Wednesday, May 23, 2007

Empiric's Encompass.NET RIS...
...The Amicas of RIS's

You may recall from a very early post that I had originally planned no RIS for our Amicas PACS. We were going to use paper and PACSGear scanning software to simulate a RIS, if you will. However, we ultimately decided that this would be rather tedious, and would not allow us to do some of the things we have grown accustomed to doing, such as editing reports. So, we went in search of a RIS. We didn't need a big bad hospital system, but we did need something. Basically, there were two requirements: the RIS had to be very easy to use, and it had to be reasonably priced. We found the the ideal combination for our purposes in Empiric's Encompass.NET product. Functionally, it is straight-forward, and easy to use, and most importantly, it doesn't get in my way. That's why I call it the "Amicas of RIS's". Amicas probably doesn't like that title, because they have their own RIS. We looked at it, and it is a great product, but it was more powerful and more expensive than we really needed for our little operation.

Now, I don't want to leave you with the impression that Encompass is underpowered, because it isn't. It is streamlined, and its interface is rather spartan. (More on that in a moment.) It does, however, have everything we needed. From the Empiric web site:

Primary RIS Functions:
Patient registration and scheduling
Embedded digital dictation
Electronic report signatures
Auto faxing (direct or by
Multi-site support
Audit trails
PDA capabilities
Management reporting
Mammography tracking
Document scanning
Inventory tracking
Paper-less consent forms
Radiologist peer review functions
Film library management
Additional staff and equipment management tools

PACS/Imaging Functions:
Web viewer w/auto study retrieval
Image routing & archive management
DICOM worklist
RIS-integrated workstation

Referring Physician Functions:
On-line study requests
On-line report access
On-line image access
Optional integrated EMR

Complete Billing Functions:
Claim generation
Payment posting
Collections management
Credit card co pay capture
On-line eligibility verification

Obviously, there is a lot to this system. We have it integrated nicely to our Amicas PACS, and the two play nicely together. Encompass does have its own viewer available, and it isn't bad, but we are much happier overall with the combination.

The best part of the RIS, as with Amicas PACS, is that it doesn't get in our way. It can provide reports viewable from within PACS, which the clinicians love (and so do we). We are really thrilled with the simplicity of reviewing and signing off of reports. We log in to the system (from anywhere, as this is a .NET web-accessed program), hit the "batch sign" button, and all of our pending reports are displayed. There is the option to edit them if necessary, which is a rare need given our incredible transcriptionists, and then they can all be signed with ONE CLICK! We use Cerner at our Agfa hospital, and Meditech at the other places we cover, and the concept of "ease of use" has obviously never been heard by their developers. But it is the backbone of Encompass.

Now, I mentioned the somewhat spartan nature of the Encompass.NET interface, and indeed, it isn't particularly fancy. But I do have the honor of announcing their next interface, with screenshot below, which will make its official debut at SIIM next month. Empiric hired a "prominent West Coast GUI design firm that specializes in ergonomics" to revamp the front end. Notice the "at a glance" concept that will instantly show the user the status of each patient and exam. It's prettier than the functional design they have today (screenshots of which can be seen at their website.)

If you are in the market for a RIS, and you aren't trying to outfit the entire Mayo Clinic, have a look at Encompass. My partners and I like it, and we're rather hard to please.....

Wednesday, May 16, 2007

Dalai Gets Trumped!

Unbeknownst to me, there has been a game of sorts going on among some of my partners called "Trump the Dalai", wherein they have to find some piece of technology I haven't already tried. My partner Rick (well, to be honest, it was actually his wife) won the game hands down this week. For his birthday, Rick received a brand new FlipStart super-compact PC. I'll let you read the stats on the FlipStart webpage, but suffice it to say, this is a fully functional Windows XP computer that is about the size of a largish paperback book. Most remarkable for a tiny machine like this is its large screen, a "5.6 inch diagonal high ­resolution display (which) makes computing easy on the eyes, with a full view of Windows® (1024 x 768)."

When Mark, my PACS guru, got hold of this thing, he went absolutely wild with glee, and proceeded to access our Amicas server, which turned out to be just as easy as on any other laptop. You can see the results above. Note the quarter on the screen placed for a size reference. With the size of the image displayed, you might think we were using a scanner like this one:

Rest assured, however, that these are real human images from a regular old MRI. (The little scanner, image courtesy of Craig Woody, BNL, actually is a minature PET detector used for animal research.)

The screen resolution of the FlipStart is adequate for reading digital modalities such as CT, MR, NM, US, etc. I don't think I would try to read CR, but it might be possible in a pinch. Especially for rat radiographs.

Rick's prize for winning Trump the Dalai? An extra night of call! Just kidding.....

Friday, May 11, 2007

New Trix From Impax 6

Silly Agfa, Trix are for Kids, not for PACS!

In the last few days, I noticed that my profile on Impax had changed in subtle ways. Different worklists than those I had selected were displayed, there were different columns of information within those worklists. Some of my tools and display settings were not as I had left them.

I thought I was crazy, which is probably true anyway, but now, some of my partners are noticing the same thing! Our PACS people are looking into this, but I see only a few possibilities:

  1. Someone is getting in there and messing up the settings

  2. There is some problem with the communication between our three production servers, and settings are getting tweaked somehow in that process

  3. The data tables are becomming corrupted...seems to me things would have deteriorated a lot more if that were the case

  4. The damn thing is haunted

Personally, I'm voting for #4. I'll keep you informed.

Saturday, May 05, 2007

Speech Recognition...Again

There are a few ways to get noticed on an discussion. Mentioning GE Centricity always draws a lot of attention, but these days, a thread talking about speech recognition will be pounced upon like Howie Mandel after some poor "Deal or No Deal" contestant opens the case containing $0.01.
A recent AuntMinnie front page article reported the results of a study from the U.K. and Germany that discovered

. . . speech recognition technology eliminated "significant delays" in report transcription and typing issues, leading to an improvement in service to both clinicians and patients. Researchers at Hammersmith Hospital and Charing Cross Hospital also concluded that a well-planned organization-wide implementation of speech recognition technology "can have a dramatic impact on radiology service delivery. . ."

In 2004, emergency room and primary care reports took three to five days to complete at Hammersmith Hospital. Finished inpatient and outpatient reports ranged from a low of three days to as many as eight days for inpatient reports in August 2004. With the advent of speech recognition technology, the time from report generation to completion declined to one to two days from January 2005 to February 2006.

This article prompted a number of responses on an accompanying discussion. A few were positive about SR, but many were doubters, including yours truly. You may remember my earlier post about SR, and I haven't changed my mind. I haven't seen any evidence to suggest that SR has improved. Articles like the above don't do much to help SR's reputation. I mean really, three to five days! That is totally unacceptable under any circumstances. Did our British friends have only one transcriptionist available? Did she have to use the loo for 30 minutes of every hour of her 4 hour daily shift? If you set the bar that low in other venues, I could be the Steeler's next quarterback! I will have to admit that SR might be able to improve the situation if things are that bad.
Fortunately, here in my little corner of the boonies, things are pretty good. Our turnaround time with Human Transcription (HT) is usually from 10-20 minutes, with STAT's coming out within 5 minutes. Of course, if there is reason to do so, we type in a prelim, leave a voice-clip, or (gasp) even pick up the phone to call the clinician. Why would we ever want to switch to SR?
Look, I love technology more than anyone else I know, and I am absolutely fascinated by the concept of the computer listening to me and converting my uttered pearls of wisdom to text, or to commands, etc. Wonderful. But if this is such a wonderful idea, why hasn't it caught on elsewhere, such as among the administrative types that are pushing it on us rads? I think the ultimate reason is this: A machine will never understand the nuances (pun intended for the Powerscribe set) and the outright inherant inconsistancies of human speech. I can dictate this: "The left shoulder, I mean the right shoulder shows no fractures" or some equally flawed speech, and it will come out OK with HT, but not with the machine. Those for whom SR works well have not only trained the machine, but moreover, they have trained themselves to dictate in a completely different way than they learned as youngsters. I personally am not that big a fan of technology that forces me to adapt to it.
I have to wonder if some of the more ardent supporters of SR on the various AM threads work for Agfa or Nuance, or if they are just low-level administrator types taking some heat for spending $300K on something that doesn't work very well.
Has anyone really added up the cost of SR vs. HT (speech recognition vs. human transcription)? I suspect that once you pay the $300K for the initial set up, add in training time and costs, cost of upgrades, cost to replace the darn thing in 3-5 years, etc., there won't be much savings with SR. That does not, of course, take into account the radiologists' time, effort, pain, and potential malpractice suits caused by using SR. But then, the administrative types that usually make this decisions AREN'T PAYING FOR THE RADIOLOGISTS so they don't really care about that. But we rads DO care. If SR is so bloody wonderful, why don't administrators as well as the occupants of the C-suite use it? Apparently, it's good enough to generate reports upon which life-or-death decisions are made, but not good enough to replace the secretaries of any of the above. Think about it, folks....