Radiology

Article – Radiology Staffing: How to Do More with Less

dondennison Radiology , , , ,

A lot of people are talking about using analytics to make operational improvements (read as: lowering costs while improving quality of service), but this article describes some specific ways to do this within a Radiology practice.

Examples (from the article)…

  • Use actual procedure data to determine the specialty needed, as well as the number of staff needed in each facility/location. It also helps determine if full-time or part-time staff are needed.
  • Adapt the daily shift schedule based on hourly exam volume peaks.

The article also explains how technology is used to improve efficiency…

  • Cloud based image sharing, integrated with PACS, to distribute reading of exams among distributed Radiologists.
  • Shared worklist across facilities

Article – CPOE use can reduce unneeded CT scans

dondennison Radiology , , ,

Not a mind-blowing revelation, but when doctors are told that the information they want already exists, they don’t order more tests (usually).

And while the results of the study summarized in this article reflect only a small decrease in new CT exams being ordered (“physicians canceled orders after receiving the alerts about 6 percent of the time, making for a net cancellation of 1.7 percent of studies. In a control group, physicians canceled only .9 percent of alerts.”), every bit counts.

And it reduces the radiation the patient receives, as well as helps keep the Radiology schedule free for really important exams.

A goal to simply reduce the number of exams performed is misguided. This blog post summarizes a proposed model to help separate the necessary from unnecessary exams.

Article – The 8 RIS innovations you need now

dondennison Healthcare IT , , , ,

Here is a summary (note: may need to register with site to access) of some RIS (Radiology Information System) innovations that providers should be looking for.

Sneak peek…

  1. Digital dashboards
  2. Electronic medical record aggregation
  3. Clinical decision support
  4. Critical results reporting
  5. Customer service
  6. Technologist feedback
  7. Peer review
  8. Data mining, surveillance, and outcomes

I am working on an article on how (and why) RIS and PACS will be deconstructed and will not exist (as we know them today) in the future. Stay tuned for that.

Article – Report Offers System to Separate Useful and Wasteful Imaging

dondennison Radiology ,

In this article, the authors describe a simple classification system for defining different types of additional imaging exams. Too often, additional imaging is deemed wasteful, so having a model to separate the necessary from unnecessary is a good idea.

The model excerpted from the article…

  • A supplemental image — many of which are medically necessary — would occur during the same clinical encounter but utilize a different modality, such as a non-contrast CT scan and a renal ultrasound to identify kidney stones.
  • Duplicative images involve the same modality during the same or subsequent clinical session. These images are taken for a variety of reasons, including the unavailability of previous scans or a change in the patient’s condition.
  • Follow-up imaging can involve the same or different modalities during later clinical meetings, such as repeated imaging in cancer patients to verify there’s been no relapse of disease.
  • Unrelated imaging — scanning of the same body area with any modality — is often an unforeseen event. For example, in its paper, HPI discussed unrelated imaging in a woman who had CT screenings for breast cancer staging two weeks prior to a car accident that prompted identical scans.

Q&A – 10 Questions with Tessa Cook, MD, PhD

dondennison Radiology ,

Check this out. I know Tessa from my work on the SIIM board. I greatly respect her positive attitude. It’s one of things that makes SIIM great.

Blog – Bundled Payments Could Short Change Radiology

dondennison Policy ,

In this blog post / article, Dr. Douglas G. Burnette Jr. expresses his concerns over Radiology reimbursement cuts, and bundled payment in particular. Provides a good perspective of how those affected by policy are feeling these days.

Article – Survey finds growth in use of department dashboards

dondennison Radiology

This article has some stats from a survey on the use of dashboards in Radiology.

Some key stats…

  • 62% of the respondents used dashboards for managing accessibility, financial, and productivity indicators; of these…
    • 50% started using dashboards < 2 years ago
    • 10% had used dashboards for > 10 years
  • 73% of departments used their RIS (only) as the source of data, 6% from their PACS (only), and the remainder from both the RIS and PACS
  • 35% viewed productivity metrics more than once a month, only 8% viewed the information daily
  • Most commonly viewed access metrics: department turnaround time and patient backlog were the most frequently used
    • 50% regularly reviewed transcription times
    • 60% were interested in the time from preliminary findings to report finalization and sign-off
  • Most commonly viewed financial metrics: reporting revenue, actual expenses compared to budgeted expenses, and the number of days that billable exams were in accounts receivable
  • Most commonly viewed productivity metrics: total examination volume, volume per modality, and productivity performance by radiologists and technologists

Article – ARRS: Facial photos curb wrong patient errors

dondennison Healthcare IT ,

This is an interesting study.

Providing patient pictures were found to significantly improve the Radiologist’s ability to detect that images had been associated with the incorrect patient.

I have heard of the idea of using pictures to ensure the correct patient is involved in a procedure or treatment (when the patient is actually in front of you), but not in the diagnostic image review process. It would probably make sense to ensure that the patient picture was available in the EMR, and that the EMR was available (in context of the patient) at the PACS client—that way, even non-PACS users would benefit.

Article – Patient Steerage Could Harm Radiologists, Confuse Patients

dondennison Radiology , ,

This article explores the trend of “patient steerage”—a practice of payers directing patients to lower-cost imaging providers.

Some thoughts…

  • The article also touches on the idea of patients with high-deductible insurance plans, and awareness of costs, steering themselves to lower cost options. How long until consumer-driven review web sites rating costs and quality (like a travel review and booking site) become ubiquitous? The site could even broker the scheduling across involved facilities, like a travel site does this for airlines.
  • The frequent mention of quality of service as a method for imaging providers to differentiate themselves ties into the blog post I did on the SIIM web site here. The ability to offer services at a lower cost ties into my commentary on Productivity.
  • This trend could have another implication on the management of results. Often, referring physicians will refer to an imaging provider that not only provides quality of service (summarized in the article as “scan quality, turnaround time, communication with referrers and patients”), but convenient results access. So, I might send my patients to Imaging Provider A because they provide me with a secure portal to access the report and images, and send me notifications when the results are available. If my patients are steered to an imaging provider with lesser capability (just faxes reports out), I would not be as productive (or happy). If patients are steered to several imaging providers in the area, how results are accessed may vary significantly from one exam to the next. Referring physicians in regions that have an operational HIE, capable of managing both reports and images, and providing a so called “EMR Light” portal function will likely experience less of a negative impact from patient steerage when accessing results.

Article – Enterprise Imaging: Beyond Cloud-based Image Sharing

dondennison Healthcare IT , , , , , ,

Read this, seriously.

Some thoughts…

  • I agree with most of what the article covers. I believe that Radiologists will be more consultant than owner of the Enterprise Imaging (EI) platform.
  • One topic that is not covered is the informatics around the metadata to collect at the time of capture. DICOM and IHE provide guidance as to what metadata we want to capture and include when doing a CT exam, but what needs to be captured when a clinical images are captured and stored is far less defined (though this will evolve as EI is adopted). Hopefully, we can start defining this by using some standard lexicons and codes (like SNOMED CT), as these are more mature now than when we started defining metadata values for traditional radiology modalities.
  • There needs to be close attention paid to the indexing of metadata in the EMR and the EI platform; more than is traditionally done when doing a basic EMR and PACS viewer integration. If an HIE is in place or planned, this also needs to be considered. Not all systems will be capable of managing all the desired metadata (including unique identifiers).
  • The EI platform should be considered a component of the EMR and managed as such–don’t put EI in your radiology PACS; just don’t.
  • We need to develop EI professionals through education and shared experiences, if we want to succeed. I may be biased, but I believe that SIIM is one of the organizations well-positioned to provide this. Check out my two-part blog post (part 1, part 2) on the SIIM web site.