Ramapo Radiology Associates, based in Suffern, New York, has been part of the Hudson Valley community for nearly 70 years, but the need to easily share medical images has never been as important as it is now.

THE PROBLEM

Years ago, people expected to wait hours or days to get their images and reports. Everyone expected the hassle of having to physically carry radiology films or CDs from location to location. But today, those expectations have changed completely.

"We live in a digital society accustomed to easy access to seemingly everything, so it's really no surprise that people want the same kind of experience when it comes to their healthcare," said Steven Ryerson, IT director at Ramapo Radiology Associates. 

"Convenience and speed mean everything – especially when you're a referring physician or a patient who's anxiously waiting on imaging results to determine a diagnosis or treatment."

The problem Ramapo faced was one of volume versus speed, accessibility and security. The organization performs more than 100,000 exams per year, plus reads for area hospitals. 

Sharing images through the traditional method – by burning CDs and either handing them to people or dropping them in the mail – had become a brutally slow burden that was inconveniencing patients and referring providers.

"First of all, it takes 10 to 15 minutes just to create an imaging CD," Ryerson explained. "So, it's an inefficient use of our staff's time from the very beginning. Then, there are added time and security concerns involved in getting the CDs to the appropriate patients and referring providers.

"Even once they had CDs in hand, providers often found that large studies took a long time to open and read," he continued. "In addition, our referring providers were stuck with the responsibility of keeping the CDs secure and disposing of them properly once they were outdated. Patients had concerns because they would lose, break or couldn't access their CDs."

"Patients and referring providers can start viewing images in less than two or three minutes. The report is there, and they can download the images to view on another system or save them if they choose."

Steven Ryerson, Ramapo Radiology Associates

Ramapo takes pride in the compassion, care and respect with which its providers and staff treat their patients and colleagues. But image-sharing was becoming a pain point. It was a time-intensive manual task for staff.

The patient experience was suffering, and staff knew there had to be a more efficient method to support referring providers. Image-sharing is vital to good patient care; the organization just had to find a way to streamline the process.

PROPOSAL

Ramapo Radiology's search team explored several solutions, including share-file solutions, to solve their image- and information-sharing challenge. The team felt some of the solutions would create as many problems as they were solving.

"For example, the USB solutions we reviewed were too slow, too unsecure, and could be infected by a patient or referring physician," Ryerson explained. "We thought about using Blu-ray discs, but too few people have Blu-ray drives in their computers to make that option practical.

"Other solutions were astronomically priced, including some image-transfer-sharing software," he added. "Alternatively, some vendors would have charged our patients to store their images instead of Ramapo. While certainly less expensive for us, we felt that was not what we wanted to offer our patients."

Ramapo decided to go with vendor Novarad's CryptoChart technology, which it concluded was a simple solution. The idea was the organization could instantly share images with patients and referring physicians using an encrypted Quick Response (QR) code rather than a CD.

"The solution receives images and medical reports from any DICOM modality, PACS or HL7-compliant electronic health record," Ryerson said. "The files are then compressed, encrypted and sent to Novarad's Object Vault cloud system for storage. This cloud system uses AES-256 [256-bit Advanced Encryption Standard] to store images and HTTPS [Hypertext Transfer Protocol Secure] during transit for security against brute-force attacks.

"The Object Vault cloud system then returns an encrypted, shareable code to a networked printer," he continued. "By scanning the printed QR code, patients can view their images on their mobile devices or PCs and share them with their referring providers or others through text messages or emails. The viewer works on any mobile device or desktop."

For referring physician locations, there also is a secure web access code that prints out and can be provided verbally, faxed or emailed directly to the sending facilities. They simply type that access code into a webpage.

"During the demo, the first thing I did was look at the solution as an IT guy," Ryerson recalled. "I didn't want a system that required a lot of staff training downtime. I needed something simple for us to implement and straightforward for our patients and referring providers to use on-demand. The QR code solution met both of those requirements.

"The technology suggested a way to use familiar tools to give physicians and patients easy access to imaging information on-demand, with built-in security features that would alleviate the usual password hassles," he added.

MEETING THE CHALLENGE

The CryptoChart technology can be used in a software-only model or in combination with hardware. Ramapo chose to use PC hardware supplied by Novarad so that the vendor could upgrade and manage the PC without Ramapo's involvement, and to prevent any issues with other software that might be on Ramapo machines.

"Integration with other systems was minimal," Ryerson noted. "It only required us to set up a destination on our Novarad PACS system to send to the CryptoChart machine, which took us a couple of minutes to complete.

"The demo we received basically gave us the information we needed," he continued. "We plugged in the PC, gave it a static IP, then configured the destination on our PACS archive. Novarad completed the rest, and we were up and running. The team was delighted that we didn't have to go through a lot of training."

Now, after a patient's imaging exam is complete, anyone on staff with access to the PACS system can route the exam to CryptoChart. Within a minute or two, both a QR code and an access code print out on a regular piece of paper, which staff hands to the patient.

"Patients can scan the QR code to open their images on any mobile device instantly," Ryerson explained. "Or they can go to Ramapo's website and use the CryptoChart button at the top of the home page. There, they can enter the access code along with their date of birth to view and/or download their report and image.

"Referring physicians can either open the links that patients email or text to them or use the website option," he continued. 

"We can also provide an access code over the phone to referring physicians within a couple of minutes. Either way, patients and referring providers can start viewing images in less than two or three minutes. The report is there, and they can download the images to view on another system or save them if they choose."

Because patients are used to QR codes, Ramapo had very little patient education to do. Instead, the solution has transformed the experience for patients, referring providers and staff. Patients have on-demand access and the ability to share images. Physicians can open and read images faster, and staff don't have to waste time on CDs.

"In total, it's allowed us to make a complex process simple through the innovative use of mobile technology," Ryerson stated.

RESULTS

"We've experienced success getting referring physicians to adopt the new technology in large part because of the time it saves them when trying to open and read files – especially if they're large studies," Ryerson said. "For example, for a mammography study, the QR code can open images as much as 10 minutes faster.

"We now have patients and physicians who specifically ask for a CryptoChart code because reading images from a CD/DVD is a significantly longer process – and that's without considering the fact that CDs can be scratched, corrupt or incompatible, making them completely inaccessible."

For Ramapo staff, it's all about the time saved from not having to burn CDs anymore. Generating a QR code takes less than two minutes instead of the 10-15 minutes it used to take for each CD. When multiplied across all of Ramapo's imaging exams, that time savings is substantial.

"We used to burn about 4,000 CDs a month throughout our practice; we're currently at about 50% of that now with the new solution," Ryerson reported. "So, even calculating conservatively based on 2,000 images, we estimate the new workflow saves 333-500 hours each month that staff can now dedicate to more mission-critical activities.

"Cost savings in the form of reduced CD packaging and shipping expenses can't be overlooked, either," he added. "Although I'm unsure exactly how much we used to spend to mail or courier CDs to their destinations, that expense is no longer necessary."

ADVICE FOR OTHERS

"I've led the planning, management and installation of vendor solutions since 2002, and the ability to keep things simple is always a win," Ryerson observed. "My single biggest piece of advice regarding image-sharing technologies is to look for solutions that don't require a lot of training.

"The whole goal is to simplify what's become a complex challenge," he continued. "So, remember that innovation doesn't necessarily have to involve the newest technologies. Sometimes, it just involves looking at things in a brand-new way."

Also, make sure not to lose sight of the forest for the trees, he added.

"It's easy to get caught up in the day-to-day, but we have to remember that our ultimate purpose is to care for patients and make their lives better," he advised. "That includes reducing their imaging-related anxieties and delivering on their expectations. Solutions certainly must improve physicians' image-sharing processes, but they must be equally focused on providing an excellent, modernized patient experience."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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