Diagnostics and Telemedicine Center, Moscow

The foundations for URIS were laid in 2012, during a large-scale modernization of Moscow’s healthcare services. “Hundreds of CT and MRI scanners were purchased for and installed in the primary care and out-hospital facilitie. Previously these modalities were mostly available only in hospitals,” describes Professor Sergey Morozov. “The mission was to make these types of imaging more accessible to patients, in a cost-efficient way, through the outpatient primary care and out-hospital facilitie. The success of this approach has enabled us to launch other key initiatives since then, such as a lung cancer screening program and an MRI prostate screening, to name only two.”

Very soon after the installation of the new modalities, discussions began on how to connect them within a unified information system. “This would offer clear and necessary benefits, including overall standardization, increased efficiency, efficiency metrics, and harmonized workspaces and workflows for radiologists and technicians,” Professor Morozov continues.

To enable this connection, AGFA HealthCare’s Enterprise Imaging platform was selected. Professor Morozov: “We needed a solution that could work as a radiology archive, and provide advanced tools and workflow automation for radiologists and referring physicians. It was very important to select a vendor that delivers the highest international standard for enterprise imaging. But we also needed the possibility to scale in the future, especially in terms of adding many more modalities. So when I became chief radiologist of Moscow in 2015, I was very pleased that AGFA HealthCare’s Enterprise Imaging had become part of the URIS project in 2014.”

The task-based workflow management is a key functionality in Enterprise Imaging for each radiologist on the platform. It adds value not only for the radiologists, but also for technologists, referring physicians, patients and the healthcare system overall. “Worklist management based on automated task assignment enables us to distribute studies among our radiologists, based on subspeciality rather than location. Every study is thus reported by an expert in that subspeciality, not, for example, the radiologist who happens to be in the hospital or primary care and out-hospital facility on that day.”

This distributed way of working has had several very important benefits for radiologists across all locations, he continues. “Firstly, we can reduce second readings, because every report is already an ‘expert’ report. Secondly, radiologist satisfaction has increased, because these professionals are working with their familiar studies and pathologies.

Furthermore, as the radiologists have the specific knowledge needed for the studies they are working on, report turnaround time has drastically improved. Five years ago, it was five days. Now it is on average less than one hour! This is a very important metric for patient care quality, as it means the referring physician and the patient have access to the diagnostic information much more quickly.”

Other functionalities enabling a more comfortable and efficient workflow for radiologists include the ease of switching from one working place to another, and helpful tools such as hanging protocols.

The centralized, standardized platform was also key to enable the launch of the Moscow Reference Center for Radiology (MRC): the first teleradiology center created as part of the public healthcare system. Opened in 2020, it now has 96 radiologists remotely reporting some 25,000 imaging studies each week and plans are to grow the number of radiologists even further.

Radiologist productivity has doubled with the MRC, Professor Morozov explains. “Around the clock IT support, dedicated workstations with diagnostic monitors and automated worklist management provide the radiologists with an environment that is very conducive to efficiency. In fact, because radiologist productivity has doubled, we can make the same number of reports with half the radiologists.

Not only is this more cost-effective, but it allows us to provide additional specialized training to upgrade the radiologists’ skills. We can also deliver more and better services to remote locations. Russia is a huge country, and it is not possible to provide an expert radiologist for every CT machine. But by connecting those devices to the digital infrastructure, we can increase the reach of this critical imaging insight to more patients, and remotely report the studies. ‘Expert As A Service’, in a way.”

Beyond the centralized reading and reporting services at the MRC, the digital infrastructure and unified platform have enabled a standardization and harmonization of radiologist workplaces in every hospital in the city. “This allows us to smoothly transfer images from the primary care and out-hospital facilities to the hospitals, which reduces repeated studies,” describes Professor Morozov.

The XERO universal viewer plays a key role, providing “anywhere, anytime” access to the patient’s imaging record – not only for the radiologist, but for all stakeholders. “Radiologists might use XERO to quickly and remotely check a patient study that requires specific attention, for instance. And in the future, I am convinced the XERO functionality will be an important step in truly freeing radiologists from their physical locations,” he explains.

As new service lines have been connected to the digital infrastructure, other specialists have been increasingly making use of the functionalities, as well. “When we connected the angiography devices, vascular surgeons began using the platform to inform about their decisions regarding operations on stroke and myocardial infarction patients, for example. Traumatologists and ENT surgeons also use it, to check CT, MRI and X-ray results.”

Private PET-CT centers such as those specializing in oncology imaging are also connected, giving referring oncologists at the hospitals access to the PET-CT scans taken at those private centers. And with XERO embedded in their electronic health records, referring physicians can directly check patients’ images: in the last year, nearly 10,000 did so.