Radiology Practice: The Answer to Managing IT Complexity

Mission-Driven Efficiency 

Improving workflow and calming IT complexity is CIRA IT’s mission. Lacy is responsible for clinical workflow and operations within IT, including day-to-day operations as well as evaluating, recommending, designing, and testing clinical workflows that are IT-specific. He also focuses on troubleshooting and resolving inefficiencies within the practice. In fact, it was this activity that led the group to seek out an enterprise worklist. It is also Lacy’s job to interface with various stakeholder committees— Executive, IT and Operational—to bring forth clinical and IT workflow challenges and propose solutions.

He works alongside Steve McHenry, the senior informatics engineer who focuses on clinical informatics standards such as HL7 and DICOM. He also works on software development, specifically applications that need to be developed to facilitate and boost workflow. “A lot of the pain points came in normalizing information,” he says, “including aggregating information from multiple EMRs into an enterprise worklist comprised of both interpretation and quality spaces.” 

To improve workflow and reduce IT complexity, the radiology group focused on a better way to get the appropriate work to the appropriate radiologist to offer the most appropriate care. “This really affects patient care,” Lacy says.

They also wanted a better way to dig into the data and showcase their high performance, Lacy offers. Looking beyond the measure of turnaround times, they are looking at quality metrics such as peer review and critical test results management. “Once appropriately managed you can pull all your organizations data together in your business intelligence (BI) tools to offer a dynamic display for discussion with your hospital partners. This helps build and strengthen that partnership,” Lacy says.

“The No. 1 intention of an enterprise worklist is study aggregation for interpretation,” Lacy underscores. “That’s what we were looking for, but we also wanted to simplify the ways we view clinical quality metrics. The workflow product offers both. So that brings us back again to reducing complexity. The BI tools [Change Healthcare Workflow Intelligence] support the rules-based engine for critical test result management.  We were impressed with the ease and flexibility of the rules-based engine. It allowed for unique workflows within a sub-specialized practice like ours.”

The Search for Solutions

“When CIRA embarked on a search for a single worklist solution, it was CIRA IT that was tasked with the challenge,” Lacy says. 

Lacy and McHenry did a lot of research and explored their options. They interviewed vendors and gathered details on features, functionalities, existing integrations, and cost. They considered working with current partners to reduce complexity. They discussed options in IT Committee meetings and narrowed the field. 

Once finalists were identified, the team delved into limitations and implementation logistics, and they dug deeper into financials. They asked: Will this ‘pay’ for itself from a clinical perspective, offering the ability to mine data appropriately and submit to our QCDRs? Will it allow for more effective assignment or efficient workflow for our radiologists?  Is this going to save us money or allow us to scale back FTEs or integration costs? From an IT perspective, does this minimize effort or support, or eliminate manual processes? 

CIRA chose Change Healthcare Workflow Intelligence based on capabilities as well as tight, and proven, integration with their Change Healthcare (formerly McKesson) PACS, which accounts for approximately 60 percent of the volume of exams reported by the group. “While there’s a standard for HL7 and DICOM, there’s not a standard API out there to launch into other vendors’ PACS,” McHenry says. “We knew that launching Change Healthcare PACS was available out of the box. We also had verified they already had facilities launching from our two other most common PACS.”

There also was a high degree of confidence that the selection would meet their needs because they had already seen it work. “Whereas other enterprise worklist vendors claimed they could do what we needed,” McHenry says, “the worklist is already working with the other PACS, so we knew it would launch, open and close a study appropriately. For example, if you open up five studies, it opens and stacks them appropriately within the PACS.”

With the must-haves covered, wheels really started to turn on defining how they’d put the worklist to work. “In a rules based engine the configuration is highly adaptable to any workflow,” Lacy says. “The increased efficiencies, the study assignments, the integrated workflows for quality. We asked each other, ‘How do we want to do this?’ We can now build rules specific to facilities, sites, physician’s slots or physicians. For example, creating a rule for a type of study during a certain time of day being assigned to a certain subspecialty group or specific physician. Our first focus was going to be interpretation, just seeing the big picture with a single worklist. After that it is going to be a more advanced study assignment and understanding of the physician’s day.”

At CIRA, putting the patient first is always the primary goal. “Getting a study efficiently and effectively to the right physician,” Lacy says, “not only creates a benefit in the quality of that report, but delivers other positive downstream effects in patient care and satisfaction. With a worklist launching into the facility’s PACS, all the available priors are available for that physician. They don’t need to wait or call one of our ‘air traffic controllers’ to find a patient and send over the prior studies. That extra step took them out of the workflow and the mindset of the exam. Now they can keep their eyes on the exams, focused on the patient.”

Physicians also benefit from consistent workflow. And from an IT perspective, a single worklist simplifies work in terms of people hours and tasks. “There is potential for unintentional rogue or repetitive process to cause inefficiencies when not automated. A rules based engine for assignment helps curb these concerns” Lacy says. 

It’s also less complex dealing with fewer vendors. When IT gets a report that the PACS, dictation, or orders aren’t crossing, there’s less complexity in the troubleshooting process. “Normalizing the workflow makes it a lot easier to determine where the failure is when someone calls and says, ‘this is the study I’m having issues with,’” says Lacy, who can jump on the worklist, double-click on the study and see the problem. He also knows they’re following a consistent process.