NeoTool — Singular Focus, Healthcare Integrated

A recent Radinformatics article entitled CIO at the Table highlights the fact that most radiology practices have not welcomed their CIOs to sit at the executive committee table. Nevertheless, research indicates that having the CIO at the management table will facilitate the practice’s growth more effectively.

Creating a competitive advantage for your radiology practice is critical in today’s market. Healthcare IT is a critical strategic element that can automate, streamline, enable, etc. radiology workflow. Having the CIO present at the business level can only help your radiology practice meet the growth and operational goals.

Many of the radiology practices we work with have a CIO who has a strong involvement in the operational discussions, and they have produced impressive results. The results can include improved turn around times (TAT), improved billing cycle times, or other elements of the radiology workflow.

The Radinformaticsarticle highlights some important insights about radiology CIOs, including the valuable role they can play and the skills they can bring to the management table.

In radiology particularly, there is alot of discussion around workflow. Streamlining radiology workflow creates even more conversations. Where there is talk is their action? Probably not to the degree that you would think… With such a flurry of words, the important point may be lost.

In my opinion, the important point is keep it simple. For your radiology workflow:

1. Document your current workflow
2. Document what you would like your workflow to look like
3. Identify the gaps
4. Adjust the workflow to close the gaps
5. Enable the flow

A little more detail on each:

Document your current workflow. Talk to the people involved in the key steps - from schedulers, physicians, radiologists, technologists, billing professionals, etc. Get the current workflow first-hand, from the people doing the work.

Document what you would like your workflow to look like. As you talk to people, ask for ideas on how to improve. Meet with key leaders in your organization to determine objectives. Most importantly, talk to the physicians who receive the results that you deliver. Get the customer feedback!

Identify the gaps. What are the key differences between the way you do it today and the way you would like it done? Again, more importantly, what is the way your customers want it done - both patients and physicians?

Adjust the workflow to close the gaps. Not all of the gaps can be closed simply. Identify the high impact - low implementation effort items and do those first. For the others, develop a plan of how to close the gaps and continue to implement to the defined goals. Communicate your results along the way!

Enable the flow. Some activities in the workflow will require no technology. Others will require technology investments. Look for ways to automate the radiology workflow, simplify the steps, and deliver value to the people doing the work throughout the process. Look for ways to leverage technology for the improvements that enhance patient quality, enhance radiologist productivity, and deliver real service to the referring physician community.

There are many ways to improve your workflow, but the best way is to get started… with the basics.

A recent article in Radinformatics highlighted the radiology workflow of one of our customers - EPIC Imaging. The article is entitled Look, No Hands: Reports Go Directly to Referrer EMRs. 

As the title implies, the article is about how EPIC Imaging implemented an electronic means to connect with various referring physician practices and send patient reports quickly, efficiently, and accurately. John Griffith is the CIO at EPIC Imaging, and he and his team have taken the initiative to solve the radiology workflow and operational challenge.

A few highlights from the article:

• Addressing Physician Requirements:  “The physicians wanted the reports to show up automatically in each patient’s electronic medical record (EMR). They wanted to open the patient’s EMR and have the report right there waiting for them, with no staff time spent clicking links or handling paper.”
• Maintaining High Service Levels:  “We have been held as the gold standard for providing service… but Epic administrators knew that if they were to retain that gold-standard mark in the face of increasing competition, they would have to answer the demand for electronic report delivery.”
• Delivering to the Physician - Choices:  “We could not have used a Web-based system because the physician would still have had to log in, look up the patient, and move the report into the chart… The demand was to get that report seamlessly into the chart with very little human interaction.”
• Leveraging Healthcare Interfaces:  “We had an existing interface that was sending results from our RIS to our PACS. We redirected that results feed to the NeoTool engine, and then NeoTool forwarded the report from there onto the PACS… Then, Epic constructed a rules base to tell NeoTool how to route the report to the referring physician’s EMR and directly into the patient’s electronic folder.”
• Achieving Positive Impact: 
  • “Clients, once interfaces are complete, will find report delivery much more convenient. That means that Epic will probably retain their business, or get more of it.”
  • “Quicker, more direct reports mean that patient care can be expedited. From the standpoint of eliminating human intervention and becoming more solidly electronic, we improve patient care.”

Since the above bullets are just clips from the article, take a few minutes and read the article. It provides great insights into how EPIC Imaging (case study PDF) understood their physician requirements and addressed them in a creative and operationally-sound way while also - and importantly - improving the way patient care is delivered. 

Congratulations to John and his team!

The technology used in imaging centers and radiology practices is rapidly evolving. These technology changes affect both the front-end and back-end radiology workflows. The front-end workflows are affected by ever changing imaging and modality technology advancements while the back-end workflows are affected by advancements in information technology (IT). Keeping up with the changes can be a challenge.

The focus of this blog is the IT back-end radiology workflow changes. The goal of healthcare IT is to make all the systems work smoothly together or interoperate for organized, seamless data flow. The first step to achieving such goals is to understand your current workflow.

In an example imaging center, the workflow might be:

• Schedulers enter orders manually on the radiology information system (RIS) or orders move into the RIS electronically from external referring physicians or hospital systems.
• Those orders flow to various internal systems such as the picture archiving and communication systems (PACS) and Voice Recognition (VR).
• The images are acquired:
  • Modalities query the modality worklist manager (PACS).
  • Once the procedure is completed, images are returned to PACS.
• A radiologist reads the images and dictates the results into VR.
• A radiologist self-corrects and approves the reports.
• The reports are distributed to RIS, PACS, Billing and the applicable referring locations.

As is possible to observe in the example radiology workflow, in an imaging center, clinical data must move to and from multiple systems. Even though the workflow is unique for each imaging center, the need to transfer clinical data is not. The moving of data is where HL7 interfaces can make the most headway towards bridging the gap for interoperability and creating that organized, seamless data flow.

Using an HL7 integration approach to move clinical data between applications helps:

• Optimize information systems
• Reduce errors in multiple, manual entries
• Maximize radiology workflow
• Facilitate growth through an efficient workflow

Whatever applications and systems are used to perform the tasks necessary in your imaging center, there is still a need to make the data flow to the right place at the right time based on the capabilities of those systems. With greater requirements for RIS-driven workflow and data exchanges with referring physicians, the HL7 Standard plays a prominent role in automating the radiology workflow.

For addition information, read an interview with the CIO at Radiology Consultants of Iowa and watch a 15-minute web seminar on what role HL7 messaging can play in radiology workflows.

Many radiology practices are focusing on various radiology workflows to understand how to improve turn around times or increase efficiencies. Austin Radiological Association (ARA) focused on their billing workflow and highlighted their approach and success in a recent article entitled ARA Floats an Automated Billing Process… And Inhales. 

In the imagingBiz.com article, ARA discussed the old process and stated “We would touch each radiology report approximately six times to manually key demographics and charge transactions into the billing system.” They went on to describe the completely manual nature of their billing workflow that involved lots of people, pens, and paper.

By focusing on the workflow and determining best practice approach on how to automate it, ARA implemented a new way to deal with the billing process that has delivered big benefits. The primary benefits center around reduction of errors, expedited posting of revenues, and a leaner approach to getting the work done.

The technology applied to the workflow included a document scanning and storage application and an HL7 integration engine. Once the information is in a database, ARA will “push it through our interface engine, convert it to an HL-7 message, and upload it into our billing system.”

ARA is one of our customers. The article highlights, nonetheless, how a radiology workflow can be automated to drive real results. For additional information, please read a customer case study (PDF).

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.

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!

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.