Tools to Improve Radiology Efficiency

Imagine opening up your PACS system at 8 a.m. to see someone has hand-picked studies for you to read, putting them in order of urgency. Or, you bring up a CT scan and a list of suspicious detections is included. Maybe your diagnosis comes with a ready-made Next Steps list.

Sound familiar? It might. It’s what’s occurring in radiology practices nationwide. Smart tool talk has become smart tool use, and the results are trickling in. The majority consensus, so far, defies earlier fears. Smart tools are being considered a boon for radiology that will continue in the future.

“We’re headed to a place where radiologists can spend more time doing what they’re trained to do with diagnoses and recommending next steps,” said David Hirschorn, MD, who serves on the ACR Commission on Informatics. “They can focus on those things instead of spending so much time trying to detect findings in the first place.”

This type of technological growth is necessary, he said, because hospital and health system consolidation is continuing steadily. Smaller, independent, and community hospitals are disappearing. Consequently, to meet the needs of larger, more complicated facilities, radiologists must develop more efficient workflow strategies.

Smart Worklists
Fewer things can slow you down more than an unorganized, overcrowded worklist. It impedes your turnaround time and affects the quality of care you provide. The longer you search for studies that fall under your subspecialty purview, the less time you can devote to detection and diagnosis.

According to Stephen Willis, chief technology officer for Canopy Partners, a healthcare medical imaging company, a smart worklist sidesteps these issues by automatically organizing studies by subspecialty and prioritizing them by the most severe or timely cases. Every time you log in to read studies, you only see the ones you’re most qualified to read.

In many instances, he said, the time savings are significant. And, that’s been the case for Canopy partner Greensboro Radiology in North Carolina.

“The first week, the new worklist was clean at 4:30 p.m. instead of radiologists being buried, trying to clean it up,” he said. “It was all based on getting the right study in front of the right radiologist.”

Initially, the worklist, produced by Clario, prompted fear. Radiologists worried the tool would strap them to the reading room all day. Instead, Willis said, they’ve been freed up to consult with referring physicians more and answer questions. In fact, the 70-radiologist practice has seen a 15% increase in efficiency since implementing the tool in 2015.

Workflow Orchestration
As a next step, Hirschorn said, your practice could consider workflow orchestration. It goes beyond the worklist, bringing together your PACS, dictation software, quality improvement tools, scheduling, and EMR. Together, they give you a more complete picture of a patient’s history, making it easier for you to present the most accurate diagnosis.

“A good workflow orchestrator will interface and bring down the essential elements of interest to the radiologist,” he said. “The EMR sifts through the data, pulling out what’s pertinent, so the radiologist doesn’t have to slog through it all.”

For example, he said, if you’re reading a chest CT, this type of smart system extracts and sends you information about a patient’s smoking history and any previous lung screening results.

Like a smart worklist, workflow orchestration balances workload and prioritizes studies, but it can also alert you when studies are overlooked. Additionally, it paves the way for enhanced communication between you, your technologists, and your schedulers.
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Some practices and departments, including the Medical College of Wisconsin (MCW), also use orchestrators, such as Conserus Workflow Intelligence, to facilitate peer review. To help residents learn, said Greg Holl, MCW’s radiology informatics system manager, attending providers use the orchestrator to track and analyze diagnostic discrepancies, routinely discussing mistakes as educational opportunities. The department also uses the system to highlight outstanding performances.

Overall, the peer review results contribute to the Physician Report Cards the department chair uses in his individual discussions with providers, he said.

Artificial Intelligence
The biggest step forward with smart tools is the move toward artificial intelligence  and machine learning. The technology is still young, but the University of Virginia Health System is currently testing AI software, produced by Carestream, for your PACS.

In addition to flagging musculoskeletal studies with abnormalities and alerting you when your PACS launches, Hirschorn said, this smart tool also includes algorithms that can determine bone density via CT scans, identify lung lesions, and pinpoint fatty liver filtration.

Even with these capabilities, he said, AI can’t make a diagnosis on its own.

“AI can detect and bring findings to a radiologist’s attention,” he said. “But, the radiologist can still agree or disagree. It’s up to the radiologist to take the interpretation further or decide whether to follow-up with the patient.”

Radiologist Reaction
When smart tools, such as computer-aided detection, first appeared on radiology’s scene, reactions were mixed. Radiologists were simultaneously excited about tools that could streamline workflow and anxious about whether the same technologies would slowly usurp the provider’s responsibilities, eliminating the need for their services.

Now, several years later, radiology is still the master of technology.

“The industry is nowhere near the point of replacing the radiologist,” Hirschorn said. “It doesn’t even make sense that that would be reality.”

Instead, he said, smart tools are being used to augment and supplement what radiologists do. And, the benefits extend to both large and small practices alike. Larger practices gain from workload balancing and from ensuring the right providers see the right studies. Smaller practices see positive impacts when the EMR plays a significant role in the smart tool system.

But, smart tools can also help smaller practices grow if they’re used properly, said Vikram Krishnasetty, MD, vice president of body imaging and clinical director of information technology for Columbus Radiology in Ohio. By implementing Clario’s worklist, the practice streamlined their workflow, opening up capacity for the practice to read more studies and serve more facilities.

In fact, Krishnasetty said, without the worklist, the practice would’ve likely remained a smaller 25-radiologist practice.

“If we didn’t have this tool, I really don’t think we would’ve been able to grow to this size,” Krishnasetty said. “It wouldn’t have been technologically feasible or efficient.”

Instead, to fulfill the demand, Columbus Radiology started hiring, and today it’s a 115-radiologist practice.

Barriers
But, positive results don’t mean all roadblocks have disappeared, allowing for widespread smart tool implementation, Willis said. However, proper preparation can successfully address most resistance.

First, he said, not every tool is designed to function the way radiologists prefer to work. Discuss your specific needs with your smart tool vendor to solve this issue.

Second, changing how your practice manages its workflow requires transparent conversations. Encourage your partners and colleagues to test the technology and ask questions.

Last, Krishnasetty said, pivoting toward smart tools is a culture change. Older radiologists are more apprehensive about using new technologies than younger providers. It means fundamentally changing how they’ve practiced for years, potentially decades.

No matter what, he said, embracing these technologies will be a positive step for the industry.

“We’re not too terribly far off before we see radiologists really beginning to appreciate smart tools,” he said. “It will help them create better results.”