NeoTool — Singular Focus, Healthcare Integrated

In healthcare IT, there are varying standards. One standard is LOINC® - Logical Observation Identifiers Names and Codes.

LOINC facilitates the exchange of results data by providing a universal standard for identifying laboratory observations. The LOINC database and its supporting documentation are maintained by the Regenstrief Institute, Inc.

Why was LOINC established and what are the benefits?

LOINC was initiated in 1994 by the Regenstrief Institute to identify observations in HL7 messages (OBX segment). Prior to its establishment, no universal standard for laboratory test names existed. Therefore, laboratories would send varying values in the OBX-3 (observation identifier) and OBX-5 (observation value) segments. When working with multiple laboratories that used different codes for different test observations, a lack of standardization hindered the development of clinical repositories and research databases.

LOINC provides a standard way of identifying observations using approximately 41,000 observation terms. Nearly 31,000 of these terms are used for laboratory testing. LOINC codes allow you to merge clinical results from multiple sources into a single database, allowing results to be automatically sent to the appropriate place and improving patient care and clinical research.

Who uses LOINC?

LOINC is endorsed by the American Clinical Laboratory Association and the College of American Pathologists. It has been adopted by some large commercial laboratories for use in HL7 result messages and is used by some US federal agencies with healthcare interests. While initially created specifically for HL7 messaging, its use has expanded to Digital Imaging and Communication in Medicine (DICOM) ultrasound messages and Clinical Data Interchange Standards Consortium (CDISC) pharmaceutical industry messages.

Where can I get a copy?

The LOINC database and REMLA - a program for browsing the database, and mapping local files to LOINC - are available at no cost from the Regenstrief Institute. It can be downloaded here. More information about LOINC is available from the Regenstrief Institute.

Final thoughts on LOINC.

• In general, LOINC is a work-in-progress rather than a final standard.
• There is no US government mandate to move labs to LOINC. Movement will be gradual.
• ELINCS uses LOINC for the top 100 tests, not the results. More information on ELINCS can be found in a previous post.

An Imaging Economics article - The Purview of the PACS Administrator - highlights the critical components of a PACS Administrator’s role that impacts radiology workflow. It is a great article because it outlines many of the key knowledge and work activities required to be an effective PACS Administrator. More than ever, PACS Administrators contribute significantly to defining, enabling, and refining radiology workflow.

Key Knowledge of a PACS Administrator. DICOM is always the healthcare standard people think about when radiology workflow is mentioned. Today, the knowledge required has expanded to include the HL7 Standard. HL7 integration is the standard that facilitates the data flow between the various applications (e.g., RIS, HIS, EMR, PACS, etc.) and streamlines the workflow by automating various activities. It is refreshing to read an article about PACS Administrators that acknowledges the HL7 Standard as a required element to gain efficiencies in a radiology practice or department.

Key Work Activities. PACS Administrators play an essential role in defining radiology workflows, re-engineering radiology workflows, and enabling radiology workflows with the right technology. This requires the PACS Administrator to have strong interpersonal skills along with strong communication, project management, IT, and healthcare standard skills.

Other key activities include monitoring the data flow, ensuring it is continuous so that a radiologist’s workload is even throughout the day. Again, this article points out it is not just the PACS that needs monitoring but also the integrated systems and interfaces. Seamless workflow requires integrated systems, which also requires flexible and robust interfaces between the various applications. The PACS Administrator is required to know more about data flow between all the systems that eventually touch the PACS or are eventually touched by the PACS. 

Equally important is data quality. Automating data flow through the systems and applications removes the opportunity for keying (re-keying) errors; additionally, it means that the data needs to be translated into different formats correctly in order to meet the various applications’ requirements.

As we have discussed in other posts, the PACS Administrator plays many different roles and the responsibilities and knowledge required have grown. In this healthcare IT article, Imaging Economics has delivered this message very competently.

Health Data Management published an article entitled CIO: Get the Workflow Right First. At the Medical Group Management Association Conference, Phyllis Schuck, CIO of Pinehurst Surgical Clinic, spoke about their EHR implementation experience and highlighted that the key tip is to focus on your workflows first. As she stated, “Technology really doesn’t fix broken processes, but it can magnify broken processes.”

Focusing on your workflow is critical to any healthcare IT project or initiative. Once the workflow is documented and understood, then determining how technology can be applied to streamline it, increase its capacity, or otherwise improve it can be determined.

Other tips offered by this CIO should be applied in evaluating healthcare software purchase decisions, whether it is an EHR or healthcare integration platform. The tips include:

• Only consider vendors who’ve been in business at least seven years, so they have a track record.
• Make sure the vendor has successfully deployed interfaces to the practice management and lab systems in place at your practice.
• When hosting demonstrations of software at your practice, require the vendor to demonstrate how the application would handle your specific workflows.
• Schedule site visits to organizations similar to yours, and bring multiple users from various departments, such as nurses, schedulers and cashiers.

HIStalk posted an interview with Eric Fishman MD, President, EHRConsultant. This is an interview worth spending a few minutes to read. Dr. Fishman’s site is EHRScope.

The HIStalk interview spans several topics including:

• EMR vs. EHR terminology
• Implementing EHR insights
• CCHIT and their impact
• Insurance companies providing EMR software to physician practices
• General physician practice trends

One missing question that would be interesting to ask:  What are physician practices doing to implement effective interfaces to their partner providers, such as labs, imaging centers, and hospitals? EMR connectivity plays a key role moving patient data effectively through their complete cycle of health care interactions.

In your EHR efforts, HIStalk and EHRScope are great resources for healthcare IT professionals and physicians.

Outlined below is an interview with Joe Moore, CIO, Radiology Consultants of Iowa (RCI). RCI recently was recognized as one of the “Top 25 Connected Healthcare Facilities” by Healthcare Imaging & ITmagazine. In this interview, Joe responds to questions on what led RCI to receive this recognition, and his thoughts on connected radiology workflow.

What led RCI to apply to be recognized as one of the Top 25 Connected healthcare facilities?

What we are doing is unique, and uses a model that we believe others would like to follow. We wanted to get the word out to other private physician groups on how to drive the connectivity process to benefit everyone. Ultimately, at Radiology Consultants of Iowa (RCI), we believe in our approach and the results it has produced for our outreach customers and their patients.

The stated goal of the award is to highlight firms that have a seamless path of incoming and outgoing patient information. What are RCI’s attributes in light of this goal?

Generally speaking, Radiology Information System (RIS) driven workflow is the key attribute. The workflow is triggered by specific events and the information flows downstream to the radiologist seamlessly and without much manual intervention. Orders and results, or patient reports, all flow electronically and productively throughout the radiology workflow.

More specifically, we could not find a commercial RIS that could extend our reach to remote sites economically. While the smaller healthcare facilities did not have a RIS, the larger ones did. We needed to develop an architecture and approach that met the needs of both our larger and smaller customers. Our objective was to enable our customers’ electronic order process, not RCI’s.

Our approach was to develop our own RIS (RISLite) for our smaller customers and leverage the commercial RIS at the larger hospitals and then use our interface engine - NeoIntegrate - to tie the two models together with one integrated workflow.

The new RCI model now is to communicate information electronically and seamlessly from the technologist to the radiologist, especially since the radiologist is no longer at the exam site.

Events in the RIS trigger events throughout the workflow. NeoIntegrate manages the radiology workflow logic and the message traffic between the various systems and locations. With this workflow and technology model, the results have been tremendous for our outreach hospitals and their patients.

The Health Imaging & ITarticle states that imaging procedures have grown for the award winners. What has been RCI’s experience?

Procedure volume is up, and utilization is up. Likewise, our outreach hospital customers have experienced growth because of our systems, approach, and workflow.

Previously, the family physicians sent patients for radiology service to the larger university hospitals. Today, it’s 180 degrees – the family physicians get better service from their local hospitals that utilize RCI’s services. Our outreach hospitals are now on even ground with the larger hospitals. In fact, the services that they now provide may exceed that of the larger university-type hospitals.

Another characteristic of healthcare facilities receiving this recognition is turn around time (TAT). What is RCI’s TAT experience with your current model and approach?

Our final patient report turn around time is phenomenal compared to what it was before we implemented the new systems and workflow. It is one of the key reasons that our volume and customer base have grown. RCI is now in the top 5% in the country for final patient report turn around time.

Improving patient report turn around time takes effort. You have to set goals, implement effective supporting technology, and push forward to make it happen. The difference is from days to minutes in what we have achieved with final patient report turn around time – it is truly amazing.

With volumes up and TAT happening within minutes, what has this done for radiologist productivity?

Our metrics have shown steady improvement across physicians. You have to measure, because the physicians want the performance metrics on the investments being made. You cannot just install the technology and expect the results. You have to roll-up your sleeves and make it work.

For example, physicians hear horror stories about voice recognition and how it slows productivity and error rates increase. Physicians were skeptical. In our implementation, we have proven that the error rate is equal to or less than a transcribed report. We have fewer errors and increased productivity with voice recognition technology.

We implemented the technology with our processes and concerns in mind. Consequently, we have a transcriptionist backing up all of the physicians, reviewing the reports that are being self-edited by the radiologist. Tailoring your implementation approach to what works for your operations is key. You have to be realistic in your approach.

At the core of the recognition is connectivity. How has this played a role in your accomplishments?

Focusing on connectivity has produced tremendous benefits for RCI. The physicians are more productive and happier, and the workflow is now steady throughout the day. With the focus on connectivity and workflow and applying the right technologies, we are able to accept a higher workload without adding new people. In fact, when two radiologists retired, we did not have to replace them. The results from effective connectivity are solid.

Finally, what about the patient’s experience? Has that changed?

Although the patients may not recognize it directly, the impact is clear in two primary areas:  enhanced patient safety and care and availability of patient information.

Improved workflow delivers higher quality. Equally important, patients now can receive equivalent quality service from their local hospital. They no longer have to drive to an urban area to get high quality care.

Available patient information comes in two forms. First, when an ER physician transports a patient, they send a CD with them that contains the recent patient images and information. Second, because the system is shared among providers, a physician has access to all prior exams for a patient when reviewing current information. No matter where the physician is, they have access to all patient information in one place. Overall, patient care is greatly enhanced.

Final thoughts?

What we have is a model for the future, and we are happy with it. We are proud of this recognition. Being in the Top 25 Connected and being from Iowa is tough to do. It would be nice if we had the infrastructure that some places have. We could use a little less award and little more bandwidth!

If you are considering a career move from healthcare IT team member into team leader, IT manager, or even CIO, here is an interesting article to read and ponder. It provides an interesting quiz (of sorts) that, in my opinion, seems to capture the pros and cons of being a manager in any industry.

Motivation: At some point almost every healthcare IT team member — say an interface engine analyst at a hospital/clinic or HL7 implementation/support person at a software vendor — will consider a move into management. The first and hardest move, IMO, is being the team leader — you are expected to continue doing “real work” (building interfaces, troubleshooting issues, maybe even carrying the on-call pager) and at the same time you are asked to be Mr. (or Ms.) Manager. You are truly stuck in the middle of being both “one of the gang” and being “in charge” at the same time. This article outlines the challenges pretty well — read before you leap.

John McKee is the author of two books and blogs weekly (Success Coach) on TechRepublic. Here are his 10 signs that you’re not cut out to be an IT manager.

At one time or another, most of us will come to a point in our lives when it’s time to determine our next step. As a business and success coach, I often hear from people who are wondering if it’s time to make a change in their lives.
…
We are all more successful when we are doing things we enjoy. To help clients decide what that may be, I ask them a few questions designed to get them to take an honest look at who they are at their core.

For those of you who’ve been thinking, “Maybe I should make the move into management,” I’ve put together this list of 10 warning signals. If any of these hit you as your personal reality, the chances are that you are not cut out to be a manager.

1. You have a real desire to be liked
2. You prefer to avoid the spotlight and just be a part of the gang
3. Every time you are called on to comment about the topic being discussed, you experience short-term memory loss
4. Having a tough conversation with an employee causes you a great deal of duress
5. You don’t like to make tough decisions
6. Being stuck in the middle between the leaders and the team makes your stomach churn
7. You prefer to keep a low profile, just doing your job; when people look at you, it reminds you how many flaws you have
8. Having a verbal duel in a meeting isn’t your idea of fun and you feel uncomfortable standing up to communicate in a meeting
9. You dislike having to work hours beyond the “regular” schedule
10. You could never fire someone because after all, everyone needs a job

In this post, we interviewed Brian Moreau, IT Director, Henry County Health Center. Henry County Health Center was recently recognized as being one of the Top 100 Most Wired hospitals in the US by Hospitals & Health Networks magazine. Below is the interview with Brian.

What was the evaluation process to become one of the ‘most wired’ hospitals?
Henry County Health Center raised its hand to participate in the 2007 Most Wired Survey and Benchmarking Study sponsored by released Hospitals & Health Networks magazine. It is a detailed study that covers how Henry County Health Center uses information technology to address five key areas:  safety and quality, customer service, business processes, workforce, and public health and safety.

What was it that motivated you to undertake this initiative?
In 2003, the Henry County Health Center management team developed a strategic plan in which being a “Most Wired” hospital was one of the key elements. We knew it would be important to advance our information technology efforts in order to deliver the right type of care and services to our patient community. 

In Good to Great, Jim Collins talks about the flywheel concept. If everyone in the organization is pushing on the flywheel – moving initiatives forward turn-by-turn, momentum is gained. It is a continuous improvement effort over time. This is illustrative of our approach – everyone was involved, and we made significant incremental improvements over time.

We had initiatives to realize our strategic plan, including physician chart, electronic medical records (EMR), website additions for patient education and personal health manager, etc. These initiatives were not single stroke, bold implementations, but many people working hard and strong focus on improving turn-by-turn.

For us, it came down to setting a vision, and sticking to it. We kept the discipline to stay with it.

As part of your strategic plan, what was the level of focus on workflow?
It was one of the key elements, and one in which technology can play a significant role in advancing and streamlining various operational processes and patient flows.

One of the key workflows for our hospital was the relationship with ambulatory clinics. To enhance the flow of patient order and results, bi-directional communication was essential. A significant tactic to enable this was purchasing and implementing an interface engine. In a recent article – IT Performance Excellence, I highlighted how we used technology innovatively to make workflow easier and connect effectively with our doctors.

What about patient flow specifically?
The patient experience has changed significantly. With the advances that we have made, patients now have educational content they can access from our website; patients can pay bills on-line; patients have access to health calculators; and patients have access to a personal health manager. Basically, much more relevant information is now available to our patients in a convenient, accessible manner.

Another patient flow enhancement is the efficiency that they experience. Physicians have immediate access to a patient’s information. EMRs and healthcare integration technology have positively impacted efficiency, accuracy, and access – all which enhance the patient’s experience.

The physician’s experience has changed as well. The physician now orders requested patient tests electronically and receives the results back electronically in their EMR system. No paper, no scan … radiology, laboratory, etc. results are seamlessly received in a faster turnaround time. With these changes, quality is enhanced and greater efficiency realized, positively affecting both physicians and patients equally.

One of the ten lessons from the top 100 hospitals was that infrastructure is key to the future. What are your thoughts on that lesson?
In my view, infrastructure is a fundamental responsibility of IT. We need to advance, protect, secure, and unify it. Infrastructure is a very important piece of the puzzle. We need to deliver all of the elements that I just mentioned while ensuring that it is reliable. In the end, infrastructure translates to patient safety and quality.

What lessons have you learned in working through this process?
Two key lessons learned:  never give up or get discouraged, and never make excuses. 

On the “never give up” principle, there are many great people on my team and throughout this hospital that made the strategic plan happen. Their work and diligence enabled our achievements and recognition. Whether we realized it or not, we were all advancing the “flywheel,” and together we realized a significant transformation in how we deliver care in our community.

With the “never make excuses” principle, saying you cannot afford it is not an answer. There are good vendors willing to work with you. Find them. From medical content to health management to interface technology, we found great vendors willing to work with us.

This is a team effort across the spectrum:  people, physicians, patients, and partners.

What’s next?
We are done celebrating. We want to continue our success, so we have a number of initiatives to “keep pushing on the flywheel.” Initiatives include a new CPOE system, redesigning our website, electronic documentation, etc. We look forward to our work ahead.

AuntMinnie.com is running a series on surviving the Deficit Reduction Act (DRA). The first article was on Leading Your Imaging Center, and the second one was on Attaining Operational Excellence. The final article is entitled Deficit Reduction Act Survival Kit, Part 3 - Growing the Business.

This article is basic - Marketing 101 for Imaging Centers. Yes, a marketing plan, budget, and database are all good marketing elements. However, the most valid point of the article is “Get your house in order before you go out and market.”

The “get-your-house-in-order-first” point is really tied to the previous article on gaining operational excellence (e.g., improving your radiology workflow). Essentially, if your marketing message does not align with your operational capability, then you have wasted your marketing dollars and efforts.

Strategic relationships with referring physicians are critical. Combine that with efficient workflow to accept patient orders and quick turnaround times to deliver the patient reports, the physicians will likely increase the number of referrals being sent to your radiology practice. The message of efficiency, productivity, accuracy, and strong relationships will resonate loudly with that type of alignment between operations and marketing.

Again, it is taking the perspective of your clients and working back into your imaging operations. This approach is highlighted in an RT Image article that we wrote entitled A Novel Approach: Turning Your Imaging Practice Outside In.

The AuntMinnie.com series has been good in that it has highlighted the importance of leadership, operational excellence, and strategic alignment in addressing DRA in a potentially effective manner, but it scratches the surface of what needs to be done. Dig deeper, and you can survive in this new environment.

As mentioned in a previous post, AuntMinnie.com is running a series on surviving the Deficit Reduction Act (DRA). The second in the series is entitled Deficit Reduction Act Survival Kit, Part 2 - Attaining Operational Excellence. The interesting points of this article include:

• Target small, incremental changes. With this approach, the multiple small improvement steps taken will lead to a large improvement in imaging center operations and in radiology workflow.
• To gain the incremental changes, focus on the workflow. Identify the gaps; determine the root causes; and implement the changes.
• Focus on three operational components:
  • Access and service
  • Capacity and throughput
  • Revenue cycle

From an integrated radiology workflow perspective, patient report turnaround times (TAT) and billing efficiency are two key areas which will lead to large payoffs in efficiencies. 

TAT.  According to the article, two of the top reasons for a referring physician to send patients to an imaging center are quick scheduling and fast TAT on getting the report. The HL7 standard can facilitate improved TAT with scheduling patients and delivering patient reports to the referring physician. HL7 provides the language in which to communicate the information, but electronic communication exchange will quicken the interactions. Scheduling patients and reporting patient radiology results can easily be enhanced by using an interface engine. Simply stated, it will orchestrate the communication and streamline the workflow.

Billing efficiency.  HL7 can be used to capture patient demographic and charge capture data in the billing workflow. If your radiology practice is collecting this information manually today, enabling the electronic flow of this data will deliver tangible dividends in increased productivity and increased cash flow.

AuntMinnie.com is running a series on surviving the Deficit Reduction Act (DRA). The first article in the series is entitled Deficit Reduction Act Survival Kit, Part 1 - Leading Your Imaging Center. DRA is driving articles and best practice suggestions on how to enhance the operations of a radiology practice to soften its impact. Some of DRA’s impacts are highlighted in a previous post.

This article focuses on the importance of leadership and culture within an imaging center. Some of the key points include:

• Understand the culture of your radiology practice - organizations with defined cultures generally perform better
• Establish a flexible decision-based framework for gaining consensus
• Lead to motivate people toward a vision and drive change
• Manage, drive, and monitor activities to support the goals

To gain further insights on how to innovate your radiology practice’s approach and enhance your radiology workflow, check out an article that we wrote on turning your imaging practice outside in.