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“It isn’t that no one realizes fax is obsolete.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.

Chris Craft, the CEO and founder of ScriptSender, had been in Bonasera’s shoes. He had been the CIO of a large imaging center in Connecticut and had faced the same pressing issue. How can an outpatient imaging practice foster collaboration with scores of referring physicians—when each has its own disparate IT system? “It kept eating at me,” Craft said. One day, he had a eureka moment.

Craft’s solution would enable users to print documents securely over the internet, with real data resulting on the other side—data that could be recognized, harnessed, and processed automatically to populate information in the RIS. Two weeks later, ScriptSender was born.
Print and done—the order is sent in one click. Without being buried in paper, everyone’s job was easier, from referring physicians to schedulers.

Because ScriptSender allows the secure submission of any document, from any application, referring physicians can add clinical notes, labs, and other documents—not just orders. Radiologists thus had better data for their reads, and billers had more information to ensure appropriate coding.

The intent behind ScriptSender—to improve the data flow and relationships between clinicians—made it a concrete value proposition for Bonasera. Other products delivered benefits for the imaging provider, but ScriptSender made life easier for the provider and the referrers—particularly since referrers have no installs, no downloads, and no costs to use the technology.

“We found physicians refer to physicians they trust, the ones that they know will provide true value,” said Bonasera. “ScriptSender was the only company we found that met our initial needs but that also offered us so much more value for our referring physicians.”

Exceeding Expectations

Northeast Radiology’s first priority was making it easy for referring physicians to send orders. “ScriptSender set that up painlessly,” said Bonasera. “It took a few minutes, that’s all.” Part of the implementation was understanding the referral patterns of the practice. ScriptSender provides a toolbox for all referring types—so that the needs of a chiropractor (that sends one MR order each week) and the needs of a neurologist or orthopedic practice (that send hundreds of orders each month) are each addressed appropriately.

“A fast implementation is a jump start on ROI from the beginning,” said Bonasera.

The scope began to widen, however, as Northeast Radiology dug deeper into the needs of its referrers. Research indicated that referring physicians wanted the report in-hand immediately—and to be able to view and share images from that report easily.

“ScriptSender has brought us at least 150 MRs a month.”

Chief Information Office, Northeast Radiology

ScriptSender technology automates that process, and that value has been confirmed by feedback from Northeast Radiology’s referring physician staff. “Reports with links to the images is outstanding,” said Bonasera, “and is being used to improve patients’ understanding of their issues. It also translates into better referral management to subspecialists who need information ASAP.” Digital image sharing also enables Northeast Radiology to reduce the need and costs associated with producing CDs.

“Our referring physicians are psyched about image links being embedded,” said Bonasera. “When we link with other physicians for referrals or consult, they’re amazed and very appreciative. It fosters collaborative clinical relationships across the board. Improving care while lowering costs is a win for everyone.”

At a pivotal point, Northeast Radiology was able to see concrete, measurable value from ScriptSender. Forced out when hospital radiologists were installed in an orthopedic building, Northeast Radiology continued to get referrals from the existing orthopedic group because ScriptSender made the referrals, and other communication, so easy. That made a difference of about 150 MRs per month for Northeast Radiology.

“We provide value to our referrers in our study interpretations, and we also provide value in terms of how efficient it is to work with us,” said Bonasera. “That’s how we grow our business. ScriptSender really understands the business and is key to retaining and growing our referral base.”

Common Sense

ScriptSender’s value proposition is strikingly intuitive. “It’s like explaining the difference between voice-over IP and a land line,” said Bonasera. “It’s just common sense—make it easy for referring physicians to access your services, without breaking the bank—but ScriptSender is the only one really doing it. The enthusiastic reaction from my referral base is a clear demonstration that ScriptSender is a great value.”

ScriptSender provides a whole portfolio of solutions—such as Web Orders, ReportSender, and Translation Services—to facilitate clinical collaboration.

“You get what you tolerate. We weren’t going to tolerate any unnecessary delays to our turnaround times or hits to our referral base,” said Bonasera. “ScriptSender is helping us grow our business.”

Interested in learning more?

Schedule a demo and take ScriptSender for a spin.