Using Cloud PACS for radiology practices

All right well we will go ahead and

get started Now it seems

like people are starting to join

so hello everybody and thank you

for joining us. My name is

Will Sweet. I'm R. B. M. A. S. Education

coordinator and I'm pleased to welcome

you to today's webinar which

is cloud packs for radiology

practices, strategic partnerships

and practical considerations which

is sponsored by Change Healthcare.

And before we begin just a few housekeeping

items to share. All

attendees are muted throughout the webinar.

But you're encouraged to submit any questions

or comments through the Q. And A. On

your zoom platform.

This program is being recorded and

the recording will be shared with all registrants

afterwards and we will have

a brief evaluation survey to

share at the end of our program and

we'd very much appreciate your participation

in the survey.

Um And now um I'd like to

introduce the speaker or speaker

for today eric lacey. The

director of clinical applications

and informatics for central

Illinois radial radiological

Associates.

ErIC oversees clinical software

at C. I. R. A. Where

he works to develop new capabilities

that improve care and efficiency

and without any further ado I'll turn

it over to eric to begin

today's presentation.

Thanks will and uh C.

I. R. A. Also pronounced sierra.

So you'll hear me reference sierra.

I'm not saying sarah but

you'll hear me reference sierra some

some somewhat throughout the presentation.

So thank you for the introduction and of course

the invite back to dive a little deeper

into how we partner with our hospitals

or how you could partner with your hospitals

to achieve better care through

normalized datasets, workflows and

the delivery of images for interpretation,

a couple of statements or disclosures to

share similar to last time and this time

a little bit different. Um Some of the

disclosures are very similar.

I'm still excited about these topics

and after R. S. N. A. Last week

that excitement's probably increased

exponentially. So I'll

try to keep things, I'll try

to speak slow. Um I have a tendency

to to get excited and speak fast

um raise your hand, submit

questions. Let's have conversation

after the presentation.

Um A special shout out to all

of our Ai vendors and I don't

think I'm supposed to mention any vendor names

so I won't but new integrations and validation

of efficacy for

imaging AI has me

looking forward to 2022. Um

and implementations of further

and deeper integrations are going to really

affect radiology interpretation workflow

so I'm excited about that um

to uh same as last time

I'm not and do not claim to be or

or no more than the next person in any

of these areas or topics.

I'm humbled by the

invite to speak and

I hope through the presentation and discussion we can all benefit

and move forward with more knowledge than what we had

when than than what we had and came with.

Um and then finally

shout out to my team and sarah as

an organization. Thank you for allowing

me the opportunity to be in a position

for discussions like this. Uh I

do have the joy and privilege to lead such

a talented team. Um

and and just great physician leadership.

Uh next time you'll be hearing from somebody

from the team either in conjunction

with me or maybe alone

uh steve or Ryan uh

either one uh and I look

forward to hearing their unique perspective

is they dive a little bit deeper into some

of these topics potentially or even new ones

and I think will's handling the slides,

will can we move on to the, so

a couple of things for learning outcomes?

Uh we kind of bounce around

throughout the presentation but the

the ideas that we bring all this together

and we identify the implications

of a cloud shift across the medical imaging

world and how moving sooner

rather than later can benefit your practice.

Uh we shift loosely because

I'll reference the lift and

shift of uh your VM

environment into the cloud. That's not

what we mean by shift by shift. We mean

transition to cloud native.

Um and and sometimes

that that transition to the, within

the lift and shift and we'll go a little bit

deeper into that later uh, will

determine what uh what

are the key considerations when building a plan

for moving to the cloud. Uh there's

a lot of moving parts in this, whether

it's the technical hurdles,

the the security or B

A. N. D. A. S that need to be signed, uh

financial implications uh

and then just kind of the process of

of what that trans transition

could look like hybrid models of

that transition and and how we get

across the finish line and get there

strategically determine who

and how to engage partners in your cloud planning

and implementation process. Obviously

my perspective is going to be a little bit different than

uh you know, the small hospital

or large hospital centers. Uh

our radiology, a private practice radiology

group. So um our

our partnerships with

with hospitals and

and imaging centers looks a little bit different

than the design would from a

hospital perspective.

I do have years

of experience being on the hospital side

and would love to have the conversation about

what where that what that looks like and some of the

benefits, both the private practice

and the hospitals they transition. So I hope

to have that conversation um

during the Q and A.

Can we move on to the next slide? There we go. So

uh introduction the widespread of

adoption of cloud for medical imaging

is is coming and offers key advantages

for radiology practices,

especially if the right vendor solution

is selected. And and we're going to talk

about vendor selection. So is

we start to talk about vendor selection.

We we really need to better understand

what what pieces are involved

in that um who

who to involve in the process of vendor selection

and in vendor selection should we be

looking at this a little bit different.

So the big picture,

um cloud is a tipping point,

even with the demanding requirements

of medical imaging, the technology

is maturing and uh the

benefits of on prem are

becoming harder um

to to deny.

So we we need to we need to look at

cloud solutions and we we

understand the benefit of of on prem and

what it's offered throughout the years but as we as

we transition to the cloud and

and we really are at that tipping point where

a lot of clinical applications are starting

to offer cloud native solutions that

are going to tie into

uh less downtime, better

sls with your with your partners

and uh a lot of things

of that nature. Almost all of the large

pack spenders last week talked about

their their big announcements of moving to the

cloud

uh some as as

we discussed further we realized that right

now they're not a cloud native there in that

lift and shift and transition into the cloud.

The benefit of that is obviously reducing

that footprint within your own data center offering

some high availability or disaster

recovery options but not

necessarily being cloud native and all

the benefits that come with that. We're going to talk

about that high level. I know we talked about it in the

last presentation as well

but it probably deserves to be discussed

in every conversation with cloud because

there really aren't too uh

distinct areas when we start

to talk to potential vendors about

what cloud is.

There's also a number of startups and small players

somewhere in our sunday and it was it was fun to have

the conversations about what their vision

is and and how agile

that they can be in in that startup mode.

You see this a lot with ai

vendors obviously but we're even

seeing it with image viewers as well.

And the cloud creates real

opportunities to drive improvement in patient care.

Uh You know we we see

this in the high availability

models and uh

The down times that are .001%

or less. And

uh I think the time to start thinking

about migration to the cloud it

doesn't mean we just uh

we uh you know storm, storm

through this and get through it as quickly as possible but

we need to start thinking about what that migration

looks like to the cloud through your practice

or your hospital um or

the hospital organization is a large

enterprise. Um If we

if we don't start thinking about it now we won't be positioned

appropriately to to get

there.

So why why cloud for imaging

providers?

Um We of course eliminate

some I. T. Infrastructure

um that that

drives down costs either in FT

es on site through

no management of hardware, software

security concerns or shifted to

that software as a service model. Uh

You know, we outsource the maintenance and headache

of security. Security is big this year.

We see uh large

organizations, small organizations

being targeted

with with all kinds of

ransomware and and other viruses

and and to remove some of that target

from from your own data center

and and put it in the hands of

of that software as a service model uh

does does help uh

and and get you focused back where we

like to be focused, which is which is patient

care. Um we eliminate

the maintenance and upgrade downtime. You

know, if we talk about downtimes

uh and we've discussed

this before downtimes cost more money

than than just the application is

unavailable during this downtime. We have planned

downtimes we have unplanned downtimes. Uh

there's substantial diminished

care during these

these downtimes whether they're planned or

unplanned. Um there's no easy

access to current studies potentially.

Uh there's no access remotely for

your remote readers. Uh no

access to prior years reports

aren't getting posted back to referring and ordering physicians

all of this is downstream. And

the standard of character shift significantly

during the downtime. It's it's not

something that we um

take lightly and it's something

that we we have to take into consideration

that that downtimes mean more than just that three

hour downtime,

you have reconciliation workflows

and and things like that afterwards that

they can take up time and and obviously

introduce uh remove

the integrated workflows that existed

prior and and put a human being

in front of these integrated

uh an automated workflows

for reconciliation, which

can lead to all kinds of human

error for posting of results

or whatever it may be

contracted. Uptime guarantees, we

look for that 99.99%

or higher. I

think most of the

at least that S L. A. That you see with a

lot of the the cloud based

solutions, you know, claim claim

to be in this uh if

we're looking at cloud native solutions,

uh realistically it's probably a lot

higher Um in that lift

and shift format that we talked about

and that that transition

that there is a benefit to but once

you get to cloud native, uh

you start to see uh

these above 99.99%

because it's just tiny little micro processes

that are getting shifted and in

transition during this time, uh

application upgrades and

and things like that are are no

no longer server downtimes and

uh you have you may still have that client

upgrade but you don't necessarily

have all the server upgrades and

the clients are typically quite a bit lighter

because they're not relying

on what traditionally they've relied on

in doing

it drives down costs and we talked about this.

It's FTS on FTS on site

through no management of hardware,

software security concerns, all

of that get got shifted to that software

as a service model. It doesn't mean that you

remove your I. T. Uh

support system and structures it means

that it shifts a little bit. Um

And they're able to focus everybody's

overworked today. Uh

They're able to focus on the other things that are sitting

on their plate. Um So it

does free up a little bit. Um

And then the software as a service

benefits beyond that. The single

sign on the enormous for group our

size where we have seven distinct

uh databases of the what

what seemed to be the same application but

all have different user names. All have different

passwords. All have different password requirements

either in complexity

or how often we have to change them uh

single sign on and a single pain into a

work list that they're single pane of glass

into a work list that that offers

you everything that you could potentially

read um allows

for the next steps of once

that that seems like low hanging fruit that's

enormous. Once that's accomplished

we can start looking at smart

work list and assignment and subspecialty

workflows. Um It simplifies

the application and infrastructure troubleshooting

because you're no longer wondering

which one of my eight image servers

is acting up.

Um They're behind this load balancer

and we're having inconsistencies

uh in in import times

or we're having inconsistencies and

image retrieval. Uh

This really simplifies that. Uh

It should be. Uh It's not it's

not it's no longer going to

be something that

uh when it works, it works

and we don't question it when it doesn't work, it's

a needle in a haystack. It's something

that should be repeatable if it's not

working uh in the way that that

cloud natives designed and you're consolidating

service center discrepancies in sls

as well. So where we,

we used to rely on the

canary in the mine or whatever and somebody calling

in and saying, I feel like this is

slow. Can we look into it? We

start looking into it and maybe

it was just a precursor to

a specific service or function

within that application going

down whether it was packs or your

dictation platform or whatever it was.

Uh This is a little bit different because it's

managed at a higher level and those sls can

be dealt with appropriately.

So. White cloud for patient care, uh,

Cloud facilitates and

and accelerates the transfer of key

patient information, including relevant

priors. We talked about this last

time a little bit um, we know

that relevant priors exist today

in the environments of,

of everyone's packs. What what we

really mean by this is that we've

we've normalized display protocols,

relevant priors or no law sitting

in an archive that need to be pulled back

uh and and untarnished

and presented back to a local cache

in order to be viewed. It's, it's

real time sitting out in the cloud

available to you at any given point

and we're letting the cloud manage that storage

on whether it's on faster storage or slower

storage or whatever, but it really

ends up being a

service or a service level that

is met and consistent.

Um We have guaranteed up time and read from anywhere,

uh increased access to timely care,

guaranteed up time. Uh

Yeah, we do have all

kinds of uh guaranteed up time

with with with cloud

native solutions as we talked about the

99.99% the

read from anywhere. We're probably doing this

today through an HTTPS.

So we're probably doing this through managed VPNS.

What we really mean by

this is that in that in that guaranteed

up time and the read from anywhere we we

um not only have access within

the four walls of the hospital, but also outside

of the four walls of the hospital.

And the unification of large imaging datasets

can drive improvements in population health

and innovations and diagnostic ai

assist radiologists with accurate reads.

Uh You know, this is

the slight kind of a summary of everything

that we've we've talked about what, what cloud

can do. Some of these things can be accomplished

with on prem, but they're just native

in the cloud uh and it

deserves to be on its own slide but it's really

just a summary of topics and reasons that we're

all familiar with. Um

and and looking forward to the normalization

of it as we transition to the cloud

collaboration.

Um We could probably do

an entire message

or presentation on collaboration.

Uh and what it looks

like to sit down with

your hospital partner, you're imaging center

hospital or for hospitals to sit down with their

radiology practice and

kind of talk through uh co management

of of departmental workflows,

co management of vendor

selection.

Um But you know, you look

to your hospital or your

hospital network, your partners

is key collaborative and and developing

a cloud strategy uh

boils down to is that you have

a single workflow across your practice for your

radiologists. Um

The workflow offers the same tools, such

toolsets such as display protocols,

keyboard shortcuts overall,

just the overall usability heuristics

for interpretation regardless

of where the study was performed. And it's not

limited to just interpretation

text that transition across

multiple hospitals within your footprint

are gonna have similar workflows as well.

The referring providers and and ordering providers

that uh maybe

participate within multiple hospitals

within your footprint are gonna have

the same look and feel regardless

of where they're at. And it's a it's a single product

and easier to work through.

So it doesn't just make your radiologist

more efficient. It makes them more effective

and and the care that's that's delivered

and maybe that leads

to and and helps reduce frustration for

them and and burn out.

And we probably shouldn't limit that

just a radiologist. Uh Maybe

I receive less negative feedback from

from our shareholders or radiologists. Maybe

maybe the hospital receives less uh

feedback. Maybe they're happier with the turnaround

times for enhancement

requests and and things of that nature.

And so

for when we talk about collaboration, we talk

about aligning cloud strategy from the start,

ensures that there are no missteps

or critical misunderstandings that impacts

service or patient care. Cloud

is an enabler for delivering delivering

better services, but also

lower geographic barriers to competition

and building that partnership and

and shared vision. And the collaboration around

that creates a barrier, making it tougher

for other practices to capture

your business. You know, when we talk about who

our customer is for

Syrah, it's our hospital and imaging centers

for hospitals, maybe it's the

ordering and referring providers or

the radiology practice. But software

as a service can be a packed overlay

um for the benefit of

the radiology practice and in a single

unified workflow for

us. Software as a service

in the cloud can be a hybrid where

it's used as high availability for

that critical access hospital uh

as an overlay for the radiologist, but also

the high availability for

one of our hospital partners that maybe doesn't

have a disaster recovery

data center, maybe doesn't have

high availability or

um within their within their current

data center to where they feel comfortable

uh in the event that

they had either a hardware failure or software

failure. Uh Software as a service

can be a strategic pathway for our partners

that offer all

the same benefits that it can for

syrah. So as we talk about Sarah

having a single unified workflow hospital

partners could have that as well. They could

reduce the footprint that they have within their data

center, within their disaster recovery

center, within the high availability

that they have. Um And

and it really just transitioned to

at software as a service

uh format

excited please.

These seem to be a little bit different order.

So I apologize. Um

So in intelligent

interpretation workflows uh

partner with your customer to drive improvements to workflow

in workflow for both

individual customers and load balance across

your entire customer pool. We talked a little bit

about this in the last slide and that

transition that transition of

consolidating all of your imaging into

a single work list that's

tied to a single sign on uh

takes you to that next step of

of creating a work list designed for

the radiologist. When they sit down as

a radiologist sits down for the day. They have

uh simple work lists that

are defined based upon their subspecialty

uh work list that may

be automatically prioritized

based upon the type of study where

it was performed, how long it's been sitting on

the list whether it was ordered

stat uh for

um imaging or staff

for interpretation um and

then rural sets that would

increase based upon potential

positive findings from ai software

that could route to individuals

or groups of individuals. Um

not only in prioritization but let them know

that there was a potential positive finding

in that ai

um we could preemptively identify

relevant priors and like I said that all those

relevant prior sit out there in

the cloud are available and we're no longer

have the restriction of pulling things back from

an archive. Uh and

then and then taking that and presenting

it back to the

individual which could take minutes

uh in some of our on prem

solutions that were sitting out there.

Um but we we also have those

relevant priors come up automatically.

So whether whether all your priors

are running through an AI algorithm for

body region assignment

or you know, as

you start to build display protocols,

maybe a

learning option that that

helps uh you know, further

define what you like to see and for

your relevant priors, maybe you don't

like to see the plain films. If you're if you're

looking at a cross sectional study, you'd

rather see other cross sectionals that meet

the same body region. So, and then

future integrations of diagnostic aI

accelerate diagnosis. Again,

this could be imaging AI um

but it's not limited to the imaging

ai that's out there

and then this is a very busy slide.

So I apologize, I probably

should have put it on um

you know, onto multiple slides

but as we normalize departmental

and hospital workflows. There's

there's quite a bit of things that we need to take into

consideration. This is really for the hospital

as they transition to that software

as a service model,

um technologists workflow

needs to stay the same regardless.

So all on prim technology

or technologist and physician workflows

have to and must be

in that software as a service model. Um

It's it's probably embarrassing,

but I know we're not alone. So I'll say it, we

still rely on scan documents uh,

at some of our hospital. Um

we we rely on integrations

into the, into the the EMR whether

that's epic or or another. EMR

those have to, those have to still exist.

Um the HL seven normalization

is you take multiple ordering systems

uh that has to happen somewhere

and although we see hospitals starting to transition

to to rad legs for procedure

descriptions and

that

procedure descriptions and codes,

um

there's there's a ton of other normalization

that that needs to happen that

can happen within art

interface engine. It can happen in

between the hospital interface engines or

it could happen in the cloud. So as you transition

all this out there, there's there's

obviously going to be interface

engines that are helping get the H L seven

scheduled orders uh and image

availability notifications

out of your,

your cloud packs to any downstream systems.

So normalization could happen there as well

if you're limited in not having

your own interface engine or not having

the influence to um

to help normalize in, in partner with

your your hospital. So

you know when we talk about the radiologist, there's there's

all kinds of things that have

to be there um There there an on

prem they've been there throughout

the entire time

of of pACS and imaging approval.

Although that doesn't necessarily explain

much what I mean by it is that

the it's the process for the patients in the room

and the text done some images, they

sent them off, they've they've called radiologists.

And the radiologist needs to prove that

they don't need to do any further imaging. This happens

a lot in ultrasound pediatric

ultrasound, especially at least in um

our experience with

our Children.

And so the tech will routinely

get on the phone with the radiologist, have them review the

images and determine whether either the

radiologist needs to come down and perform

further imaging or that the techniques to perform

further imaging. So this

doesn't work too well as in the packs

is an overlay uh

type of format, but it is something that

has to be there in any packs

that is going to be deployed within a hospital setting.

Um And then the the interpretation

we have to make sure that we don't we don't just think

about attending radiologist dictating.

There's a lot of different workflows just for an attending

radiologist, whether they're drafting a

report or sending it off for transcription,

we still do have that not everybody

is in a in a self edit type of

scenario. Um

And uh and then what a final looks like,

what do addendums look like. Um

what does it look like when we start to

look at resident workflows or fellow

workflows. We want to make sure that all the work that's

been done throughout the last 20 years

and in the on prem pacs workflow

and and everything that's been designed

is properly transitioned

into any

cloud based packs.

Actionable results. Again,

this this could be an entire presentation

about what communication looks

like for actionable results. Where

do you document it? How do you follow up

on it? How do we manage follow ups?

Um and any accompanying

integrations and workflows. There's uh

R. S. N. A. Of course there were um

you know vendor after vendor that

that we're talking about how

they're going to manage follow ups for us,

how they're how they're going to manage

critical test results and

and how they would how

they would manage the remaining actionable results,

whether it goes to a queue for

uh a navigator

to manage or it requires

physician to physician communication. There's

a lot of things that become manual throughout this,

but you need a workflow on the back

end that helps document and walk the

physician through the process

and remind them in the event that

there was a requirement for physician to

physician communication,

technologist. Q. I. We see,

we see tech you I

kind of collapse into that software

as a service packs. Typically it's it's

low hanging fruit for

tech UI and interdepartmental

review tumor board,

multidisciplinary conferences,

all of that can kind of collapse into

that software as a service. And these used

to be things that you look

at potentially look at a third party app

to do because they just

did it better. And when you transition

to cloud native solutions

and you and you have the container ization,

you have the ability to take enhancement

requests and and return them back

without having to go through full FDA approval

and everything. You do see turnaround time

in these other areas that

maybe weren't as well understood

by uh the traditional

packs developers. So you'd ask for one

thing and get get something else. This

this becomes a lot easier to get to your end result

and a lot quicker to get to your end result

in the solution that you used to rely

on that third party application for

and and analytics. Uh

you know,

again, we could talk about analytics

forever and without going

into too much detail. Um

you know, you have a single workflow

and and and integrations

built on normalized data sets, you

know, allow for deep dive and analysis of your hospital

or practice. What does that really mean?

Uh analytics can help you better understand

your practice

and maybe that helps drive some difficult conversations

within your practice. Maybe it helps drive some

difficult conversations with your hospital partners

but ultimately helps

your partners better understand the value

beyond

just being another radiology group and

and what what your group can offer beyond

that interpretation and and helping

manage departments helping manage

and and understand the

busy times of the day when uh

you know we could we could better manage uh

some of the some of the stuff without throughout the

imaging department and and radiology

is what we do.

Um So with the

data at your fingertips you can analyze

and and can present it in

ways that have not been thought of

otherwise. Uh And and a

lot of times hospital administrators aren't

in a position where they have that finger or

that all that data at their fingertips.

Um because it's it's

sitting in an I. T. Application that they

don't have access to or haven't been given training

on. So it it offers

it's just added value that a radiology practice

can offer back to their

partners.

And I guess that's all I have for

today. Um We did we did

rush through it and I did notice that

there's a little bit of Q. And A. Out there.

So I'd love to open

it up for any further conversation.

Sure I'm happy to help with um

the Q. And A. And just as a reminder to

everyone you can type in any questions

or comments that you have but we

do have a couple in the in the queue.

I'll read the first one for you eric

um when

talking to your partners, how do you start

the cloud conversation and

position it in a way that gets them motivated

to start planning and acting?

Um

I think there's there's a couple of things so

um we have we have pretty strong relationships

with our hospital partners

um and we've we've

built those over the years, so even

even the tough conversations become

a little bit easier because it's

it's not us walking in and saying this is what you

should be doing, we're not trying to

bully them into

uh this, it's something we're looking

at, we know that

that hospitals are looking at cloud

solutions and um

you know, it's it's more of that partnership

and and and less about,

just as I'm not looking for a vendor, I'm

looking for a partner to walk alongside.

Uh it's the same way with our hospital partners

were not just a radiology practice

for them, we're a partner of theirs to

walk alongside and help help

them, you know, be successful within

their hospital or within the imaging

department.

So we kind of start with that

we find out what what they

know and what they already know what they have already

researched what they're looking at and we

learned from that, it's much like this

this presentation in this conversation. Um

you know, I don't I don't pretend to know

more than the guy that has spent

his entire time uh in

I. T. Looking at cloud native

solutions but I do know a little

bit about radiology workflow,

what a radiology practice needs. So

we get together with them and and we work

alongside each other to figure out

what the best solution could be.

I think the motivations are different

for some of the hospitals too. So if

it's a if it's a smaller hospital you

you look at what their motivations

maybe and their motivations may be

looking at

a way to shield themselves or or

give themselves high availability and disaster recovery

and shield themselves from security. So

uh since you since you already a partner

with them and already already know that about

them you can bring a solution that

that automatically does that to them, get them excited

about it start the conversation larger

hospitals, it's completely different. They

already have high availability, they already are paying

for disaster recovery. Um

So it's it's a different

approach with them. Uh It's more

about what the radiology practice

can do with a unified

viewer and unified workflow. And

and this happens to be one

that that meets all of our needs

as far as being a small footprint within

our data center and in a smaller I. T.

Group. Um

And how do we how do we interact and build

the necessary integrations and put them in place

in order to accomplish where

we kind of both benefit out of it. It

also shields that large hospital organization

from if they're down, we end up being a backup.

We've been that in the in the

dictation platform for some large

hospital organizations. Uh

but not by design just because we already

had bidirectional interfaces in place.

So they see that from the history

and what a partnership can offer. Um

And I think it helps drive the discussion further

uh as we start to bring other ideas

to them. Okay.

Um you may have touched on this, but

maybe there's um something to expand

on with this next question.

How does it work with big health systems

that cross state lines

and have multiple radiology groups?

Well, we're just a single radiology group.

Um but uh

there's an inverse of this where we read for

a large hospital organization and

we're not the only radiology group that reads for

for that hospital organization. Um

is we look at how

the S. L. A. Criteria across different

customers and and resolve potential conflicts

and wait, what was the question? Because it looks

like the question that I have up here is different.

Yes. Sorry, I was that question

came in through the chat. Sorry.

And then you pay it again? Well, sorry.

Yeah. How does it work with big health systems

that cross state lines and

have multiple radiology groups?

Yeah. So in in that scenario,

big health systems that cross state lines

and have multiple radiology groups. It might,

it may be easier. I'm

not in that scenario. I think about

our our large hospital organization that

does cross state lines. We

are one of many of the radiology groups

that read for that large hospital organization.

And that transition

to the cloud would would be

um very calculated

and a large project

they have over a petabyte of of imaging

data. I've seen

smaller hospitals transition

to a cloud based

archive or cloud based solutions

for the viewer and the archive and they can

get 40 to 60

terabytes migrated

in 2 to 3 weeks. Um

A petabyte is quite a

bit more than that but you have you have different avenues

in there whether you're going to bring something

on site and do the migration uh

to to a box and then take it to one

of the data centers, whether it's google or

whatever and do your upload or

if you can do it in real time and kind of

live in that as we discuss, the hybrid

solution for some time. Uh

That hybrid solution offers not just

your radiologist but you're referring community

ordering community and hospital to

transition at their own pace as well and

kind of have a foot in uh just

just a toe in the water as they as

they transition and then kind of diving

in either per hospital

within a large organization um

or that opportunity just to

dive in and have everybody transition

at once.

Okay. And now I'll go to the other question,

how do you integrate S. L. A. Criteria

across different customers and resolve potential

conflicts in the work list?

Um

So

service level agreement criteria

across different customers. I'm not

certain if we're talking about specific turnaround

times or or focus on

uh some specialty reads.

Um If

if we're talking about how those get categorized

within an intelligent work list

and how prioritization

could be mis

assigned.

Um Obviously I've

never had any difficulty

in receiving feedback from a radiologist.

So my radiologists are

very good at letting us know

if something is not working properly or

or looks to have been escalated

or prioritized inappropriately.

Um I would suspect that they're

going to do the same if they if they see that in the

work list. And

if we if we were to notice a

specific trend that wasn't

meeting in S. L. A. I

go back to the analytics piece and

as you start to go through and analyze. What

are our E. D. Inpatient outpatient

turnaround times. How often

are our rule sets being applied

for prioritization for outpatient studies

or inpatient studies meaning that they were getting close

to meeting that or not meeting

that S. L. A. Because you would

ideally want to escalate and prioritize

prior to to not meeting it so you can

still meet your sls.

Um And then as you start to

dive a little bit deeper into the

analysis. You could look at these

specific physicians are sub specialized

maybe in in body or neuro

or pedes. How often are

they reading within their subspecialty. So

these are all things that can be done. Uh

maybe maybe it's not as proactive

as we want it to be but they're all things

that can be done almost real time

with the proper analytics and

proper normalization of your data

sets. So you could say that

our pediatric physicians are reading pedes

cases 95% of the time, 100%

of the time Monday through Friday.

Uh you could say that it looks like

our neuro subspecialty. Physicians

uh get get to sit in their

subspecialty, you know 87%

throughout the week uh and maybe

maybe fall into that general radiology

pool for the other, you know

13%. So I think

the analytics would play a large part

in that. And ideally we'd get proactive

with analytics and uh

and and start to apply the

appropriate tool sets to the work

list to make sure that we can meet those sls.

Alright, well that is the last question

that has been submitted um

if anyone wants to has

any last minute questions, you're welcome to

um send them in

but

in the meantime I will bring up

um

eric's contact information on the screen.

So if anyone has any further

questions or thoughts that come to you and

you want to follow up offline. Um

there's erIC's information

um And before we vlog off today.

I do have a couple of

polling questions we want to share with you

um To get your reaction to

our webinar today just to get

your quick overall feedback

on our program.

Um There will be an evaluation

survey um with further questions

if you want to fill out

um you're welcome to at the end

as well. Um But

um I'll leave this up for

a few more seconds

and then I have one other

poll question that we

want to launch and have you respond to

just to get a quick reaction of how

how you felt about today's

information.

So as you respond to this I'll just

close out by saying

thanks so much to ERIC lacey

for today's presentation. Um

And thanks to Change Healthcare for sponsoring

this webinar. Um And we thank

each of you who attended and participated.

Um Thanks for attending

and asking your questions and we hope

that you have a great rest of your day.

So thank you very much.