Mike Bonasera had a problem, and it was getting more urgent by the day. Chief Information Officer of Northeast Radiology, Bonasera knew that order volume—a steady stream of physician referrals, the backbone of any imaging practice—was under threat.

“We have four outpatient imaging centers in our practice, and we’re competing with massive healthcare systems that have the resources to maybe out-flank us on gaining referrals. That’s even though their imaging services turn out to be the same quality, often at a much higher cost,” said Bonasera. “That’s a wall closing in on one side. On the other side, we’re facing decreasing reimbursement from the Centers for Medicare and Medicaid Services for many imaging procedures, and we all know that major payers follow the government’s lead. That’s another wall closing in.”

But there were even more facets to the issue.


Workload that call center staff devotes to fax follow-up, instead  of patient calls

“It isn’t that no one realizes fax is obsolete. Plenty of people are frustrated by it. It’s that most haven’t found good, cost-effective alternatives.”

Faxing: We Have a Problem

Those referring physicians who were sending orders to Northeast Radiology were doing so in the most inefficient way possible—through no fault of their own. Nearly every referrer in healthcare relies on an archaic method of clinical communication: the fax machine. Its shortcomings—the delays, the errors, the back-and-forth, the expense—are being brought to light more and more.

Bonasera took a closer look and discovered that most orders are faxed in and put in piles to be worked by call center personnel. Those staff members have to manually sort and scan orders into radiology or electronic medical record systems. When those faxed orders are illegible or have fax artifacts, as they frequently do, staff has to call the referring physician’s office to clarify the data. Some practices reported call center staff devoting 70% of their workload to these kinds of calls, which inhibits them from working approximately 200 patient calls a day.

Bonasera isn’t alone in recognizing the inefficiency, not to mention inaccuracy, inherent in faxing. CMS Administrator Seema Verma recently announced initiatives to make every clinical setting a “Fax-Free Zone.”

Bonasera found that it was a constant challenge to keep operational productivity flowing in the practice. When speaking with his referring physician offices, he found it could take 18 to 36 hours to process an order. Given Northeast Radiology’s commitment to timely turnaround of reports—for referrers and for their patients—this was naturally a source of concern.

“It isn’t that no one realizes fax is obsolete. Plenty of people are frustrated by it. It’s that most haven’t found good, cost-effective alternatives,” said Bonasera.

When a Solution Doesn’t Solve the Problem

Some in the imaging industry have “solved” the fax problem by creating interfaces between the imaging provider’s system and its referrer’s system. “That solution for receiving orders costs around $30,000 or more per connection for VPN and HL7 connections,” said Bonasera. “So, I hesitate to call it a real solution. After the months of development it takes to get it up and running, you’re still looking at hefty costs to maintain the whole infrastructure—that’s on both the provider and referrer sides—and we would have to build a connection for each referrer we have.”

That approach can create yet another obstacle. Leadership must be convinced to spend money on technology, and in the case of complex interface set-ups, the juice isn’t always worth the squeeze. “In IT, we always have to justify how or why a spend is necessary,” Bonasera said. “What is that new software really going to do for the practice in terms of hard, practical, concrete benefits? We need to show a return on investment. It can’t be this black hole that we pour money into.”

Still, Bonasera is a CIO. He knows that technology, properly leveraged, can solve even the most difficult challenges. And he knew that the thinking behind system-to-system connections was a good one: ditch paper and make it easier for referrers to get orders to an imaging provider. In other words, get real data flowing between clinicians—quickly, accurately, and securely.


Average cost to build a single VPN/HL7 connection

The Search—and the Solution That Works

Optimistic, Bonasera started his search. He would use technology to re-engineer their system, facilitating a smoother connection with referrers and improved customer service. The best solution would not only stem the tide of potential lost referrals but even increase order volume. He searched in all the usual trade publications, associations, meetings, and national conferences like RSNA.

Having no luck, Bonasera considered developing the platform himself—and then discovered ScriptSender.

Print and done—
the order is sent in one click.