PACS downtime drill: testing departmental workflow with an enterprise imaging viewer and archive.

In today's workflow, radiologists rely on the picture archiving and communication system (PACS) to view images. Unplanned downtime causes significant delays in patient care and lengthy downtimes can have lasting effects on patient care and end-user confidence. The purpose of this manuscript is to describe the planning and implementation of a disaster drill where the departmental PACS was taken off-line and the hospital enterprise viewer was used for departmental image interpretation.

Disaster Planning During SARS-CoV-2/COVID: One Radiology Informatics Team's Story.

Disasters cause a major disruption to normal operations. Hospital information systems are often well-prepared for events such as fires or natural disasters. This type of disaster planning focuses on redundancy and manual workarounds. The SARS-CoV-2/COVID pandemic represented a new type of disaster for our radiology informatics team. In this pandemic, the information systems continued to work but the employees, and the computers that they worked with, had to be distanced. The purpose of this manuscript is to discuss the four phases of the disaster planning process: mitigation, planning, response, and recovery. We will illustrate the process with the example of how our radiology informatics team responded to the SARS-CoV-2/COVID pandemic.

Image-Enabling the Patient Portal of an Electronic Health Record.

Today, radiology departments still rely on compact disks to share imaging studies with patients. This practice is outdated as the majority of modern computers do not possess optical drives. In effect, hospitals are providing disks to patients to enable a single use, physical transport between two locations. This practice contrasts with the original goals of providing patients with their images: to empower ownership and provide transparency about their healthcare. The purpose of this manuscript is to implement an online platform for patient image viewing through an electronic health record patient portal. The number of study viewers was recorded daily over the first 90 days on our platform. During this time, the patients viewed 12,257 imaging studies. This represents 22% of the 56,413 imaging studies performed in our department. On average, there were 136 imaging studies viewed/day (range 52-250). We determined that an online platform enabling patients to view their images is feasible. At our hospital, a large percentage of patients quickly identified this feature and began using it to view their imaging studies.

Using informatics to engage patients.

As a specialty, radiology has spent much of the last two decades implementing information systems that improve departmental efficiency and the ordering provider's access to information. While our patients have realized benefits such as improved access to care and reduced turnaround times, there has been little focus on using these information systems to improve patient engagement. In the last decade, society has shifted. Now, consumers in every industry expect to be able to use technology to help them accomplish different tasks from scheduling to communicating. Medicine, in general, has been slow to respond to the concept of the patient as a consumer. In this manuscript we describe some of the informatics efforts we have employed in our department to improve patient engagement. We present these initiatives, corresponding to each aspect of the radiology value stream, from the patient's point of view.

Building and Implementing an Operational Plan.

Radiology practices engage in planning processes with varying frequency. Organizational planning can occur on three levels. Strategic planning is an infrequent event occurring every 5-7 years. It is aspirational and is guided by the mission and the vision of the organization. Operational planning is a yearly process in which businesses articulate their goals for the year. Creating a yearly operational plan provides departmental employees with a road map for the upcoming year and helps to tie their daily activities to the larger strategic plan of the organization. Finally, a project plan provides details describing how a specific goal will be met. The differences among these three types of plans (strategic plan, operational plan, and project plan) are described. The article then focuses on operational planning, providing a rationale for building an operational plan and then a description of the method used in the authors' division to build an operational plan. ©RSNA, 2018.

Creating a comprehensive customer service program to help convey critical and acute results of radiology studies.

OBJECTIVE: Communication of acute or critical results between the radiology department and referring clinicians has been a deficiency of many radiology departments. The failure to perform or document these communications can lead to poor patient care, patient safety issues, medical-legal issues, and complaints from referring clinicians. To mitigate these factors, a communication and documentation tool was created and incorporated into our departmental customer service program. This article will describe the implementation of a comprehensive customer service program in a hospital-based radiology department. MATERIALS AND METHODS: A comprehensive customer service program was created in the radiology department. Customer service representatives were hired to answer the telephone calls to the radiology reading rooms and to help convey radiology results. The radiologists, referring clinicians, and customer service representatives were then linked via a novel workflow management system. This workflow management system provided tools to help facilitate the communication needs of each group. The number of studies with results conveyed was recorded from the implementation of the workflow management system. RESULTS: Between the implementation of the workflow management system on August 1, 2005, and June 1, 2009, 116,844 radiology results were conveyed to the referring clinicians and documented in the system. This accounts for more than 14% of the 828,516 radiology cases performed in this time frame. CONCLUSION: We have been successful in creating a comprehensive customer service program to convey and document communication of radiology results. This program has been widely used by the ordering clinicians as well as radiologists since its inception.

Quality initiatives: department scorecard: a tool to help drive imaging care delivery performance.

The radiology department at a midwestern U.S. children's hospital has created a scorecard that is presented quarterly to the institutional leadership and is available to all radiology employees on the institutional intranet. The scorecard currently has 33 measures in six areas: clinical services (safety, quality, timeliness); education; research; professionalism, communication, and user satisfaction; finances and administration; and staffing. For each measure, the goal, current value of the measure, interval at which the measure is updated, date of last update, and previous value of the measure are listed. Each measure was reviewed over time to determine those measures for which target goals were met. Results indicate that a visible and transparent department scorecard is one of the more powerful tools available to the radiology leadership to call attention to and improve performance in specific areas. The use of such a scorecard can help develop a departmental culture of quality improvement, focus healthcare providers on specific quality improvement projects, and drive departmental performance.

IRQN award paper: Operational rounds: a practical administrative process to improve safety and clinical services in radiology.

As part of a patient safety program in the authors' department of radiology, operational rounds have been instituted. This process consists of radiology leaders' visiting imaging divisions at the site of imaging and discussing frontline employees' concerns about patient safety, the quality of care, and patient and family satisfaction. Operational rounds are executed at a time to optimize the number of attendees. Minutes that describe the issues identified, persons responsible for improvement, and updated improvement plan status are available to employees online. Via this process, multiple patient safety and other issues have been identified and remedied. The authors believe that the process has improved patient safety, the quality of care, and the efficiency of operations. Since the inception of the safety program, the mean number of days between serious safety events involving radiology has doubled. The authors review the background around such walk rounds, describe their particular program, and give multiple illustrative examples of issues identified and improvement plans put in place.

Gaucher disease: alendronate disodium improves bone mineral density in adults receiving enzyme therapy.

Symptomatic patients with Gaucher disease (GD) (acid beta-glucosidase [Gcase] deficiency) are treated with injectable human recombinant GCase. Treatment results in significant decreases in lipid storage in liver, spleen, and bone marrow, but the generalized osteopenia and focal bone lesions present in many adult patients are refractory to treatment. A double-blind, 2-arm, placebo-controlled trial of alendronate (40 mg/d) was performed in adults with GD who had been treated with enzyme for at least 24 months. Primary therapeutic endpoints were improvements in (1) bone mineral density (BMD) and content (BMC) at the lumbar spine, and (2) focal lesions in x-rays of long bones assessed by a blinded reviewer. There were 34 patients with GD type 1 (age range, 18-50 years) receiving enzyme therapy who were randomized for this study. After 18 months, DeltaBMD at the lumbar spine was 0.068 +/- 0.21 and 0.015 +/- 0.034 for alendronate and placebo groups, respectively (P =.001). Long-bone x-rays showed no change in focal lesions or bone deformities in any subject in either arm. Alendronate is a useful adjunctive therapy in combination with enzyme replacement therapy (ERT) for the treatment of GD-related osteopenia in adults, but it cannot be expected to improve focal lesions.

A simple method of capturing PACS and other radiographic images for digital teaching files or other image repositories.

OBJECTIVE: We sought to develop an easy-to-use method of capturing and storing radiographic images. CONCLUSION: The method that we developed can capture any digital image-including an image from a picture archiving and communication system (PACS)-using widely available, inexpensive software. Our method is easy to learn, simple to use, and inexpensive to implement. It is adaptable in a wide range of networking environments and can capture and store images rapidly for a variety of uses. It can be used without interfering with clinical workflow at the PACS workstation.