Case Studies in Radiology Efficiency

You're facing growing regulatory requirements and an ever-expanding volume of patient images as your patient population balloons. If you're going to stay afloat, the name of the game is clear- efficiency.

But, the question is, what's the best way to streamline your workflow while trying to balance all your responsibilities and concerns? One popular industry answer is information technology (IT) tools. IT advancements have been a hot topic in radiology for most of the decade, and now, the industry is seeing greater software and hardware adoption to smooth out daily work.

They might create a direct channel between you and your referring physicians, make recording findings easier, or enhance your ability to access a patient's prior records. Whatever the case, you'll know you've maximized these tools' utility, said Vijay Rao, MD, professor and chair of radiology at Thomas Jefferson University Hospital (TJUH) in Philadelphia, when you're positively impacting patient care.

"The goal is to streamline workflow to provide high quality services and enhanced patient safety," Rao said. "The strategy is to standardize practice and reduce variation by leveraging IT tools."

In most cases, improved workflow means increased automation. But any tools implemented must offer increased efficiency, quality, or value. If they don't, they should be avoided, according to expert opinions.

Communication is Key
The stronger your ability to communicate with your colleagues, the better the experience will be for all parties involved. This includes maintaining quick and direct access between you and referring physicians, as well as sharing details about studies as soon as they become available.

TJUH created a virtually real-time communication conduit. According to Rao, the hospital developed an app, called Radiologist Locator, that allows residents and referring physicians to contact an on-call radiologist immediately with questions. The process is simple. They log into the app and a list of names and cell phone numbers pops up. They select one and make a quick phone call for a consultation.[[{"type":"media","view_mode":"media_crop","fid":"61252","attributes":{"alt":"Efficiency in radiology","class":"media-image media-image-right","id":"media_crop_1460041722324","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7747","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 220px; width: 200px; float: right; border-width: 0px; border-style: solid; margin: 1px;","title":"©Max Griboedov/Shutterstock.com","typeof":"foaf:Image"}}]]

"It's an efficient way for referring physicians to get an opinion on whether the study they think they should order is appropriate," she said. "It can save time and work for the house staff."

In addition, she said, the hospital uses the communication tool Primordial, integrated within its PACS and electronic health record system, to prevent any patients from falling through the cracks. For example, if a patient is due for a 6-month follow-up visit based on imaging findings, Primordial will pop-up a screen alert, prompting you to ask his or her primary care doctor if that appointment has been scheduled. If appropriate, you can also reach out to the patient yourself.

Feedback Leads to Improvement
Whether you work in an academic medical environment or in a community setting, you can improve your workflow by giving evaluations to those who also provide patient care.

"Unless you educate and provide feedback, you will see no improvement among those who take and read images with you," Rao said.

This type of analysis isn't necessary with every case, she said, but it can be helpful for technologists and residents who are still learning the ropes. To help residents, TJUH developed a tool called Report Comparator. After a resident completes a report, the attending radiologist reviews it and records any changes within the tool. The resident receives the revised report as educational feedback.

Faster Turnaround
With an increasing patient volume, having a system in place to help you work through your reports faster can be beneficial. In these cases, a RIS/PACS reporting system integrated with your electronic health record, such as Epic's Radiant, can be helpful. Once logged into Radiant, Epic recognizes you and automatically brings up your work list, as well as the relevant patient's record. When you sign off on a report, the next case automatically pops up, keeping your workflow uninterrupted.

According to Tessa Cook MD, assistant professor and director of the Center for Translational Imaging Informatics at the Hospital of the University of Pennsylvania (HUP), this type of tool facilitates the feedback loop between patient, referring provider, and radiologist.

The University of Chicago's Clinical Context Indicator tool also helps with faster -- and more detailed -- turnaround. Connected to the electronic health record, this tool pulls a patient's health conditions and lab results into the PACS, allowing the radiologist to create a more complete, actionable report.  

Standards & Guidelines
Standardizing the way you work has been an industry goal, and now, technology is starting to catch up.

Having industry-wide terminology is one of the best strategies to do this, Rao said. Currently, radiologists in different health systems use multiple terms to refer to the same findings, which complicates sharing and mining image data. Getting everyone on board to change how they record results is a large undertaking, but there are tools at your disposal.

The RSNA Reporting Initiative has worked with subspecialty societies and groups to create templates designed to make reporting easier throughout diagnostic imaging. Today, you can download these templates in 20 subspecialty areas for free at the RSNA's site, www.radreport.org.

Other tools are also streamlining template reporting. In partnership with Philips Healthcare, the University of Chicago created the Lesion Tracker. It automatically sends reference lesion measurements from previous and current studies directly to you via your PACS. HUP created a similar tool for ultrasound measurements. It pre-populates template reports sent to radiologists with the measurements technologists record, reducing the number of measurements that must be transcribed.

The ACR also offers help with determining appropriateness with its ACR Assist tool. This real-time, vendor-neutral clinical decision support tool uses structured classifications and "RADS" languages to simultaneously create reports and provide you with evidence-based guidance.

One Health System's Experience
For Ohio's Marion General Hospital, streamlining workflow meant replacing the PACS.

"We needed to shift from the IT standpoint," said John Wiggins, the hospital's technical services manager. "We needed more storage and a better migration system for our data."

Additionally, Marion's radiologists requested enhanced voice recognition capability that didn't require extensive training, as well as better integration with patient demographics and history.

After a roughly year-long search involving eight vendors, Wiggins said, the hospital selected Carestream Vue Motion, a vendor-neutral image viewer. Alongside meeting the above-mentioned requirements, this viewer provides report templates and lets radiologists track and analyze tumors and access previous studies quickly.

"It had been so cumbersome to try to track patients, to look for multiple measurements, and do continuous monitoring," he said. "That's why there was a need for a tool to automate this for us."

To date, he said, the hospital has experienced improved data migration, mobile accessibility, and improved image sharing with other hospitals.

The Workflow Impact
Ultimately, Rao said, radiologists need workflow IT tools for greater efficiency both in the short-term and long-term.

Integrating these tools into your daily routine will improve the consistency of the reports you produce. You'll have reduced variation, and you'll have confidence your findings and any consultations you provide are rooted evidence-based guidelines. Greater efficiency also lowers cost by eliminating inappropriate studies, and it augments patient safety by reducing radiation exposure from unnecessary, repeated studies.

The over-arching benefit, though, comes when you see the value of workflow tools on the horizon, she said.

"With all the talk about adopting personalized medicine and the need for precision imaging, we need structured reports, assistance with evidence-based guidelines, and tools that help us track patient information," Rao said. "These may sound like minimal changes, but it's a radical shift in radiology because it requires us to adapt the way we create reports. But, this is where medicine is going."