaging studies, you might be concerned about the timeliness and quality of the scheduled examinations. Everything must go smoothly, without equipment failures or technologist mistakes.

If something has gone wrong, you will be probably notified that the study hasn’t been performed instead of receiving the images. Moreover, you will discover that at the last moment, when you expect the study to be completed. As a result, you become unable to make any adjustments to the schedule and lose revenues.

MPPS eliminates these issues; so, if you haven’t implemented it yet, your business may run into a bottleneck even at the initial workflow stages.

How it works. Having received an order from Modality Worklist, the diagnostic unit starts sending messages to the DICOM server connected to your information system. The system generates messages automatically (except for patient demographics, which is in most cases copied from the worklist). Particularly, these messages can tell you about:

• The incoming order. Besides data retrieved from Modality Worklist, you will know the study accession number.
• The actual performed study, which sometimes differs from what was scheduled initially. For instance, the technologist may have chosen a different protocol for the examination or decided to take an additional set of images.
• Procedure status information. The diagnostic machine sends a status message to the server when the study is started, completed, paused or canceled (along with the cancellation reason). As for the cancellation reasons, DICOM has standardized many of them, so the fault management becomes much more efficient.
• The technologist’s name, radiation dose, modality hardware condition, and even billing and insurance information.

Performance of this intelligent feature is based on the connection between your equipment and DICOM server; therefore, it requires proper configuration.

What benefits does it offer? You get several considerable advantages at the study performance stage. Among them are:

• Minimized turnaround time. Reporting starts as soon as the machine acquires the order information. The system creates all messages automatically and therefore saves your technologists’ time and increases their productivity.

It helps you to track the exact time needed for the studies and thus to schedule more efficiently. The diagnostic unit immediately informs you about any issues with the studies, which allows you to troubleshoot as quickly as possible.

• Information accuracy. MPPS eliminates human error. A technologist doesn’t need to report on the examination status since it is done by the equipment. Besides, the machine tells you about the studies which have been actually performed (as we have already mentioned, they may differ from the scheduled examinations).

Together with Modality Worklist, Modality Performed Procedure Step ensures a reliable intercommunication between your information system and diagnostic equipment.

We have already mentioned problems arising from double data entry. The main issues are time expenditures and high risk of human error, as well as the need for duplicating and synchronizing databases, which may be a costly affair. In one of our previous articles, we discussed how DICOM Modality Worklist can help to transfer patient information from a scheduling or dispatching system to a diagnostic machine. However, the connection between your scheduling service and diagnostic equipment is just a single link in your IT infrastructure. This time we will look at the situation through a broader lens and talk about how integrated healthcare solutions can help to eliminate the problem completely.

Let’s suppose you run a diagnostic imaging business, and you do it in a rather conservative way. Then your workflow is probably similar to the following.

First, you obtain patients’ information: demographics (age, sex, etc.), required studies, date and time of service, the referring doctor’s name, and then you pass this information to scheduling or dispatching software, where study orders are created. At this stage, you are likely to enter data manually, which is quite common.

Then you need to pass these orders to the diagnostic equipment of various modalities (X-ray, ultrasound, etc.). If you are using Modality Worklist, which is correctly configured, the data will be transmitted flawlessly. Otherwise, imaging technologists will have to re-enter all the patient information manually, which may lead to additional errors and affect the quality of their work (we should bear in mind that medical imaging is a very technologist-dependent industry).

When the studies are completed, images are sent to a PACS. There are several reasons for using cloud PACS, you might have read about them on our blog. The images include patient information for identification in the cloud PACS.

The next stage is reading, or image interpretation. The images are passed to a RIS (Radiology Information System), where the reading doctor analyzes them and creates a report on each study.

Having finalized the reports, the reading doctor sends them to a Health Information System (HIS). Depending on the degree of HIS integration into your IT infrastructure, the patient data may be sent automatically or entered manually once again (it has been already entered twice, so this is the third time).

After that, the reports can be received by the referring physician.

That’s what it looks like. You may have gotten used to this workflow, but even if all of your sonographers and technologists are flawless in data entry and never make mistakes, you would probably agree that this workflow lacks efficiency. You may hire the most skilled medical specialists, and still steadily lose revenue just because their skills are underused.

Your business may employ multiple standalone services and still suffer from mistakes arising from the data re-entry. The primary cause is the lack of integration of all these tools.

If you are thinking about streamlining your workflow, then full-featured software might be of interest to you. It may be designed as a module-based application. Such software applications put together all the stages of your workflow and offer multiple advantages – and minimizing data re-entries is just one of them. Once you have entered the patient’s information, it will be transmitted to the following stages or just stored in the system, so that you could quickly retrieve it at any time.

If your PACS server (or cloud PACS storage) is integrated with a HIS/RIS system, scheduling service, and appropriately configured diagnostic equipment, it is possible to transfer patient demographics directly from patient records. Then your sonographers and X-ray technologists will not have to re-enter any patient data on their machines.

Owners of diagnostic businesses, including those who have many years of experience, often find themselves in doubt about implementing modern technology and going digital. Many of these businesses are long accustomed to their daily workflow and tend to overlook the benefits of innovation. However, they can simplify a lot of routine processes, eliminate numerous errors and considerably boost the bottom line by raising productivity. At first glance, all these modern digital solutions may seem sophisticated, but actually, you just need to take a closer look. Previously we spoke about setting up Modality Worklist (MWL) on Mindray M7. This time we will try to send study queries from this machine to the DICOM server.

First, the queries can be sent manually.

Choosing a patient. Enter the Patient screen by pressing the Patient button. After that, press the Worklist button and the Worklist screen will open. In the upper section, you may see the search criteria: Patient ID, Search Key, Exam Date, Patient Name, Accession Number and Worklist Server.

Here you need to enter the required information in the corresponding fields and click the Query button. The patients who fall under your criteria will appear in the lower section of the screen. Now your machine is connected to the DICOM server, and you can easily update the worklist in real time.

Performing studies. Now let’s try to do a scan. Select a patient in the patient list, then choose his or her record, and click “Start exam.” The machine will import the patient data and begin the study.

Then click the Transfer button, and the patient information will be displayed on the screen.

Edit the patient information, and click OK. Well done! Now proceed to the next study. If you need to view detailed patient data, click “Show Detail” in the lower toolbar.

Not too difficult, is it? But can we make sending the patient queries even more straightforward? Definitely! Let’s see how.

Automatic query function. Orders can be sent automatically via the DICOM server. This is a very useful feature, especially if you contact your referring doctor day-to-day. You will have to set it up first, but once it is done, your equipment will get along and cooperate with the Worklist server on its own. Open the DICOM Service Preset page, then follow the path: Setup – Network Preset – DICOM Service – Worklist. The Worklist page will open.

Select the desired item from the service list, and press the Default button. The Worklist server will be set up as the default service. Enter the Setup menu by clicking “Exit,” then click the “Return” button.

Now open the Patient info page by pressing the “Patient” button. Go to the Worklist screen by clicking “Worklist.”

All set. Now the diagnostic unit automatically queries the studies scheduled for every day. All the scheduled patient records will appear on your worklist.

Our machine is set up and ready to perform its duties. As you see, the system interface is quite user-friendly. However, the key part of your job is being a medical professional. Just hand over routine tasks to the machine to better focus on your patients.

The DICOM standard has become a substantial component of today’s imaging technology. It offers such features as Image Storage, Structured Reporting, Modality Performed Procedure Step (MMPS), and Modality Worklist. The vast majority of modern imaging equipment as well as software is DICOM compliant. However, to use advanced DICOM capabilities, an imaging technologist may need specific training, skill and practice, and it does not always come easy. Therefore, a lot of useful tools may remain unused or simply ignored. We would like to share an insight into DICOM benefits.

Previously, we spoke about essential features of DICOM Modality Worklist. Now let us move from theory to practice. We are going to set up MWL on the Mindray M7. This portable ultrasound machine is a popular choice for many sonographers. If you use another model, our quick guide might still be useful, because different systems often follow a similar structure in their settings.

If you have been following our blog, you know that diagnostic equipment sends patient queries to a DICOM Worklist server and thus needs to be connected to it. So, first, we need to add the DICOM server to our machine, if you have not done it yet.

Enter the Setup menu by pressing the Setup button, then go to Network Preset and select the DICOM server you need to add. The Server screen will open.

There are only two parameters you need to enter here: Device, which refers to the name of your equipment unit, and IP address of the Worklist server.

Use the Add and Delete buttons for adding and deleting servers.

You can also check the network connection between your machine and the selected server by clicking the Ping button in the Device area.

The next step is configuring the Modality Worklist. All the preferences are set on the Worklist Page. To enter it, follow the path: Setup → Network Preset → DICOM Service → Worklist.

Select the needed service in the Service list and enter its info, then click Add. At this stage, there are a few more parameters you need to enter: Device, Service name (which refers to the Worklist server), AE Title (AE stands for Application Entity; its title is locally unique), Port (DICOM communication port number) and Scheduled Station AE Title.

If you need to change some settings, select a device, enter the new parameters in the Configuration area (right above the Service list), then click Update.

Similarly, you can delete the unnecessary items or set the server as the default one by clicking the corresponding buttons on the Worklist tab.

After that, you need to verify the connection by selecting an item in the service list and clicking the Verify button.

When done, click Exit.

All set. Now you can proceed to sending queries from your machine to the Worklist server.

MWL configuration is not as sophisticated as some technologists might find it. Anyway, if you have any issues concerning the Modality Worklist settings, please refer to the official operator’s manual or contact your vendor.

Thanks to all the organizers, participants, and guests of APDA 2019 Billing Midyear Conference. Great event for sharing your valuable experience and plenty of opportunities to present our latest products for x-ray and ultrasound billing. See you next time!

If you want to follow up or have any questions, please don’t hesitate to contact us at connect@emsow.com.

EMSOW is proud to take part in APDA 2019 Midyear Billing Conference, organized by the American Portable Diagnostics Association.

Meet EMSOW team on May 8–9 at Booth 2 to learn about how our software can help you bill for mobile X-ray services (including transportation and setup), dispatch technicians, store and interpret DICOM images in one easy-to-use app.

If you are looking for a radiologist to read X-rays, EMSOW can help you find the right doctor in your state via MDW radiology marketplace we partner with.

You can contact us online or on the phone. Schedule a meeting, and we will get in touch with you at your convenience.

Go 100% paperless and mobile with smartphone apps and modern PACS-integrated software!

Document management is a daily routine for any healthcare enterprise. If you run a mobile diagnostic business, you surely have faced many paperwork-related issues. The most obvious of them are workflow complexity and low usability, but that’s not even half of the story. Let’s talk about some hidden pitfalls of paper record-keeping and see how modern technologies, such as PACS and smartphone applications, spare your time and effort and, at the end of the day, cut your expenses.

Workflow complexity. Typically, your staff has to create multiple documents for each patient: referral and consent forms, progress notes, eligibility approvals, reports etc. Such documents are often handwritten and manually handled, which, first of all, means time expenditures on copying, sorting, and handwriting deciphering. Besides, all these loads of paperwork have to be stored somewhere and kept in order.

Data security issues. If every document exists in a unique copy, the probability of loss increases significantly, mostly due to the human factor. On the other hand, creating multiple copies of the same document increases data security concerns.

Excessive expenditures. Another essential point is expenditures on consumables for outdated office equipment. It is probably not the highest part of your overheads, but why not cut it down?

How can a smartphone app help? We recommend looking for a solution that doesn’t just take pictures but adjusts to your workflow. Below are a few app features that we believe are the most important:

1. Capture different types of documents (consent forms, insurance cards, log sheets, patient sheets, tech sheets, referral forms—whatever is needed for your practice)
2. Integrate with your EMR. If the captured documents are automatically attached to patient records, you can save data entry time and increase data integrity
3. Integrate with your PACS. If the documents are included in DICOM image packages, your paperwork can be reliably delivered to your reading provider, together with diagnostic images

Among the main advantages of using these apps, you can expect the following:

• Automated document handling. All the paperwork is handled automatically, thus you can forget about sorting your documents manually and collecting loads of papers in your office. This feature considerably decreases the factor of human error and helps you keep things in order.
• Ease of access. With mobile apps, you can retrieve any document at any time with a single tap on the screen.
• Security. HIPAA-aware apps store patient information securely and transmit it via an encrypted connection, which minimizes the probability of loss or leak.
• Mobility. A truly mobile app can be used remotely from anywhere. Some mobile applications also allow doctors to sign their reports electronically so that you could avoid verification issues – you don’t need to decipher your physician’s signature anymore. If the app is integrated with your PACS, diagnostic images can be sent and viewed instantly without using film of burning CDs.
• Cutting down your expenses. Mobile solutions are quite affordable, so you can save your costs on office equipment.
• And finally…printing options. You can go completely paperless, but it doesn’t mean you can completely give up paper documents. No need to worry—mobile documents are still printer-friendly, and you can have them on paper too.

With paperless solutions and mobile applications, upgrading your medical business becomes much easier than you might expect. Isn’t it time to realize the new benefits and get focused on your business and patients instead of paperwork and office equipment?

With the availability of tablets and smartphones, your employees can transmit various types of data to your company’s information system instantly and wirelessly from any distance. The most common example is emailing healthcare-related images, documents, and notes to the office, which you most likely have had to do.

However, there are privacy and usability concerns associated with commonly available email and instant messaging apps. At first sight, it may seem suitable to use off-the-shelf apps, but the app of your choice may lack the necessary tools for your medical business’s specific needs. This software may have a wide range of settings, but as an end user, you are likely to adjust your business needs to the available software features rather than to configure the application according to your demands. Moreover, off-the-shelf programs do not offer any tools to help you with medical-related routine tasks, such as receiving information directly from diagnostic equipment or checking insurance eligibility.

Therefore, it makes sense to look for specialized mobile software, but if you are running a medical business, you are also aware of possible privacy-related issues. Before purchasing an application which seems to meet your requirements, it is necessary to check it for compliance with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA includes a set of federal standards that ensure the security of your patients’ electronic protected health information (ePHI). Keep in mind that the matter of HIPAA compliance may be disregarded by mobile app developers, even if the intended purpose of the app is healthcare automation. Always make sure the developer guarantees the HIPAA compliance in the end-user agreement.

Another critical issue is the compatibility of the mobile app with the desktop software you use at the office. You could purchase mobile and desktop applications from different vendors and use them separately, but the most efficient strategy would be to get a bundled software package that is available on both desktop and mobile devices and provides a consistent user interface. It is also worth noting that trying to integrate different software systems may cause reliability and security problems as well as data conflicts and errors, which often results in costly troubleshooting or even data loss.

The most advanced solutions on the market have their own mobile apps that seamlessly integrate into your IT infrastructure. Unlike many off-the-shelf apps, such mobile applications can offer exactly what you need at a reasonable price:

• Ultrasound technologists can fill out exam worksheets on the go and save them as electronic documents. This feature is especially convenient for mobile diagnostic companies that have their technologists travel from one facility to another throughout the day.
• Doctors can manage diagnostic studies and report clinical findings straight from their handheld devices, which is vitally important for STAT cases. When timing is critical, you can combine the versatility and speed of a mobile device with the app’s specialized features for the fastest communication possible. For example, you can capture an image using the built-in camera and send it along with the general report via an encrypted connection.
• Managers can supervise the workflow even when they are traveling. For example, they can track their technologists’ location in real time.
• Accounting staff can check eligibility instantly and remotely, without time-consuming phone calls to providers or visiting their websites.

These are only a few examples of mobile app functionality that a healthcare business may benefit from. In practice, your software vendor should work with you before developing the app in order to perform requirements analysis and ensure the final product can help you with every facet of your business.

With an application tailored to your specific needs, you can turn your mobile device into a powerful and reliable tool which enables you to complete multiple routine tasks from anywhere easily and thus streamline your medical business.

Medical specialists who deal with diagnostic imaging, regularly have to communicate examination queries and patients’ demographics to various diagnostic facilities and equipment. At first glance, it is quite simple, because data transmission is a regular part of our everyday life. But if you are a doctor or a medical business supervisor, you are aware of several industry-specific issues.

Quite often medical businesses work with multiple facilities and various equipment. Imagine that you need to consistently inform each technologist which study needs to be done for each of your patients or regularly receive orders from multiple hospitals. Just to perform this single task promptly, you’ll need to hire a dispatcher.

Without an adequate automated task manager, each patient’s data has to be double-entered manually. Several issues are arising out of double manual data-entry. First of all, this process is usually time-consuming, but that is not all. Probably, one of the most pressing problems is high error rate, which means that some of your patients’ information would likely be confused, incomplete or even missing. In such cases, you would have to cover not only the query costs but also correcting expenditures (not to mention that double-entry increases the error incidence twice).

So, the way out of this tricky situation is getting a dispatching service that would automatically send information on required studies to multiple diagnostic providers and equipment.

Some medical businesses hire consultants and managers, or even software developers to create a specific application for transmitting study queries. Of course, such solution is acceptable, but it cuts both ways. The main advantage is that you’ll get a tool designed to satisfy your needs. However, in this case, you likely have to bear huge expenses, mainly because such software would be built from scratch and so you are expected to cover all the development costs. However, that does not mean that the result would meet all your requirements. Besides, you stay vendor- and support-dependent all the time. Another issue is integration into your IT infrastructure.

The Modality Worklist (or MWL) is a feature of the DICOM protocol that allows you to transfer procedure lists to be performed from a PACS server to your diagnostic equipment. This service is often available in advanced specific-purpose software for healthcare businesses. It works with DICOM-friendly equipment, which means compliance with the vast majority of modern machines. Still, before considering this tool, it makes sense to check if your equipment is DICOM-friendly.

How does it work? Each medical equipment unit sends a query to the application (depending on your network configuration, it can be done either directly or via a DICOM gateway). After that, the server replies with a worklist which usually includes patients’ demographics (name, age, gender, etc.) and types of required examinations. This workflow is rather simple and efficient in solving multiple dispatching problems and thus reduces your expenses. Probably you will not get rid of all the processing mistakes arising out of manual data-entry, but you will at least cut them by half because MWL eliminates double-entry.

Needless to say that MWL meets the DICOM standards https://www.dicomstandard.org/current/, which also eliminates concerns related to using various imaging systems (RIS, PACS, etc.).

Modality worklist is a ready-made solution for both clinics and imaging providers. It simplifies the study dispatching process and makes things go much more smoothly. –

Links:

DICOM standards: https://www.dicomstandard.org/current/

An article on MWL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3452969/pdf/10278_2009_Article_BF03168381.pdf

An introduction to cloud-based PACS for mobile diagnostic operators

Mobile diagnostic imaging is in high demand by many practices and doctors who are looking to expand their services to new locations and avoid the cost of maintaining an in-house diagnostic lab. Portable diagnostic equipment makes it possible for X-ray technicians and sonographers to travel between facilities. At the same time, it delivers image quality comparable to that of stationary equipment. However, today’s technology has a lot more to offer to mobile diagnostic operators than just portable ultrasound machines and X-ray appliances. In this article, we’ll take a look at one useful tool that can help your mobile imaging business work more efficiently – web-based PACS.

Picture archiving and communication systems (PACS) have become a vital part of the IT infrastructure of many healthcare organizations. PACS software allows to capture, store, view and share all types of medical images within local networks. This provides a great number of advantages, including long-term storage, easy search, and image transfer via the network (which is much faster and cheaper than burning CDs).

However, if you are considering getting your own PACS server as a mobile imaging operator, you may face at least the following difficulties:

Maintenance is expensive. Even if you’re a small business, medical images are a heavy kind of data: one echocardiogram, for instance, may take up to 1 GB of storage space depending on the compression level. Moreover, you are legally obliged to keep the images for a long time in most cases. Add to this the need for a trained IT specialist to manage, service, and backup the image storage server.

External sharing issues. A local PACS server may work for you if your images are supposed to remain in your local network without any external access. However, if you use remote reading radiologists like most mobile operators, you will not be able to easily send the images to their remote computers, because a) the images are large, and b) it may violate the privacy of your patients. To include a remote site in your network you might choose to use the Virtual Private Network (VPN) technology, but then the cost of the above-mentioned IT guy may reach a six number figure.

Fortunately, in the age of internet services, both of the problems are easily solved with web-based PACS solutions that allow you to:
– Upload images from any location via the internet, with HIPAA-compliant encryption
– View the images in a web browser from any internet-enabled device. To invite a radiologist to read an imaging study, all you need to do is send them a link
– Forget about the long-term storage problem, since now the images are in the cloud (though you should make sure to carefully read the terms and conditions of your contract; for example, you may want to check their policy on data migration in case you decide to move your data to another provider in the future)

If you and your reading doctor are using different PACS systems, advanced web-based solutions should allow you to connect your system to theirs. Thanks to the interoperability of the DICOM protocol, the core of any modern PACS, your web-based solution can be joined with any other system. Security can be provided by the same VPN technology we mentioned, except for it will not be at your own expense anymore – the web service provider should take care of all the technicalities as part of the package.

Therefore, the web-based PACS services allow you to create a secure distributed clinical environment that is available 24/7 from any location. They can reliably connect technicians and reading doctors as well as your office personnel and thus help you manage your workflow completely. There is a couple more things you might look into to get the most out of your web-based PACS experience:
– Manage the schedule of your technicians and transfer it straight to their equipment with Modality Worklist.
– Transfer patient information from the EHRs of your customers to your worklist
– Integrate the billing part of your business with your PACS.