Clinical analytics for radiology can play a critical strategic role in practice development and growth, but only if the approach to aggregating and sharing analytics is effective, according to Paul Potok, DO, radiologist and board member with Quantum Imaging & Therapeutic Associates, Inc (Lewisberry, Pennsylvania), a 40-radiologist practice. “Many of the metrics we track are the same ones people have been tracking for years, but we do it differently,” Potok says. “We make the information instantly accessible to everyone.”
Transparency of analytics is key, Potok says, because of its ability to promote modification of long-ingrained behaviors—changes that, in the service of key strategic goals, can accelerate a practice’s progress in its market. “It’s tough to modify your behavior without getting something back for it,” he says. “When data are readily available as feedback, change occurs more quickly and definitively.”
Strategic Imperatives
Potok outlines how the analytical feedback loop is used to accelerate change by offering two examples of strategic imperatives identified by leaders at Quantum Imaging & Therapeutic Associates. “We’re keying in on quality issues related to report clarity and clinical utility,” he notes. “Radiologists often live in a vacuum, and technology has pushed us further toward the periphery. Our workflow, today, is not sitting in a reading room and talking to physicians. We have to be productive, in a distributed manner, while maintaining the quality and clinical utility hospitals need.”
For instance, Potok says, voice-recognition technology and the frequent need to self-edit reports for optimal turnaround have led to a proliferation of word substitutions and deletions. Radiologists might miss these spoken typos—also known as speakos—and that may lead to confusion about the final report. “The easy availability of images creates the opportunity for referring physicians to forego the radiology report altogether,” he notes. “Describe a severely comminuted calcaneus fracture to an orthopedic surgeon, and he or she will probably ask to see the pictures. If we aren’t going to be clinically relevant—and crystal clear in that relevance—we’re going to hear more and more of that in the future.”
Dovetailing with that initiative is another: to make clinician consultation and activities such as hospital-committee participation a priority to radiologists. “Like all practices, we’ve found we can be more efficient by using internal teleradiology, but there’s the risk of losing clinical credibility if it is relied on too much,” Potok says. “Among other things, we need to promote clinical consultation, teaching, and conference participation; all of that demonstrates our value.”
Transparent Solutions
To tackle the problem of report clarity, Potok plans to begin mining the practice’s reports for speakos, both to identify common mistakes—he offers the example of voice-recognition software interpreting the word compression as oppression—and to report radiologists’ objective error rates to them. “You can argue about using the active voice and whether that’s the best approach, but you can’t argue that the word oppression belongs in the report,” he says. “At a minimum, it can make you look silly; at its worst, it can be dangerous for the patient.”
That potential danger is amplified by the accessibility of today’s electronic medical records, he adds: “Decisions will be based on these reports for a long time, including decisions made by patients.” By critiquing radiologists’ reports and giving feedback on their clarity, the practice can encourage its physicians to be “as clear as they can be,” Potok says. “One of my goals is to compile what we learn from our critiques and develop a curriculum based on them for our radiologists to assimilate.”
To address the issue of deepening radiologist engagement, Quantum Imaging & Therapeutic Associates has taken a unique approach, using an internally developed software tool to track productivity transparently, in real time. While it sounds contradictory to the goal of giving radiologists incentives to do more work that doesn’t produce RVUs, Potok explains that the tool, in fact, does just that.
The software works by letting radiologists know, on a continual basis, how productively they are working. When radiologists need to leave their workstations to engage in other activities, the system automatically calculates their average rates of RVUs per hour. “The software uses your recent past productivity as a basis for crediting your time,” Potok explains. "You're not penalized for getting pulled away to do these other value-added activities. You see objectively that you are providing a service equally important to the practice, and everyone else sees it too. Sometimes non-RVU work cultivates things that take time to repay, or may not repay at all. Sometimes it’s putting out fires, through which the practice can gain by not losing. These activities are difficult to value, and even more difficult to value on a daily or hourly basis, so we don’t try.”
In addition to leveling the playing field in such a way that activities that don’t generate RVUs are valued equally with image interpretation, this system enables Quantum Imaging & Therapeutic Associates to report to its health systems on the value-added work of its radiologists. “We recognize the importance of consulting with our clinical colleagues, and we make it very clear that we encourage it and reward it,” Potok says.
The transparency of the practice’s analytics enables its radiologists to take pride in their contributions, Potok concludes. He says, “We track performance in real time, up to the minute, all day—and I’m happy to prove my value, every day.”
Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.