Development and Implementation of a Semi-Automated Workflow for Point-of-Care Ultrasound Billing and Documentation Within an Electronic Health Record.

Point-of-care ultrasound (POCUS) is widely used for both diagnostic and therapeutic purposes. With its many advantages, including ease of use, real-time multisystem assessment, affordability, availability, and accuracy, it has been adopted by all medical specialties. Despite its advantages, the lack of standard workflow and automated billing solutions makes it difficult to launch a comprehensive POCUS program. In this work, we describe how we created and implemented an efficient standardized EHR-based workflow for POCUS that has been used across multiple division and settings within our organization.

Creation of a Multi-vendor Image-Sharing Solution.

Transferring medical imaging studies from one institution to another is a common occurrence in today's medical practice. For the past two decades, radiology departments have relied on physical media (compact discs and digital video disks) and human couriers to accomplish image transfer. This mode of transfer is slow, prone to failure, and reliant on outdated technology. To address these shortcomings, multiple image-sharing vendors have created electronic, cloud-based solutions. While these solutions solve multiple problems, a new problem has been introduced: it is difficult to send or receive images across image-sharing platforms. In this work, we describe how we have developed a solution to share images across multiple vendor platforms.

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.

Improving efficiency in the radiology department.

The modern radiology department is built around the flow of information. Ordering providers request imaging studies to be performed, technologists complete the work required to perform the imaging studies, and radiologists interpret and report on the imaging findings. As each of these steps is performed, data flow between multiple information systems, most notably the radiology information system (RIS), the picture archiving and communication system (PACS) and the voice dictation system. Even though data flow relatively seamlessly, the majority of our systems and processes are inefficient. The purpose of this article is to describe the radiology value stream and describe how radiology informaticists in one department have worked to improve the efficiency of the value stream at each step. Through these examples, we identify and describe several themes that we believe have been crucial to our success.

Practice policy and quality initiatives: decreasing variability in turnaround time for radiographic studies from the emergency department.

A study was performed to evaluate use of quality improvement techniques to decrease the variability in turnaround time (TAT) for radiology reports on emergency department (ED) radiographs. An interdepartmental improvement team applied multiple interventions. Statistical process control charts were used to evaluate for improvement in mean TAT for ED radiographs, percentage of ED radiographs read within 35 minutes, and standard deviation of the mean TAT. To determine if the changes in the radiology department had an effect on the ED, the average time from when an ED physician first met with the patient to the time when the final treatment decision was made was also measured. There was a significant improvement in mean TAT for ED radiographs (from 23.9 to 14.6 minutes), percentage of ED radiographs read within 35 minutes (from 82.2% to 92.9%), and standard deviation of the mean TAT (from 22.8 to 12.7). The mean time from when an ED physician first met with the patient to the time a final treatment decision was made decreased from 88.7 to 79.8 minutes. Quality improvement techniques were used to decrease mean TAT and the variability in TAT for ED radiographs. This change was associated with an improvement in ED throughput.

Development of an interactive model for teaching emergency pediatric radiography: preliminary report.

PURPOSE: The authors describe the development of an interactive digital teaching module designed to help prepare residents to diagnose emergency pediatric radiology cases. METHODS: Cases were identified using the authors' own dictation search software. Cases were selected that depicted common conditions that had been misdiagnosed by the radiology resident who had first interpreted them clinically. Normal cases involving similar anatomic regions were also collected. Images from these cases were captured from the picture archiving and communication system. "Hotspots" were superimposed on abnormalities to highlight them. Example dictations were captured. A simple user interface was developed for the teaching module, and a database was built to log all user responses. RESULTS: The system has been well received at the authors' institution. It has been incorporated into the standard orientation for all incoming residents. Residents' diagnostic performance has subjectively improved since the module was launched. CONCLUSIONS: The module is interactive, easy to use, and subjectively improves incoming residents' diagnostic accuracy. A prospective, controlled study assessing its impact on short-term and long-term diagnostic performance is under way.

Improving patient care: the use of a digital teaching file to enhance clinicians' access to the intellectual capital of interdepartmental conferences.

OBJECTIVE: We describe a simple method for creating teaching cases from clinical data, radiologic images, surgical images, and images from pathologic slides that are presented at tumor board conferences. CONCLUSION: The resulting interdisciplinary case files are of educational value both during and after conference presentations and can be used by clinicians to gather appropriate historical, laboratory, imaging, surgical, and pathologic data on their patients. This system improves the efficiency and accuracy in gathering patient histories when care is transferred among clinics, the emergency department, and wards.