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The Role of Integration in Radiology:Moving from Necessity to LeverageLarchmont Imaging AssociatesInsights with Robert Walsh, Director of Professional Services, DLC Technology Solutions, Inc.

BiographyRobert Walsh, Director ofProfessional Services for DLCTechnology Solutions, Inc., hasMarket BackgroundImaging centers are under increasing pressure to exchange data. Internal systems, such as theRIS, PACS and billing must be able to communicate and exchange patient data with one anotherto optimize the patient experience. External systems and groups, such as HIEs, referring physicians, hospitals, clinics and labs must also have access to the images and reports generated by theradiologist and radiology technicians. Not exchanging data effectively and efficiently risks businessbeen actively involved with therelationships in addition to the most important element of all, patient safety.integration strategy for LarchmontImplementing and managing the various applications can be complicated. Working within theImaging throughout the lastdecade. He has been instrumentalin establishing the framework andinfrastructure needed to supportthe workflow currently in place.traditional information sharing model using point-to-point interfaces would require a significantamount of time and financial commitment. However, having a modern integration solution givesyou the flexibility to manage the interfaces for the integration projects while creating leverage torealize even higher value initiatives and goals, using less time and saving money.For the radiology industry in particular, having a competitive workflow is critical for businesssuccess. Despite the competition among machine and application offerings, the competition forreferrals and patients from customer service has greatly increased in the past decade. Wait times,turnaround times and patient report access are some of the key factors radiology facilities leverageto gain business, referrals and ultimately improve their bottom line.Radiology practices that have realized the benefits of leveraging an integrated environment areable to process patient information faster, and with fewer complications, than practices that havemaintained a traditional, manual information sharing strategy. Leveraging an integrated environment is a strategic differentiator and is being taken advantage of by leaders in the radiologyindustry.BackgroundInsights with Robert Walsh, Director of Professional Services, DLC TechnologySolutions, Inc.Larchmont Imaging Associates, located in Hainesport, New Jersey, is an imaging center with fourfacilities serving Burlington County and its surrounding communities.Approximately, three years ago, we began the initial stages of our integration environment evaluation. We were replacing the Sage Medical Manager RIS with Sage Intergy RIS in order to improveworkflow and accommodate more recent data sharing expectations of the industry.It is not uncommon for a health care facility to reevaluate their integration strategy when makinga major upgrade or replacement. Our initial integration challenges required a solution that wouldintegrate the new Sage Intergy RIS with our PACS and external mammography tracking system.Additionally, the solution would be required to identify and differentiate results and demographicsbetween the Virtua Memorial Hospital and Larchmont Imaging Associates workflows.Corepoint Integration Engine was initially selected to manage our new integration environment.It was then we realized there were many more initiatives coming our way, such as HIE connectivity,that we needed to act upon. It was at this pivotal point we really realized the power of a robustintegration platform and how it could be used to enable our strategic and operational plans.Following the implementation and use of Corepoint Integration Engine, we discovered an opportunity to leverage the integration infrastructure to meet new demands and challenges productivelyand feasibly. We were able to leverage participation in the local health information exchange,or HIE, integration with a voice recognition dictation system, integration with an outside codingcompany for billing and integration for the billing of services provided to the local hospital.

Initial Integration Challenges SolvedOutlined below are some of the projects which we scoped for in our initial integration engine evaluation. Corepoint Integration Enginewas chosen to help establish the workflow between our RIS system and the HIS system at a local hospital, and the time we saved usingCorepoint Integration Engine was incomparable to the time we would have spent establishing these interfaces in our previous method.The freed time allowed us the opportunity to focus on more complex interfaces as well the ability to focus on the analytics of the connections.Initial Problem Solving OpportunityApplications involved:Interoperability challenge:Sage Intergy RIS and CodeRyte - RABC Solution:Workflow required Intergy RIS to use fileCorepoint Integration Engine was used to based methodology for results and DFTbuild DFT batch files from CodeRyte for theimportsRIS and also used to build individual ORU fileswith a master index file for the RIS’ resultsimport processCodeRyteDFT for RABCADT / DFT / ORU from RABCDFT Batch from CodeRyte for RABCIndividual ORU Files with “Index” FileADT / DFT / ORUIntergy DBPatient MatchingVirtua Memorial(SIEMENS HIS)(RABC)Sage Intergy RIS –RABCRABC ORU StoreRABC ORU ForwardMicrosoft SQL ServerORU Store and Forward for patient matchingbetween Virtua and Larchmont

Initial Problem Solving OpportunityApplications involved: Interoperability Challenge: Siemens HIS and Sage Intergy RIS – RABC Solution: ADT, DFT and ORU messages needed from Virtua Memorial to Sage Intergy RIS - RABC Established interface from Virtua to CorepointIntegration Engine and an additional interfacefrom Corepoint Integration Engine to SageIntergy. Corepoint Integration Engine usedto perform gap analysis between Siemensand Intergy message structures and resolvemapping and formatting issuesCodeRyteDFT for RABCADT / DFT / ORU from RABCDFT Batch from CodeRyte for RABCIndividual ORU Files with “Index” FileADT / DFT / ORUIntergy DBPatient MatchingVirtua Memorial(SIEMENS HIS)(RABC)Sage Intergy RIS –RABCRABC ORU StoreRABC ORU ForwardMicrosoft SQL ServerORU Store and Forward for patient matchingbetween Virtua and Larchmont

Initial Problem Solving OpportunityApplications involved: Interoperability Challenge: Sage Intergy RIS and Centricity PACS Solution: Multiple applications required the same data Integration engine was used to filter, modify,that was already being exported from the RISformat and route to the appropriate applica- With the possibility of implementing a voicetions according the contents of each messagerecognition system for dictation, gettingorders and results into the PACS system asquickly as possible was a priorityGE Centricity PACSADT / ORM / ORU from LIAORU (Diags from CodeRyte)ADT / DFT / ORUDFT Batch from CodeRyte for RABCIntergy DBPatient MatchingRABC ORU StoreRABC ORU ForwardIndividual ORU Files with “Index” FileVirtua Memorial(SIEMENS HIS)(RABC)ADT / ORM / ORU / MFNSage Intergy RIS –LIA PracticeORU Diagnosis for LIA / DFT for RABCADT / DFT / ORU from RABCADT / ORU from LIAMicrosoft SQL ServerCodeRyteORU Store and Forwardfor patient matching betweenVirtua and LarchmontSage Intergy RIS – RABC

Leveraged Problem Solving OpportunityApplications involved: Interoperability Challenge: MRS (Mammography Reporting System) Solution: Needed to implement an external system to track mammography patient results notifica-matically provide demographic informationtion for legal reasons Established interface to MRS in order to autoand orders to that application Wanted to make the system as automated Provide observation and recommendationas possible to reduce staff requirements anddata by “reading” the reports being sent tokeying errors for manually entered dataMRS and creating custom message segmentsto populate the correct fields within MRSMRS (Mammography)GE Centricity PACSADT / ORM / ORU from LIAADT / ORM / ORU from LIAORU (Diags from CodeRyte)ADT / DFT / ORUDFT Batch from CodeRyte for RABCIntergy DBPatient MatchingRABC ORU StoreRABC ORU ForwardIndividual ORU Files with “Index” FileVirtua Memorial(SIEMENS HIS)(RABC)ADT / ORM / ORU / MFNSage Intergy RIS –LIA PracticeORU Diagnosis for LIA / DFT for RABCADT / DFT / ORU from RABCADT / ORU from LIAMicrosoft SQL ServerCodeRyteORU Store and Forwardfor patient matching betweenVirtua and LarchmontSage Intergy RIS – RABC

Interoperability Challenges Solved – Leveraging Corepoint Integration EngineUsing Corepoint Integration Engine, we were able to reduce the amount of time we spent on workflow projects, in addition to improving the quality of the patient and physician experience with faster turnaround and wait times. As we began to realize the benefits of thedata sharing capabilities with Corepoint Integration Engine, other strategic opportunities were considered. The following outlines theadditional and unanticipated projects we were able to leverage by using our interoperability platform.Leveraged Problem Solving OpportunityApplications involved: Interoperability Challenge: Siemens HIS, Sage Intergy RIS – RABC and CodeRyte - RABC Solution: Virtua Memorial patient results were often Workflow was devised in which the hospitalsent over prior to demographic informationpreceded each result with demographics andbeing sent. Without demographics in the RIS,for each result received by Corepoint Integrationthe result had no patient to match against andEngine, the Sage patient tables were queriedcould not be processed appropriatelyfor a matching patient. If a matching patient was In cases where the patient did exist, thefound, the translation was made and result waspatient ID did not correlate to the patient IDprocessed to CodeRyte. If a matching patientin the RISwas not found, the result was stored in an orderholding database table that would be polledperiodically until a matching patient ID was foundMRS (Mammography)GE Centricity PACSADT / ORM / ORU from LIAADT / ORM / ORU from LIAORU (Diags from CodeRyte)ADT / DFT / ORUDFT Batch from CodeRyte for RABCIntergy DBPatient MatchingRABC ORU StoreRABC ORU ForwardIndividual ORU Files with “Index” FileVirtua Memorial(SIEMENS HIS)(RABC)ADT / ORM / ORU / MFNSage Intergy RIS –LIA PracticeORU Diagnosis for LIA / DFT for RABCADT / DFT / ORU from RABCADT / ORU from LIAMicrosoft SQL ServerCodeRyteORU Store and Forwardfor patient matching betweenVirtua and LarchmontSage Intergy RIS – RABC