A shadowing experiment brings radiology and IT closer together

Despite the considerable progress that’s been made to bridge the gap between IT and radiology, in part through the development of sophisticated IT-based radiology practice solutions, a considerable understanding gap remains between those who implement and support solutions and those who use them.  According to results from a recent survey conducted by Adam H. Kaye, MD, MBA, of the Hospital of the University of Pennsylvania, and presented at the 2014 annual meeting of the Society of Imaging Informatics in Medicine (SIIM), individuals from IT and radiology staff working in the same facility feel like fish out of water when asked about the specific day-to-day workflows and decision-making processes of the other group. After completing a survey and participating in a shadowing experiment, the two groups gained alignment, achieved only because they were able to experience and understand the needs of the other group and recognize the importance of communication.

On a macro level, there are facility-wide and department-specific communications systems, such as electronic health records (EHR), PACS and RIS. In large hospital systems, CIOs likely make decisions about the IT solutions used in the hospital, devise operating plans for the various service lines and directing the IT staff.  It’s his or her responsibility to understand the IT needs of a department, such as radiology, in terms of acquiring the appropriate and necessary technology solutions, as well as providing ongoing support.

While the responsibility of defining how things will get done is no small task, the process will be weak or fail outright if it is built without a complete understanding of why it’s being done in the first place.  In other words, the mission, objectives and user requirements must be the starting point of any collaborative project between IT and clinical professionals.  That means clear communication between IT and radiologists. This experiment proved that the two groups have much to learn about each other before alignment can be attained.

By the numbers

The survey, completed by 95 radiologists and 14 IT staff members, indicated that while both camps had few issues with professionalism during their encounters, they weren’t in sync when it came to understanding each other’s workloads. For example, radiologists’ mean estimate of the number of workstations in the department was 87, while IT staff pegged the number at an average of 224. Radiologists guessed the number of calls to the overnight IT staff was 18, while IT staff estimated the number to be about six.

The largest gap came in the estimate of the number of studies read per day. Radiologists submitted a mean estimate of 1,729, while IT staff estimated the number to be more than 85,000. This wildly high average was inflated by three unreasonably high guesses—one IT staff member responded that 650,000 studies were read per day—and once these outliers were removed, the mean estimate for the IT staff fell below that of the radiologists to 1,118.

“Despite some of the inflated answers on the survey, the IT staff at our facility is well-integrated with the IT needs of the radiology department, and provides support staff according to our forecasted workloads and volumes,” Dr. Kaye explains. “One of the reasons I began the project, however, was that I noticed occasions where IT was called to help with a problem, and the radiologist didn’t receive much information more than an acknowledgement that it would be resolved. Radiology was looking to get more information from the IT staff, but it seemed that the IT staff didn’t realize we wanted it. By the same token, the IT team may have been thinking that the radiologist doesn’t really understand the source of the problem, so they should just take the information and make sure to resolve the problem.”  

The root cause of this problem is none other than communication. Each team made certain assumptions on which their actions and behaviors were then based. If assumptions are incorrect or misinformed, it can lead to communication issues. “In our case, it created an environment with very little collaboration between the two groups. There was a lack of understanding about what we [radiologists] do and we knew very little about what IT did, on a micro level,” Dr. Kaye adds.

A day in the life

After the initial survey was completed, some of the IT staff and radiologists who participated in the survey went on to volunteer their time to participate in a shadowing exercise where they would spend time in the other groups’ “shoes”. Two IT staff were shadowed by five radiologists, and three radiologists—one resident, one attending and one fellow—were followed by four IT staff members. Though the scheduling proved complex, the results were worth the effort, according to Dr. Kaye.

A post-shadow survey completed by those who participated in the second portion of the study indicated a very positive response. Participants commented that they had a better understanding of the issues their colleagues faced, and a number of them even said it helped them come up with future project ideas.

“Basically, there were things that either side was doing that the other group didn’t realize was part of their daily work,” Dr. Kaye reports. “It’s easy to think that IT is just sitting there, waiting for you to call them with your problem, but we learned first-hand that the reality is they are actively monitoring the status and integration between our systems, looking for issues before problems occur so they can prevent them from happening at all.  When problems do happen, there’s a back end tally and analysis to examine what may have caused the problem. That’s one observation that was pretty universal across the board from the radiology camp.”

The IT staff reported similar experiences. “One major benefit was that they were able to actually see what our workflow was like,” says Dr. Kaye. “It’s one thing to be informed via a forecasting report about the ebb and flow of radiology patients scheduled throughout a given day or time period and make assumptions that certain times are busier than others, but it’s quite another to be sitting there next to the radiologist as he or she is reading and interpreting images. It may be very different from what their idea of optimal radiology workflow may have been. The radiologists who participated felt it was important that the IT staff have the opportunity to experience that.”

Practical applications

During one of the shadowing sessions in cardiovascular radiology, an IT staffer noticed the lengthy amount of time it took to fetch all the previous studies for each patient, which is something that’s done for each patient on the schedule. The process, however, was completed manually. Though time consuming, the radiologists performed the task for each patient.

Upon observing this, the visiting IT staff member asked a few questions and offered the radiologist a quick solution to automate the process. The solution is now part of the standard daily workflow in cardiovascular radiology. Without the shadowing exercise, it likely would have never come up because it wasn’t considered a “problem”.

“If we didn’t have the benefit of observing the actual workflow, this time consuming activity could have been perpetuated for months or years without ever surfacing as an issue that needed attention,” Dr. Kaye adds.

Ultimately, each team has a better understanding of the workflow of the other and now has the ability to integrate that knowledge into the facility’s overarching operating plan, as well as their daily communication and interactions. Spending a day in each other’s shoes proved to be a best practice worth trying to achieve alignment between IT and radiology through better understanding and appreciation of the work of colleagues whose job it is to support each other’s efforts. 

The expectation is that improved communication will drive a better return on the resources committed to the hospital’s radiology service line.  Aligning the “how” with the “why” demands that the IT and radiology partnership move out of the shadows – and into the hospital’s daily operating routine.