Hospital-Radiology Alignment for Increased Quality: OSF HealthCare

When Peoria, Illinois-based OSF HealthCare transitioned from analog to digital imaging, one aspect of the radiology continuum proved challenging: quality assurance. “We had a fairly robust, paper-based QA process when we were film and paper,” recalls Tom Cox, director of radiology at OSF Saint Francis Medical Center (SFMC). “When we went to PACS and went paperless, however, we virtually stopped getting feedback from the radiologists on quality. We knew we needed something to replace the paper process.” Cox describes the relationship of OSF Saint Francis with its radiology group—an independent practice that contracts with the hospital—as a positive one. “Even though they’re not employed by the organization, we have a good relationship with our radiologists,” he says. “They had wanted a more robust QA system than what paper allowed them for a long time. Finding a new solution met both our and their objectives.” Mutual Needs In mid-2012, OSF Saint Francis implemented QICS by peerVue for QA, result notification, and peer review. “The radiologists wanted an easier system to do more peer review,” Cox says. “Meanwhile, we wanted to be, and are now, ACR-accredited, so we needed a more robust peer review process as well. Implementing QICS allowed both groups to reach their goals.” The software works by allowing radiologists to access QA cases seamlessly within the PACS by clicking over to the QICS tab, then back to their worklists; the radiologists also can provide feedback on technologists’ techniques and protocols. “When we were using paper, we provided the radiologists with a QA matrix for each exam, so they could check if there was improper technique or the technologist didn’t follow protocol,” Cox says. “They were really good about giving us a lot of feedback. PeerVue has really helped us to get back to where we were.” After getting the QA and peer review components of the software in place, OSF Saint Francis added automated result notification into the mix, another mutually beneficial tool. “As many organizations do, we struggle with an inordinate amount of stat interpretations ordered,” Cox says. “It’s hard for the radiologists to make all those phone calls while interpreting the amount of images we need them to. With QICS result routing, the result notifications that are non-emergent can be taken off their hands.” Ongoing Goals The system also aids in aligning the radiology practice and the hospital around mutual quality improvement goals, including dose reduction. “On the front end, most of the equipment vendors now have some very good dose reduction options on their equipment,” Cox says. “The radiologists also have the ability to provide feedback via QICS if they felt that the technologist didn’t use the right technique or protocol and it led to a higher dose than necessary.” Other initiatives include changing CT protocols and tracking cumulative dose for patients, he adds. Patient satisfaction with imaging services is another area of focus. Using tablets placed throughout waiting areas in the imaging department, SFMC is able to gather the results of short, five-question patient surveys. “There is some reimbursement tied to satisfaction now, so if we have devices to measure it, we can work to improve it,” Cox says. “We get a lot of feedback from the surveys. For instance, we were hearing a lot that the exams weren’t being explained properly. We trained the staff to make sure to give a good, thorough explanation.” Steve Kastelein, manager of enterprise imaging for OSF HealthCare, notes that software-based solutions like QICS enable these kinds of initiatives to take root without interrupting radiologist productivity, an increasingly crucial issue in an era of declining reimbursement. “We want to be able to collect quality information without disrupting the workflow of any part of the radiology department,” he says. Ultimately, the system helps align radiology practice and hospital priorities, which will be especially critical in the coming era of value-based care, Cox says. “The radiologists are the experts on what is the most appropriate imaging procedure, so we will want them to be as engaged with our medical staff as possible,” he says. “We will keep looking for new ways for them to be able to engage as the guiding clinicians when they also need to be reading images. That’s the challenge—collaborating to provide efficient, low-cost imaging so that both their group and our organization will benefit.” Cat Vasko is editor of HealthIT Executive Forum.