To improve healthcare, we must empower patients. In order to empower patients, they need to be able to access and download their own health information and medical imaging reports so that they can more effectively participate in and manage their own health care.

Enter the Blue Button Initiative. The Blue Button is a highly visible, clickable button that allows patients to download their own medical records and medical imaging files in digital form, from a secure website offered by their hospital, doctors, pharmacies or other health-related service. After downloading, they can study it, examine their file and share their records with their doctors or others as they see fit.

The Blue Button Goes Viral

The U.S. Department of Veterans Affairs (VA) first used the Blue Button logo on its patient portal in 2010. By clicking on the button, individuals could download their medical records in digital form. Since then, millions of Veterans have downloaded their personal health information.

Considered to be a resounding success, the Blue Button encouraged other federal and private organizations to get into the act. The Centers for Medicare & Medicaid Services (CMS) and the Department of Defense (DoD) along with private health plans, such as United HealthCare and Aetna, have embraced the Blue Button in order to make individual health care data readily available.

Blue Button +

Stage 2 of Meaningful Use requires that patients be given the capability to view, download and transmit their health data electronically. These requirements are fully aligned with the Blue Button goals of empowering patients to be partners in their health care through access to and use of personal health information. The Blue Button vision is constantly evolving and expanding to encompass a variety of technical solutions.

The Office of the National Coordinator for Health Information Technology (ONC) created Blue Button+ as an evolution of the Blue Button. They are collaborating with health technology vendors to make patient data and medical imaging secure, more accessible and interoperable. Blue Button+ uses direct protocols to securely transport health information from providers to third party applications.

Quite simply, to support Meaningful Use applications for patients, health data needs to be seamlessly transmitted when their record is updated. Blue Button+ makes this possible – by enabling patients to request past, real-time – and better yet – “on-going” sharing of their information.

What has been your organization’s experience with the Blue Button initiative – and – do you think we’ll see widespread adoption of Blue Button+?  I encourage you to share your feedback via a comment below.

To stay up to date on the latest medical imaging news and announcements, subscribe to this blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Achieving the picture of better health means focusing on the technology and services that can help make a healthcare organization run more efficiently than ever. Technology is integrating organizational complexities, connecting care teams and streamlining workflow. Enterprise imaging solutions give medical professionals the confidence to make those decisions that deliver better care.

No Clear Picture

But just what is enterprise imaging? There doesn’t seem to be a consensus on a true description. As one definition, enterprise imaging is a solution that archives and manages image data on behalf of the systems with which it interfaces.

According to who you talk to, this solution may fall into any of the following categories:

• A zero-footprint model so that the system can be accessed from any web-connected device, at any location.
• An Electronic Health Record (EHR), since Meaningful Use requires any imaging system to interact with patients’ records throughout the health system enterprise
• A fusion of all the current imaging technologies into one seamless system
• A Vendor Neutral Archive or PACS Neutral Archive that stores data in a non-proprietary format freeing patient data from individual silos

In attempting to bring clarity to the subject, David S. Mendelson, director of radiology information systems at Mount Sinai Medical Center says, “This is both an exciting time and a little bit of a confusing time for enterprises. Vendors have recognized that there is a need for and an emerging marketplace for ‘vendor-neutral’ archives that will handle not just radiology DICOM images, but all kinds of documents and images from multiple disciplines, everything from photos and light photography to pathology slides and ophthalmology images.”

Supporting PACS from multiple vendors is a real challenge for organizations today. From the clinicians’ viewpoint, having to access each system independently to see the complete patient imaging history is inefficient. From the administrative viewpoint, managing a separate PACS at every facility is not an effective use of resources. Building and maintaining disaster recovery into many individual systems can become difficult and expensive. In addition, image-enabling an EHR requires multiple costly integration points because the images are scattered across many isolated systems.

Cohesion is King

To Dr. Rasu Shrestha, Vice President of Medical Information Technology at the University of Pittsburgh Medical Center, the reality of true enterprise imaging is that cohesion is king. “It’s sometimes baffling to see that, as the industry tries to chomp away at the challenges of enterprise imaging in bits, what we truly need is an interoperable way to tackle the problems, to truly get us past the finish line.”

He adds, “The key to unlocking the potential of enterprise imaging is to define and build a more cohesive and interoperable approach to the needs of the enterprise at large while ensuring that they complement and aid in the demands of individual departmental workflows.”

Real cohesion would be a repository that simplifies enterprise-wide access to image information with a single point of distribution for image data, while supporting image data sharing between disparate healthcare systems.

What fits into your definition of enterprise imaging?  I encourage you to share your thoughts, via a comment below.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Dave Burda is editorial director of Better Thinking for Better Health, an online McKesson forum. Here industry leaders can exchange, discuss and debate ideas with the shared goal of maximizing the performance of the healthcare delivery system.  Recently, Burda had the opportunity to ask members of the healthcare community about their biggest financial and clinical challenges.

In the video above, representatives from organizations including PresenceHealth and Catholic Health Initiatives share concerns ranging from how best to maintain state-of-the-art medical imaging solutions, to how new federal regulations will impact patient care.

I invite you to watch Dave’s video above – and share more about the challenges your organization is facing via a comment below.

To learn more subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Employing computed tomography (CT) scans has both advantages and risks. CT has led to revolutionary enhancements in the diagnosis and treatment of many diseases, as well as nearly ending the need for exploratory surgery and many other invasive procedures. The risk involved is that a CT scan delivers 70 times as much radiation as a chest x-ray.

Measuring Lifetime Health Risk

Recent articles on the dangers of radiation exposure have focused on how CT increases a patient’s risk of developing cancer in his or her lifetime. In order to examine these dangers, lifetime risk metrics were employed in a recent study published in the online journal, Radiology. According to Pari V. Pandharipande, MD, MPH, who helped conduct the study, the lifetime risks of cancer from medical radiation may be given too much emphasis when compared to the patient’s current pressing health risks. According to the study, the immediate risk of death is a vital factor when taking into consideration the benefits of the exam versus the possibility of radiation-induced cancer in the future.

Timing of Risk Is Critical

Dr. Pandharipande argues that “This [timing] must be considered when physicians make medical imaging decisions for their patients because the timing of risks changes their relevance.”

While modern radiology information systems help improve physician decision-making, it is still up to the individual patient to assess the risk. Dr. Pandharipande adds that “Risks incurred later in life are not the same as those faced in the present. If you had to choose between the chance of incurring a serious risk now or later in life, most people would choose the latter.”

Overestimating Risk of Cancers Later in Life

The study forecasted outcomes in patients with testicular cancer who were undergoing CT exams after orchiectomy. It compared the loss of life expectancy from testicular cancer to life expectancy losses resulting from CT induced cancers with the purpose of quantifying the effects of immediate risk as opposed to future risks. In using these lifetime risk metrics, the researchers discovered that it can lead to overestimating the events that may occur later in life.

According to Pandharipande, more research needs to be conducted into patient and provider risk perception. “Radiation-induced cancer risks, often discussed at the population level, can be challenging to conceptualize and apply to imaging decisions that have to be made at the patient level. We as physicians can benefit from dedicated educational efforts to improve decision-making and better convey the risks to patients,” he concluded.

To stay up to date on how new advancements in radiology information systems are helping to support patient safety initiatives, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Is the Cloud Implying a False Sense of Security?

Placing the word “cloud” into a computing technology gives the uninitiated a false sense of unlimited space and infallible security. Well, not all networks are created equal. For teaching hospitals affiliated with a university, radiologists are most likely spoiled by the easy access to a high-speed university network. The assumption is that they can push medical images to the “cloud” quickly and with little thought.

Remember, medical imaging files are huge and measured in terabytes. When you send data outside the university’s walls, bandwidth speed slows way down. A busy radiologist, used to working through files quickly, will soon tire of the start and stutter of a slow connection. What’s acceptable on a smart phone won’t cut it in clinical practice.

We live in an age of speed with demands for more bandwidth growing every day. As a provider, you need to identify your true needs for capacity and storage, privacy and security. This is the time to be honest; can your IT infrastructure handle the cloud?

Are the Compliance Requirements of Moving to the Cloud Worth it?

Another important area of consideration when weighing the desirability of moving medical imaging into the cloud is regulatory compliance.  Are you able to comply with the implementation specs, federal HIPPA requirements and all their complexity?

For example, the Journal of the Medical Informatics Association issued their perspective on how to reconcile cloud computing with federal EHR regulations. The Security Rule alone contains 42 implementation specifications (table 2) that are “sufficiently broad and complex to elicit the publication of multiple articles and books that attempt to explain and simplify them,” wrote the author.

The impact of choosing cloud computing for medical imaging cannot be overstated. Whether you choose a cloud storage vendor or decide to bring the “cloud” in house, be aware of the full implications of this evolving technology.

Has your organization moved medical imaging into the cloud?  If so, please feel free to submit a comment below, sharing your experiences.

To stay up to date on the latest medical imaging news and announcements, subscribe to this blog via RSS feed or email, follow us on Twitter or like us on Facebook.

1. Mobile Devices. The 2nd Annual HIMSS Mobile Technology Survey published in December 2012 (available for download here) identified an increased use of mobile devices by medical professionals. Meanwhile, a Manhattan Research survey found that 62 percent of physicians used mobile devices in their daily practice last year, double the use from 2011. While 2010 may have been hot for the smartphone, in 2012 use of the media tablet heated up. Expect this trend to grow throughout the year, with goals rooted in more efficient patient care.

2. Vendor-Neutral Archiving. The use of mobile devices has led to increased collaboration across the enterprise, motivating the medical imaging industry to increase adoption of vendor-neutral archiving systems. Based on a December 2012 survey with input from 415 US hospitals, healthcare technology research and consulting firm CapSite found that one-third of the U.S. hospital market has adopted a VNA solution and that an additional 19 percent plan to introduce one in the next two years.

3. Speech-Recognition Tools. Speech-recognition tools have been in use for a number of years.  Per MGMA consultant Derek Kosiorek, their increasing use by physicians correlates to both increased EHR use and the heightened accuracy of the technology.

4. Clinical Analytics. Today’s EHR systems generate simple reports that don’t meet the demands placed upon providers from government mandates on interoperability and clinical performance. Most providers now realize that EHRs alone don’t meet their need for advanced analytics.

John Edwards, a director at Price Waterhouse Coopers (PwC) in comments about a recent survey they conducted stated that “In the clinical space, there was a belief that if you put in an EHR, all your problems of interoperability would go away. Evidence suggests that providers were realizing that the ‘silver bullet’ of EHRs needed to be enhanced with clinical informatics people.”

What trends do you see medical imaging systems contributing to, or helping to support, this year?  I encourage you to share your thoughts via a comment below.

To stay up to date on the latest medical imaging news and announcements, subscribe to this blog via RSS feed or email, follow us on Twitter or like us on Facebook.

In the final part of my interview below, we put our focus squarely on the patient, as we learn how all of medicine must work together to improve the cost efficiency of care, without sacrificing improvements to patient outcomes.

How do you see the new focus on improving patient outcomes impacting emergency medical care and/or reimbursements?

SS: Providers have always been interested in the outcome of their patients. Quality measures are simply one mechanism to assure that focus. As a patient care is now often quite complex, involving many well trained, intelligent providers, quality measures should never be developed by one specialty that involves care provided by another. Radiology should not dictate when medical images are preformed in the ED, nor should emergency physicians dictate timing for final attending interpretation of those studies. The development of these quality measures must incorporate all stakeholders.

The largest identified area of potential savings in healthcare is that spent on defensive medicine. Without safe harbor, clinicians will continue to order many tests in order to have a zero miss rate. Radiologists will continue to suggest advanced medical imaging of innocent appearing nodules in order to have their own zero miss rate.

Medicine, all of medicine, needs to work toward reforming our medical liability system so that screening tests with a very high sensitivity will be an acceptable standard of care. Unless there is safe harbor afforded those who follow established national guidelines for care, we will not be able to curtail utilization, cost and radiation exposure. Medical imaging, which plays a central role, would be a natural leader for such an effort.

Patient satisfaction is an important measure of quality and is now measured in nearly every department. Patients often present to the emergency department anticipating advanced testing and imaging. Many patients are sent to the emergency department by their PCP with specific instructions to have a CT scan or MRI. Others have been advised to have such testing by their friends or recent media reports. While the emergency physician may attempt to dissuade the patient from such testing, these attempts are largely unsuccessful and lead to intense patient dissatisfaction.

Emergency care interfaces with nearly all specialties of medicine. We have important outreach in the community through our ties with EMS. We have facilities that are staffed 24/7/365 that can be used to close the gap for patient follow-up. There may be cost savings to the institution to utilize our excess space during down times to see patients who cannot see their PCP. Under an ACO it may be prudent for all patients with acute unscheduled visits to be seen within the ED facility. Forwarding thinking institutions are incorporating ED leadership into care models in innovate ways.

What necessary evolutions in medical imaging have you seen, or expect to see come about, in response to health care reform?

SS: There will be increasing pressures to reduce cost, reduce radiation, improve patient outcomes and increase patient satisfaction. Two of these are possible, three difficult, but all four will be a challenge. Patients perceive extra value in visits that include testing, especially advanced imaging. There is an increased degree of patient confidence if the diagnosis is based on a CT or MRI. Equally important, advanced imaging does improve outcome. Appendectomy rates are down, thrombolytic treatment for stroke is only possible because of medical imaging, and countless lives have been saved because of imaging of a subarachnoid hemorrhage and pulmonary embolism. Trauma care has been significantly improved and countless unnecessary surgeries avoided because of rapid, highly sensitive CT scans.  But radiation is a serious issue for our future, particularly in children. MRI can be substituted in many cases, but at a much greater cost. The challenge for medical imaging is to retain the accuracy of its testing while reducing radiation and cost, and increasing availability.

Medical imaging is a critical part of patient assessment. In the future, this role will increase as our ability to detect and visualize disease increases. Forty years ago, grainy CT images of the brain gave us our first glimpse of cerebral bleeding. Now CT, MRI and PET scanning provide us evidence of the structure and function of the brain. It is likely that medical imaging in the future will help us identify some of the diseases we struggle with today, such as sepsis, mental illness and perhaps even pain. Advancing the care of patients will necessitate a collaborative approach to research and clinical care throughout all medical specialties. Radiologists and Emergency Physicians working together with mutual respect and transparency on a national and local level would be an important first step.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

While yesterday’s interview provided more context, the fact remains that emergency department overcrowding is an issue all the same.  And with the roll-out of health care reform, many expect it to continue to grow in severity.

In part two of my interview below, Dr. Schneider offers her take on how health care reform will impact our overcrowded emergency departments, and shares how better collaboration between the leaders of the medical imaging and emergency medicine fields can help to improve patient care in this new environment.

The American College of Emergency Physicians (ACEP) surveyed emergency physicians in 2011. The vast majority felt that the current crowding problem in the emergency department (ED) will be exacerbated if/when the new health law is implemented.

The Affordable Care Act is quickly becoming a reality and there remain a number of questions regarding how it will affect EDs, specifically and hospitals, in general. Can you elaborate on your belief that “coverage doesn’t equal access”?

SS: Massachusetts provides the best window into what will happen when the ACA is fully enacted. In Massachusetts, ED visits increased after the start of universal coverage. While there are many reasons for this, the literature would suggest that this occurred for 2 reasons.

First patients who were newly insured had chronic conditions for which they could now get care. This pent up demand has been seen internationally in countries which initiate coverage.  Secondly Massachusetts lacked the capacity within the primary care practices to see all these patients.

As more patients get insurance coverage through Medicaid and exchange products, PCP practices will likely saturate, and access for these new patients may be strained. If this coverage does not prompt primary care physicians to engage these new patients, there will be more ED visits. Primary care providers and urgent care centers can limit their practice to patients with private insurance, which reimburses at a better rate than Medicare, Medicaid or any state run program. Coverage does not equal access.

There is also an increased tendency for patients to seek care. More conditions are being treated, there is more elective surgery and many patients’ lives are improved by this increase in care. Interestingly England recently attempted to control ED costs by building a large number of urgent care centers to offload busy EDs. However they found that ED visits continued to rise, and urgent care visits rose, and now they were simply providing more care, at a greater cost.

In discussing health care reform, cost savings and patient care seem to exist side by side.  How can medical imaging technology lead the way in helping to improve patient care in a cost-effective manner?

SS: There needs to open and honest dialogue between the leaders of medical imaging and the leaders of emergency care. We need to work together to understand the needs of our patients and our workforce. We should examine new models of care, together. And we should invite to the table all of the stakeholders.

Recently quality measures were developed by the American College of Radiology and the AMA which included several specified for the ED. The input from the emergency medicine community was very limited. The entire process is now being revisited.  Quality measures that involve imaging of emergency patients should have equal representation and input from both imaging science and emergency providers. In addition, other specialties should be at the table when appropriate, such as trauma, neurology, etc.

Guidelines for medical imaging should extend to outpatient practices as well as the ED to avoid a shift of services without a decrease in cost or utilization. The conversations should be transparent and collaborative, and the focused on the patient.

Read the third and final part of my interview with Dr. Sandra Schneider tomorrow to learn more about the evolutions to patient care and medical imaging technology that will be crucial in our new healthcare environment.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

But is emergency department overcrowding a cause – or a symptom – of something larger?  And whether emergency department overcrowding is a cause or a symptom, how can healthcare organizations use new technology, including medical imaging, as a cure?

For answers, we turned to Dr. Sandra Schneider.  An emergency medicine specialist, Dr. Schneider has been recognized several times for her leadership and service to the field of emergency medicine.  A current professor in the Department of Emergency Medicine at the University of Rochester Medical Center, Dr. Schneider is also a past president of the American College of Emergency Physicians (ACEP.) Her views are based on her experience visiting emergency departments across the country.

In part one of my three part interview below, Dr. Schneider helps identify the root cause of emergency department overcrowding, shares how medical imaging technology can help to reduce the impact overcrowding can have on patient care, and helps to dispel some commonly held health care cost myths.

What role can medical imaging play in reducing hospital emergency department overcrowding?

Dr. Sandra Schneider: First of all, it is important to note that hospital crowding is the primary cause of emergency department crowding. It has become routine for hospitals to ‘board’ inpatients who are waiting for a bed in the emergency department. Because of tight finances, hospitals try to approach 100% occupancy. They may shut down (‘brown out’) inpatient units because of staffing shortages.

As the Emergency Department serves as the primary entry point for most medicine admissions, admitted patients remain for hours or even days (in some cases a week or more) waiting for a bed. Statistics show that boarding inpatients is common in 70-94% of hospitals and is particularly severe in urban settings. In some settings, boarders may routinely occupy 40-50% of ED beds. In some hospitals, when ICUs are full, inpatients currently in a floor bed may be brought to the ED if they deteriorate. Boarding inpatients is associated with delays in care for all patients in the ED, increased adverse events, and an increase in mortality and morbidity.

It is true that public hospitals often see patients who seek care for non-urgent conditions. Nationally we know that the CDC has identified that 8% of ED patients have non-urgent conditions (defined as needing care within 12-24 hours.) However 2/3 of these patients seek care after hours and on weekends, times when traditional medical care is not available. While urgent care centers offer an alternative, most will not accept patients without insurance or those covered by Medicaid because of low reimbursement. Many providers will not accept patients without insurance or those with Medicaid, again because of reimbursement. These patients have nowhere else to receive care, particularly on a weekend. Increasingly providers are even limiting the number of patients covered by Medicare that they will treat. The ED, which under Federal law must see all patients regardless of coverage, remains the only means of medical care for these patients. This Federal law is an unfunded mandate and a factor in the finances of nearly every emergency department.

Medical imaging plays a large role in overcoming several aspects of crowding. First, increasingly imaging helps us avoid admission to the hospital. Appendicitis is a great example. In the past it was appropriate for 30-50% of appendectomies to be performed on a normal appendix. Now that number is likely <10%.

The number of medical images ordered through the ED has skyrocketed. In part, this is because imaging provides more definitive answers (rules in or rules out disease.)  In addition, many physicians see the ED as a portal to rapid testing. They can get same day results AND any necessary consultation for patients. ED has come under criticism for ‘ordering too many tests’. Some of these tests undoubtedly could be scheduled as an outpatient. However, few institutions have the ability to schedule patients after hours and fewer still can provide next day service.

It is important for the emergency physician, who is likely seeing the patient for the first time, to have rapid access to a patient’s history and previous test results. Emergency physicians need access to all recently acquired advanced imaging, whether it was done on site or at an outside facility on a 24/7/365 basis. In addition to preventing unnecessary repeat testing, this information allows the emergency physician to calculate and control the amount of radiation exposure of the patient.

Finally, ED efficiency is all about throughput. Unlike inpatient services, we monitor our care in minutes. Rapid turnaround time is critical, but so is having a formal final interpretation of medical images, particularly the more complex studies. To the extent that medical imaging can be done rapidly and the final interpretation by an attending radiologist can be available rapidly 24/7/365, emergency department flow can improve and length of stay can be reduced. Clearly there are issues for the radiology department which must manage multiple demands. In addition, in a field that is rapidly subspecializing, it is difficult to have an attending neuroradiologist available at all times. However, both patient safety and ED efficiency demand just that.

What are some ongoing efforts you’re making to educate people about when to seek emergency care?

SS: We feel patients should seek care when they believe they need it. We believe that all patients should have a PCP who is familiar with all aspects of their physical and mental health, and coordinates their care. We believe that the Patient Center Home Model will benefit those that can access it. However, we are concerned that a significant portion of the population will be unable to access that care, at least until there is greater capacity in primary care. We believe that good primary care, coordinated care for patients with chronic illness, and access to resources for all patients regardless of coverage will not only decrease ED visits, but will provide a cost savings and greater quality of life.

ACEP is a strong advocate for the Prudent Layperson definition of appropriate use of the ED. This definition is now part of the Affordable Care Act. Unfortunately many studies looking at appropriate use of the ED base their assessment on the discharge diagnosis, rather than the chief complaint. Until recently chief complaints were not coded and therefore not available in large insurance databases.

In addition, many authors have erroneously used the Billings Criteria for appropriateness, which Dr. Billings carefully states in his paper is not valid. When the discharge diagnosis is used, patients who come to the ED with chest pain and sent home with a diagnosis of GERD, are deemed to have used the ED inappropriately.

ACEP has developed patient education materials, many of which are available on EmergencyCareForYou.org. We provide a regular national radio show for both the public and emergency care workers covering topics that inform the public when to seek emergency care. Recently, the Washington State Chapter of ACEP has been collaborating with several other groups in their state to reduce the cost of emergency care. Their programs involve an integrated approach to patients who use the emergency department frequently and a network that allows providers access to pharmacy records. The very early results of this program suggest they have been successful in reducing costs.

Some EDs do care coordination centered within their department, while others have utilized the 24/7 availability of paramedics to monitor chronically ill patients in their home. The medical directors of many poison centers are emergency physicians. Over the past few decades their work has dramatically cut the incidence of childhood poisoning.

ACEP and emergency care workers have also developed public education programs for diseases where time-sensitive treatment is life saving. Media programs have highlighted emergency physicians discussing the early warning signs of stroke, myocardial infarction and sepsis. Rapid intervention in these diseases not only saves lives but improves the quality of life of the survivors.

Many EDs have fast track or urgent care centers embedded within the department. These function like urgent care centers in the community except that they see all patients regardless of coverage. While there is no obligation for the ED to treat non-urgent patients after initial assessment, deferral of care from the ED often is more problematic than there is cost savings. And without community resources to care for these patients, refusing to treat these patients who then have no other source of care is morally questionable, and in the long run likely increases costs.

There is a misconception that large amounts of money are wasted on these ‘unnecessary’ ED visits, and that the savings could be huge. The fact is that ALL of emergency care in this country represents just 2% of the total cost of health care. Again the CDC has identified that only 8% of patients have conditions that can wait, but only 1/3 of those occur during traditional business hours. We cannot count on the reduction of ED visits to save our healthcare economy.

Read part two of my interview with Dr. Sandra Schneider tomorrow to learn more about the impact the roll-out of health care reform will have on emergency department overcrowding.

To learn more about medical imaging and other related topics, subscribe to the Medical Imaging Talk blog via RSS feed or email, follow us on Twitter or like us on Facebook.

Measuring Efficiency Using Key Performance Indicators (KPIs)

According to Chang, radiology lags way behind other business models in the use of BIA, which includes dashboards, scorecards and other key performance indicators (KPIs). A KPI helps measure if you’re improving your processes, efficiencies and adding value to the product or service you provide.

Dashboards indicate whether you’re on target with respect to established goals. Picture Archiving and Communication Systems (PACS), Radiology Information Systems (RIS) and Electronic Medical Records (EMR) make it far easier for radiologists to do their job, but they don’t always measure the efficiency of their actions. BIA extracts information from medical imaging systems and organizes it into dashboards, graphical elements, etc., to demonstrate ways to improve workflow.

For example, providing a dashboard for report turnaround time can help keep the radiologist on a time track and is a KPI worth measuring. If he’s taking too long on an image or she’s taking too many breaks, a red light indicates that they are falling short of the projected goal. A green light means that they’re working efficiently and are on track.

Chang explains that strategic and tactical tools are “a must” in medical imaging if you want to identify whether you’re doing what you need to be doing operationally, 24/7. In addition, you must be able to measure if you’re adding value to your hospital, your patients and referring physicians. Chang views measuring efficiencies as a way to win both the battle and the war.

Staying on Track with Workflow Requirements

Quality indicators are additional KPIs that may need to integrate information from various departments. At the University of Chicago, Chang helped implement a pilot program that applies workflow improvements to scanning equipment. “The CT scanner programs itself,” he said. “The injector programs itself. After the scan is done, it knows about all the post-acquisition workflow requirements — sending stuff to PACs and 3D work stations, notifying transport.”

“These efficiencies are realized as improvements not only in radiology, but also length of stay, hospitalization, throughput in the clinics. We were able to realize about a 66- to 70-percent improvement in cycle time in our CT scanner by automating procedures that originally were done by humans,” he added.

How has your organization adopting, or how is your organization planning to adopt, business intelligence analytics for radiology?  I encourage you to share via a comment below.

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