Article

Why Efficiency is Important in Radiology

Would you consider having a significant medical procedure based only on the physician's visual examination and evaluation of symptoms? Once, that was the only alternative. Today, radiology provides a clear idea of what is going on inside the patient’s body, for prudent treatment planning and evaluation of effectiveness. Since the first medical X-ray was taken in 1895, radiology has become a driving force in advancements in medical diagnosis and disease management. Continually increased reliance on imaging emphasizes the need for efficiency in radiology.

Volumetric growth

In 2019, UCSF (University of California San Francisco) reported on a study of more than 135 million imaging exams conducted at UC Davis, UC San Francisco, and Kaiser Permanente. The study revealed that growth in computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine increased from 307 per 1,000 of the population aged 18-64 in 2000 to 513 by the year 2016. During the same time frame, usage increased from 684 to 1,126 per 1,000 individuals aged 65 and older.1 That growth rate makes a strong case for efficiency.

Benefits of improved efficiency

Efficiency is an acknowledged concept in America’s fast-paced culture. Yet in a bustling radiology department, it helps to step back and take a fresh look at the tangible and intangible benefits of simplified workflows.

Operational economics is the primary tangible benefit. While imaging volume is rising, reimbursement is going down. A 2017 Modern Healthcare2 report cites hospital revenues constricted by a shift from higher-margin inpatient procedures to outpatient care. The article also indicates a trend toward lower-premium/higher-deductible health plans as an outcropping of the Affordable Care Act3, which could increase bad debt for healthcare providers.

Those factors bring greater importance to efficient operations. Resourceful processes improve productivity, keeping costs down by allowing fewer personnel to accommodate more patients and read more images. Ongoing efficiencies preserve the viability of the radiology department and the jobs within it.

Staff morale is another advantage of improved efficiency. Effectual workflows help to alleviate visual and physical fatigue and decision-making stressors to which the radiology team is subjected.

Turnaround time, from order request to the radiologist’s sign-off of the final report is a benchmark metric of care. Turnaround is especially relevant in an emergency department setting, where every minute is vital to the patient's outcome - a fact of which the radiologist is keenly aware.

Efficiency leads to faster discovery of critical findings. It can improve the uniformity of images and accuracy, thus lessening the emotional strain of errors, discrepancies, and rescans.

Pain points

There are three key areas where the most impact can be achieved from an efficient radiology value stream (the production line culminating with the radiology report).

It starts with the order. A radiologist needs more patient history than "pain" or "MVA" to deliver meaningful results. When the order is lacking relevant information, preparation for the exam generally requires inefficient fact-finding. This extended preparation time may include a call to the ordering physician or logging into an EMR (electronic medical records database).

This bottleneck can be improved with protocols for standardization of orders before exams are placed into the work queue. In addition, software systems, sometimes called "sidecars" are available. They dovetail with existing data application platforms, pulling information from EMRs, which is then provided to the radiologist in real-time, as the test comes up.

The worklist is the second potential for inefficiency in the radiology value stream. In a conventional setting, radiologists spend a significant portion of their time scanning the worklist and prioritizing cases. Interruptions, such as ordering physicians calling to request a quick diagnostic interpretation for a patient on another worklist, are a further hindrance to efficiency.

Integrated workflow software identifies and prioritizes exams based on standards established by SLAs (service level agreements). This type of system feeds the next exam to the radiologist, without need for manual selection.

Reports are the third key to efficiency. Workflows should not impair the radiologist's need for flexibility in delivering results. However, standardized format, information, and language improve efficiency upstream (future orders related to this report) and downstream (billing and payment).

Streamlining strategy involves technology that limits the number of individual systems requiring log-in, reduces clicks, and incorporates natural language processing to transform dictation into actionable reports.

Radiology has earned its place as a key diagnostic tool, heavily relied upon by doctors and trusted and expected by patients. At the end of a busy day in the radiology department, that human element, the patient experience, is perhaps the most compelling impetus for improved efficiency. Concise reports for the referring physician expedite care for patients who are critically ill. Efficient processes allow the radiologist to concentrate with fewer distractions on vitally important cases, helping more patients get needed care more quickly.

References:

  1. Medical Imaging Rates Continue to Rise Despite Push to Reduce Their Use. University of California San Francisco. https://www.ucsf.edu/news/2019/09/415286/medical-imaging-rates-continue-rise-despite-push-reduce-their-use January 9, 2020.
  2. Low reimbursement, high expenses contribute to poor 2018 not-for-profit healthcare outlook. https://www.modernhealthcare.com/article/20171204/NEWS/171209962/low-reimbursement-high-expenses-contribute-to-poor-2018-not-for-profit-healthcare-outlook August 1, 2019.
  3. Affordable Care Act (ACA). HealthCare.gov. https://www.healthcare.gov/glossary/affordable-care-act/ August 1, 2019.