The digital radiography sales force is out touting the benefits of "integration" between PACS and practice management software (PM). Unfortunately, the term "integration" is not defined and most “integrated” products on the market miss the mark. In this tutorial, I will describe what you should be looking for in an “integrated” digital radiography product and why “integration” might be worth your time.

The Holy Grail - what a properly integrated practice looks like:

Integration between practice management and your digital radiography system has the potential to increase revenues, decrease data entry errors, and increase efficiency in the hospital. It accomplishes this by two methods

1. Ordering studies in practice management: in a properly integrated practice, radiographic studies performed in radiology are ordered from within the practice management software. This decreases the need to enter patient information in radiology which will increase efficiency and decrease data entry errors. The number of errors in data entry should not be underestimated. In one week in our practice, there was an error rate between 6 and 22%. Errors in data entry may make it difficult to find old studies in PACS.

More importantly, if studies can only be ordered from within PM, this is the first step in capturing revenue from missed charges. By guaranteeing that a radiograph cannot be taken without first ordering the study in practice management, this will reduce the number of radiographs that were taken and never billed. {sidebar id=1}

2. Invoicing back to practice management - completing the loop: Ordering studies in practice management is a noble first step, however, there must be a method to properly invoice practice management after the radiographs are taken. This is easier said than done.

For example, what happens if a study is ordered in practice management but never performed? In that case, the system must be smart enough to know not to invoice the client.

As a second example, what happens if a thorax radiographic study is ordered in practice management but a thorax, abdomen, and pelvis were actually obtained in radiology? In that situation, the system must be smart enough to go back and add studies to the bill in practice management.

The ability to order studies in PM and invoice directly from radiology can be a powerful way to increase your bottom line. Consider the following example:

• Parkway Pet is a 24/7 veterinary practice that takes 100 studies a month and charges $200.00 per study.

• Because most veterinary practices will take more films after they transition to digital, lets assume that they will take 5% more studies a month (many take significantly more).
  
  
• Lets also assume that they forget to invoice one radiographic charge a week.
  
  
• Looking at the numbers

Increased radiographs = 5 x $200 = $1000/month increased revenues

Missed invoices = 4 x 200 = $800/month increased revenues

The Problem - most vendor attempts at integration are lukewarm or half baked:

Currently, most vendor attempts at integration fall short of the goals described above. In fact, most attempts at vendor integration between PACS and practice management have nothing to do with creating efficiency or increasing revenues. Rather, they are geared toward the questionable goal of viewing images in practice management.

Although viewing images in practice management is an interesting proposal, I question the usefulness and if the viewer provided by practice management has less features that the viewer provided by your PACS or if there is any expense associated with this type of integration.

An analogy: When I surf the web, I use Explorer. When I read my e-mail I use Outlook. Do I care that I have to close out Explorer to view my mail? Nope. Would I switch to an e mail viewer that was integrated in Explorer (such as Hotmail) just so I didn’t have to open Outlook? Never. The online mail applications are clunky, slow, and have fewer features than my desktop application.

Extending this analogy to digital radiography, I want to view my images in the fastest, most feature rich PACS viewer possible. Exiting out from my practice management to view images in my fully featured PACS viewer takes negligible effort but greatly improves my experience viewing my digital images.

The bottom line with all of this is that I would not base a purchasing decision on integration if the only feature that I got was the ability to view my images in my practice management software.


The Catch 22 - you might need a prenuptial

Anybody who has taken even a cursory look through Animal Insides knows that I am not a fan of proprietary software solutions or getting your practice inextricably linked to a vendor. Ideally, there would be a simple bridge from practice management to PACS that would launch my fully featured PACS viewer, order a study in PM and invoice from PACS to PM. At the present time, the only integrated products (that I am aware of) that offer this functionality are tightly linked products offered by only a few vendors. In this case, however, a vendor marriage may outweigh the potential downside of a bad breakup in the future.

Non-proprietary methods of linking practice management to PACS such as DICOM modality worklist and DICOM performed procedure step are largely not currently supported in veterinary medicine. NOTE: some vendors are starting to offer DICOM modality worklist support and some vendors achieve this type of integration without using proprietary schemes. Check with your vendor to determine how they achieve their integration.

Summary

Integration with practice management is currently poorly defined in veterinary medicine. Integration with practice management that only affords you the ability to view images in your practice management software is likely not worth the effort.

Conversely, if the integration allows you to order studies from within practice management and has an auto-invoicing feature when a study is performed, these are powerful features that are worth your consideration.

In most cases, I advise practices to choose the best of breed in both PACS and practice management software. If the numbers work out, effective integration is a feature that could influence your digital radiography and practice management purchasing decisions.