A Conversation with . . . Rick Jennings

Teleradiology evolves into a business partnership

Many teleradiology companies offer technology solutions to improve the quality of their reads and the efficiency of their radiologists, but more and more companies are turning a greater focus to their technology and business management offerings. Instead of simply providing extra manpower to their clients, teleradiology providers are looking to become business partners with proprietary solutions for image viewing and transfer, billing, workflow management, and marketing.

Virtual Radiologic, based in Eden Prairie, Minn., now offers its own vRad PACS to be used by all of the company’s radiologists. Rick Jennings, chief technology officer for Virtual Radiologic, talks about the industry’s increasing interest in offering more than just an overnight read.

Q   rt image: Tell me about Virtual Radiologic’s technology offerings.

A   Rick Jennings: vRad’s technology offering is something we’ve developed over the last seven years. We have approximately 150 person-years of software engineering time invested in it. The company’s strategy is, since we are a practice, to have direct involvement from our radiologists and our technology teams to build a radiology platform for radiologists, by radiologists. So there’s that synergy of working with doctors, seeing what they need to improve efficiencies, and then quickly putting it into the product. We’ve gone through that cycle hundreds of times in the last seven years. And the result for our practice is that our physicians are some of the most productive in the United States, each reading approximately 25,000 studies per year, and our quality, based on our measurements, is as high as anyone’s in the industry in terms of accuracy.

We built a platform that includes what’s traditionally called RIS, what’s traditionally called PACS, as well as facility-side components for the radiologic technologist to provide orders and, increasingly, client user portals so they can get information. Our 140 radiologists use this every day as we go through more than 2.6 million studies a year.

Starting about two years ago, as our clients saw the technology platform, the progressive radiology practices said, “Wow, now I see how you, Virtual Radiologic, read from 1,150 facilities and 7,400+ sending devices, and your radiologists all see it in one integrated environment.” Those clients started asking, “Can I use that too to read my own studies?” And that was genesis of vRad® Enterprise Connect, which is a derivative of the core platform that we use in a client form that our customers can now take and use inside of their practices. Having all that technology managed and controlled by us allows us to very quickly adapt to those clients needs as well as ours.

Q   image: What does having proprietary technology offer clients? How does it improve your business?

A   Jennings: There are some things in other industries that are rapidly coming to healthcare. If you look at services-oriented businesses – some successful examples are Salesforce.com and Netsuite.com, not that they’re in the medical space – there are many very successful examples.  They are successful because they build proprietary platforms that uniquely meet the needs of the services of their clients, as well as their operations.

So it’s important for us to build a platform that is 1) Internet-enabled and Internet-optimized, and 2) designed for a distributed model. The patients, the hospitals, and the radiologists are not in the same place, and they can be wherever they need to be in that virtualization due to technology.

In general, a commercial package from a traditional software vendor is optimized around campus environments, maybe one or two facilities in a large hospital complex. It’s not designed to be Internet-enabled.

Furthermore, our 140  radiologists tell us every day how we can make our software better. The large software firms that traditionally make a PACS or RIS don’t have that type of medical staff working with their development teams to advance the software.

Q   image: How does it affect your relationship with radiology practices?

A   Jennings: It’s something we have seen emerging over the last couple years. We think our clients, as they face the ever-increasing quality and cost-reduction mantra that is seeping into the healthcare space, are saying, “I need to get more efficient.” So our customers look to us primarily for our radiology services to augment their practice by extending their practice with our radiologists. Secondly, when they use our vRad Enterprise Connect technology, they are able to put the same business improvements of speed, ease of access, productivity gains, and staying out of cars driving between facilities, to then improve their own practice performance.

Plus there’s a synergy between us and our Enterprise Connect clients. Since we’re now on the same technology platform, they are virtually extended into the world of vRad’s 140 radiologists. We really can help them, our customers, take on ever-increasing challenges from their customers, the hospitals. It’s a synergistic long-term relationship that transcends the “just cover me at night for one year,” in terms of the typical teleradiology contract. It’s more that we’re providing solutions that our clients, the radiology practices, are using to drive up their business with quality patient care at lower cost, and stronger practice performance overall.

Our theme at RSNA was “Partnerships beyond teleradiology,”  and what we provide clients can be divided into three buckets.  First and foremost, we have a set of clinical solutions – prelims, finals, subspecialists, 3-D – and our physicians are as good as anybody, and we do it really accurately and really quickly. The second big bucket is technology solutions, and that’s where vRad Enterprise Connect and other technologies come in. The third bucket is business solutions – which includes Medicare-compliant billing and services to help practices expand their marketing in their environment and be more competitive.

Q   image: How is your technology improving for the future?

A   Jennings: We have a very rich pipeline of things that come out on a quarterly basis in our technology environment. Last month, we completed the rollout of our own PACS, for which we got FDA clearance in March. We have done what we believe no other large practice has done – simultaneously transition from one PACS to another with zero interruption to the business, and we’ve improved radiologist productivity. That technology is going to be offered in vRad Enterprise Connect early in 2010.

Other things we are going to continue to flow out to our clients are business management tools. We’re a 140-radiologist practice, so how do you plan that if you have 1,150 hospitals sending studies at various times from different modalities, with different licensing and credentialing requirements? How do you see what’s coming? How do you schedule your doctors?

We have a set of proprietary business management systems that forecast demand from facilities for radiology studies and schedule physicians in terms of who is going to read what. It factors in preferences from the hospitals, allows for shift swap, vacation, etc. Those types of tools, which we have internally now in their second and sometimes third generation, are going to be exposed, and we’ll let our clients start using them.

Q   image: What are the key features of your platform?

A   Jennings: For vRad Enterprise Connect, it’s fundamentally the ability to read studies from any type of sending device or PACS. Whether there are four, five, or six PACS or a direct scanning device, vRad Enterprise Connect allows images to come in from those disparate environments and show up on one worklist so they all look the same. With a single viewer – and soon an optional viewer with our new PACS – the radiologist reads from wherever they are. They didn’t have to get in a car and drive to a different facility, they didn’t have to log on from a GE system to a Philips system – it’s one environment.

There’s also a quasi artificial-intelligence routing capability built into platform. How do you get studies to the right radiologist? We have a rules-based engine that goes through state license, credentialing, do we want a subspecialty read, and what’s on the radiologists’ current worklist. For example, if there are two neuroradiologists for a brain MRI and one has a deep worklist and the other a light one, let’s get it to the one who can read it quickest. Further, if there’s a relationship between a facility and a certain radiologist, and the facility prefers to have him or her read, we add that into the routing.

So there are a number of factors that get the right study to the right radiologist, which improves patients’ care and reduces costs, and that in itself is the heart of our technology.

Q   image: There seems to be a growing trend of teleradiology providers expanding from being support services to being a more encompassing business partner. Why do you think this is?

A   Jennings: You’re seeing the need for radiology practices to have a partner that can add additional radiologist capacity as needed, span the clock, span multiple facilities, expand subspecialty access, and bring healthcare cost reduction to the table. So thinking beyond just, “I need a service to let me sleep at night,” it’s becoming, “I need something to help my practice continue to provide the services that my customers  – the hospitals and then the payers – are asking for.”

We are unique, in our opinion, as a teleradiology firm offering a technology solution. We don’t know of any other major firm that has both the radiology practice and a full technology offering to provide customers. The others that come close use commercial products that anybody can buy.

As for business solutions, it’s increasingly complex to get the billing done correctly. In teleradiology, you have to bill from the location of the radiologist to comply with CMS reimbursement rules. Once our clients see that complexity – and some of them want to do things across state lines and they’re looking for our help to do that – that’s when they’re looking for a partner who can bring that know-how to the table. We see our client contracts turn into multiple-year agreements, where we both focus on growing their business and helping them be successful.

Q   image: What is the potential impact of teleradiology companies’ growing interest in technology? Are they losing focus or truly improving services?

A   Jennings: There are some that are just focused on doing the night coverage and to do it as quickly and as low-cost as possible. If you look at their reports, they are often a one- or two-line report sent in the middle of the night to an ER physician.

There’s a smaller set that see there’s a new definition of teleradiology coming, and it’s about partnering with your customer. I think you’re going to see the teleradiology industry change very quickly, and there will be leaders that help practices with full solutions across clinical, technology, and business. And we believe we are the leader in that space.

– Stephanie Twining