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Tim Kelley:
Welcome to Imaging and Teletech Innovations, brought to you by TeleRay. I’m your host, Tim Kelley. Join us as we explore the latest trends and developments in teleradiology and imaging solutions, from expert insights to real-world case studies. We cover everything you need to know to stay ahead in the rapidly evolving field of radiology. So sit back, relax, and let’s dive in.
Tim Kelley:
Welcome Michael Cecil, an experienced imaging director with a demonstrated history of working in the clinic hospital healthcare industry. Skilled in all aspects of radiology with an emphasis in MRI, radiology budgets, teaching, public speaking, healthcare, information technology, and our favorite topic PACS, Picture Archiving Communication Systems. And, of course, I stole that right from your LinkedIn profile, but it was just a quick intro, I thought, so thanks for joining us, Mike.
Michael Cecil:
Absolutely. Thanks for having me.
Tim Kelley:
So tell me a little bit about yourself. I know I just went through that little intro, but what else should people know about you, Mike?
Michael Cecil:
Let’s see, I started in radiology in, back in ’87 when I joined the Air Force and had no idea what I was getting into. My recruiter didn’t know what a radiologic technologist was, just told me I’d be in a hospital. He actually told me I was working Monday through Friday, 8 to 5, that it was pretty much a day job, and being 18 and not very smart, I fell for it.
Tim Kelley:
Yeah.
Michael Cecil:
Little did I know that we’re 24/7, so being in the military, it’s one of those jobs that if you have a great NCO and you apply yourself, you pretty much do anything, and so I was able to kind of spend, dabble in every modality: spent some time at the front desk scheduling appointments, spent time in the film room. For your young listeners, that would be a massive warehouse that stored a bunch of things that look like plastic with pictures on them. And, you know, every patient had files, and depending on your facility’s policy, you would either go through and purge those files every year and get rid of anything that’s older than five, or you would just keep adding and adding and adding, and then thank goodness PACS came, and we don’t have to do that anymore. And then there were, the mad rush on silver recovery, so I got to take part in that purging and getting rid of film rooms. And believe it or not, we still have light boxes in the facility I work at now.
Tim Kelley:
For sure, it’s funny how those things, some of those old terms, don’t leave, though, even though the technology changes. So we still talk about same-day labs, wet reads, those terms don’t go away, like fax.
Michael Cecil:
Yep, exactly. We used to have a little bit of fun. We would put a button on the outside of our film processor, and we just put for STAT. So the physicians would walk up, and they would just hit that button. Of course, button wasn’t connected to anything, but it was always fun watching all the providers come by, and they would just sit there and tap it like it was a pinball machine. And, you know, I’ve worked in clinics, I’ve had chances to put departments together, I worked for a vendor, Siemens, for about five years and got to travel all over doing that, helping people run MRI machines, and really just got to a point in my life that I knew it was time to give back. So that put me where I am today.
Tim Kelley:
All right, great! Looking at your organization’s general challenges in facing and solving problems, adopting new technology and patient satisfaction, or where do you see challenges with those types of things?
Michael Cecil:
So a lot of radiologist groups, and ours is no different, are looking for maintaining a revenue stream, and as reimbursements dwindle, you have to look to outside facilities for those revenue streams. And when you do that, if you’re not a massive group like Aradia or some of those other groups, it’s hard to go into a small community hospital and say, hey, you need to put our PACS into your system, and you need to use our RIS to schedule these exams. And so, you know, really trying to come up with a seamless way where current images and priors can come over and embed in our own PACS with an accession number and everything we need to dictate a report to show up on a work list and then go back to that community hospital without them having to adopt all of our technology is a massive challenge. You know, we’re on different EMRs, different RIS, different PACS, and I don’t know if your audience saw electronic medical records, the hospital information system, radiology information system, and a printing and archiving. So having something that’s vendor-neutral, that is modality-neutral, that can live within a PACS that feeds from another location automatically pulls priors. We haven’t found that magic box yet, but we keep looking for it, and we haven’t found anybody smart enough to build it yet.
Tim Kelley:
That’s a good thing they all communicate so well together, and there’s no problem there at all.
Michael Cecil:
Exactly.
Tim Kelley:
Yeah, yeah. And that’s some of the stuff we deal with every day. Like how do we get these guys to talk to each other? Because they all say, they’re speaking the same language. There’s all the organizations, whether it’s IAG or iCOMP 3.0, HL7, adhere to the standards, and it’ll all work. Well, everyone adheres to the standards and goes like this.
Michael Cecil:
Exactly that. And then, they all have their own compression algorithm that is unique. And so don’t think it’s impossible because we have a lot of smart people walking this earth. I just think the person that’s going to invent the solution may be two years old right now.
Tim Kelley:
Yeah, yeah, unfortunately, you’re probably right with that. Well, speaking of those kinds of issues, if you look at an area like interventional radiology and where it got hurt by COVID, a lot of sites, it went as much as 56% down. Well, how do you look at using different communications technologies to bring that backup so you have a procedure, then the consultation?
Michael Cecil:
You know we’re really doing is working on, we’ll bring patients in, we have to sit them in front of a enterprise workstation and pull up the images that way. We do have the ability to project our PACs on a large monitor inside the interventional suite. The challenge with that, really, for, at least for us, is we don’t have just radiologists in the interventional suite. We have neurosurgeons, we have vascular surgeons, that are all working with the same interventional team, except all three of those groups all have different ways of doing the work. And so, you know, neurologists and neurosurgeons, they want all that imaging beforehand, and they want to be able to look at all those pictures and have a good idea before they’re sitting down with the patient. And so all of that really needs to happen upstream in a clinic setting where you have interventional radiologists that are a little more prone to working on the fly, and they’re going to go day-of and have these conversations with patients. And we’re having to do that with Cal’s computer on wheels looking at that monitor behind you in the background in your virtual meeting room space, you know, something like that, that we can get there in front of the patient. For our stroke teams, we leverage a, I won’t say the name of the app, just in case this is a vendor-neutral podcast, but all the teams communicate on this, from the paramedics in the field to the emergency room providers and nursing to the imaging staff and CT to the Neuroradiologist doing the reads down into interventional; and everybody’s communicating on the one platform, images show up on this one platform, so everything they need is right there at their hands. And right now, we’re only doing that with strokes and STEMIs, and I think we all would love to see that expand. Met with an individual that was outside of our facility recently, and their comment was, you know, it’d be great to see the use of this in a transplant team, right? And you know, this be a, not just vendor-neutral but facility-neutral as well. And so we have four competitive hospitals, all within five miles, and we can’t see, even though it’s the same app, we can’t see what each other is doing on that app. And to be able to share freely, I think would be a great advantage to developing these.
Tim Kelley:
Yeah, I completely agree. And then, with that, the lack of doctors, specialists, and of course, radiologists, that same question applies in how do you see technology resolving some of those issues and getting the tentacles out to these guys?
Michael Cecil:
Yes. Well, we have been on a lean journey, along with just about every facility in the world, for two-plus decades. And the one thing that we’ve done really, really well here is learned how to change, and so everybody that works here embraces change. We all understand from the moment we’re hired, one of the very first things they teach us in orientation is our lean methodology and how to change. So leadership is very active in all the change and helping providers embrace the change when, honestly, almost every change in a facility in a hospital is going to impact the providers the most, right? And they’re at the top of the food chain, they’re the ones that are interacting with the patients, and so their work is being impacted by it. And so, walking alongside of them, understanding what they need from this change. And so we’re then promoting that to them as opposed to the things that are part of the change that don’t matter to them. You know, the with them, approach to change. But yeah, our facility does a really, really good job at change management.
Tim Kelley:
And that’s good because most of the docs are saying it’s my way or there’s no way, and so you got to adapt to it.
Michael Cecil:
Exactly. And you know, you have a history of some technology that was supposed to make everything greater, and it was one step forward, four steps back. And we’ve had failures, but we’ve also had even in those failures, we know what not to try later or how to try it differently.
Tim Kelley:
Sure, sure. Well, you had mentioned too about being competitive. So, in keeping that edge, is there anything that would you say is like your secret sauce when you have these surrounding guys to getting docs and patients to come to your facility?
Michael Cecil:
Well, we focus on what we’re really good at, and we promote that more than we promote all the things that we’re just good at. So we focus on what we’re very good at, and we have a unique approach to healthcare that is more collaborative than competitive, so it is not uncommon to have a surgeon sitting right next to the lab and pathologist sitting right next to the pharmacist, all in one meeting and breaking down cases. And so you don’t have the surgeon being the loud voice, saying, no, we’re going to go cut it out. You have oncology, you have all these different opinions, What if we did this beforehand? And so all the complicated cases and even the basic cases before you go into a treatment plan, they’re going to be presented in a conference, and everybody is kind of required to pitch in and contribute ideas to the resolution of this patient’s condition.
Tim Kelley:
That’s great. So changing gears here a little bit, and HIPAA, DNA, those are abused terms, but they are just HIPAA because everyone thinks they understand that. For example, we’re on Zoom, and they claim to be HIPAA compliant, which they are not.
Michael Cecil:
No.
Tim Kelley:
So looking at that, how do you guys manage the whole HIPAA sphere as well as data integrity?
Michael Cecil:
So, obviously, our employee is not concerned with HIPAA compliance. We run reports to see who’s accessed records and things like that, and so we’re constantly vigilant on who’s accessing records. For anybody that is from the outside, before we talk about any patient cases, before any data or images are shared, they’re all signing BAAs, so a business agreement, to keep everything safe. So that’s how we keep everything internal. As far as image sharing with other facilities and things like that, that’s where it gets kind of a little gray. It used to be a lot more gray, right? We used to fax a face sheet with patient information, requesting images. Who knew was on the right side? And if you just missed one number, you’re no longer faxing that release of information to a hospital, you may be faxing it to somebody’s house. With electronics, now it’s a lot better. We have a, we’ll call it a soft image sharing platform where we can just go in and put in a patient’s email or a provider’s email address or facility’s email address, and request images directly from them. So it’s getting a lot better, I think.
Tim Kelley:
Sure, yeah, it’s definitely improving. And eventually, they’ll all talk together too, with their … project and those types of things are going on.
Michael Cecil:
Absolutely.
Tim Kelley:
So looking at the image-sharing stuff and patient power ranks growing, do you think it’s best that patients receive full copies of all their health information and then have a level of responsibility for when they share it themselves?
Michael Cecil:
I’m going to be the bad guy here and say not only should the patients have instant access to their images, I also think they should have instant access to their report spelled out in layman’s terms.
Tim Kelley:
Right, I completely agree.
Michael Cecil:
Yeah. I think that this idea that we need to wait until the referring clinician gets a chance to see the report first really focuses more on trying to make a little more money from the patient than giving them control over their own decisions in healthcare. Then again, I also think we all ought to have a price list menu, whatever you want to call it, when people walk into our radiology department, too.
Tim Kelley:
Yeah, the book, published book, or I should say.
Michael Cecil:
Yeah, I think transparency is the best way to battle dishonesty.
Tim Kelley:
Definitely. So, the topics we’ve discussed today, what would you leave people with, and what was the biggest lesson you learned in your role …?
Michael Cecil:
I think the biggest lesson I’ve learned is that the lights are on because of me. There’s not power at my facility, there’s not heat at my facility because anything I’m doing, it is all because the patients have chosen to come here. And once they choose to go somewhere else, I’m not going to have as much money to spend on things like power, equipment, all of that. And so when you talk about patient engagement and things like that, I don’t think it’s as much as how we’re delivering, you know, how safe we are or how efficient we are. I think it all comes down to how engaging we are with the patient, and are we providing services and exams, solutions, in a way that is received by them in a positive manner. Vendors do a really great job at making equipment that is based in technology, and it’s cutting edge and it’s state of the art. Fact, we’re going to see that next week at RSNA. You’re going to have two massive spaces filled with all of this radiology equipment, and I don’t think we’re going to see a single x-ray table that’s shaped like a human body. Now they’re all going to be flat and they’re all going to be hard and they’re all going to be cold, but humans aren’t built that way. Mammal cassettes are all flat. We’re smart people. I’m pretty sure we can make something that’s shaped like a human and that’s comfortable. And so, I don’t think we’re all there, but I think the idea that we are in this for the human beings that are coming to see us, that are choosing to have their care wherever they’re choosing to have their care, and we need to remember that, and we need to respect that and own it.
Tim Kelley:
You’re exactly right. You know, a year or so ago, Samsung came out with the new ultrasound table. It’s a complete, comfortable, basically lounge chair.
Michael Cecil:
Nice.
Tim Kelley:
For getting an ultrasound. And it just, when you see it, it’s remarkable that no one had built something like that before because it just makes perfect sense, and especially with the probes pulled down from above. So you’re not dropping them on the floor, breaking these very expensive probes, and it’s nicely done. But pulling the human element is pretty important.
Michael Cecil:
Exactly.
Tim Kelley:
So since you’re going to RSNA, my self-serving part of this, we’ll leave out, you can come right by our booth, and we can talk a little bit about that when you’re at the show, but I think there are some things we can help you out with, or we hope to, and … have a conversation.
Michael Cecil:
Perfect. Look forward to it.
Tim Kelley:
All right. Well, thanks for joining us, Michael. Greatly appreciate it.
Tim Kelley:
All right. Thanks for your time.
Michael Cecil:
Thanks for joining us today on Imaging and Teletech Innovations, brought to you by TeleRay. We hope you like this episode. If you have any questions or feedback, please don’t hesitate to reach out to us at info@TeleRay.com. Be sure to subscribe to the podcast so you don’t miss any future episodes, and stay tuned for more insights into Imaging Solutions and Teletech with TeleRay.
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