An ongoing trend to consolidate clinical information at the point of patient care, the need to minimize equipment and system downtime, and growing interest in tracking trends and patterns are a few of the factors driving the use of digital dashboards in radiology. Products designed for specific roles within the imaging chain are assisting practices, hospitals and imaging centers with the management of volume and growth. Meanwhile, further developments are in the works.
Leslie Beidleman, regional PACS administrator for Mercy Health Partners in Toledo, Ohio, has been monitoring running processes, stored data and logged-in users for about two years using the Carestream Digital Dashboard. These are important metrics for an organization running and storing about 400,000 exams across three facilities annually. For example, Beidleman recently saw an escalation in the number of studies not backed up. By contacting Carestream technical support, she found out the exact nature of the problem. “I don’t know if I would have caught on so quickly without the dashboard.” And, of course the goal is to “catch something early—before any service is affected.”
A simplified process is one of the biggest benefits for Beidleman. The tools let users pick and choose which tasks to add into the system. “I have the flexibility to add what I want, I’m not locked into a certain set of tasks that comes with the product.” Some of her tasks have made it easier to provide management with feedback on certain criteria. Plus, the simple interface lets others easily step in to monitor systems in her absence.
Metrics let users display a modality and related data such as volume by hour and workflow patterns. Since Beidleman is responsible for three different facilities, the dashboard helps her effectively monitor image and data storage. “I can get a report on whether we are growing, declining or staying the same,” she says. That also helps with projecting future storage needs. “Having the capability to look at [data] drives and see how they are filling up lets me be much more proactive.” She could spend time compiling information, but the dashboard already provides interactive, graphed displays.
The right role
Jim Busch, MD, CEO of Specialty Networks, the IT arm of Diagnostic Radiology Consultants, a 10-radiologist practice in Chattanooga, Tenn., uses Portal Radiologist from Siemens Medical Solutions. He likes the role-based design user interface that interacts with RIS, PACS and voice recognition. Since a RIS typically is designed for everybody who would interact with it, it includes features and functions for everyone from schedulers to technologists to administrative staff. Those details can be distracting for radiologists, he says. With a role-based tool, “the goal is to get 90 percent of what you use right in front of you and the rest just one click away.”
By linking with the practice’s integrated RIS/PACS solution, the portal has helped the group streamline the entire interpretation process. Exams can be autoloaded or selected, it automatically launches speech recognition software, and offers default reports and virtual reading rooms. Report turn-around time has dropped from up to several days for subspecialty reports to just one hour, and about 15 minutes for STAT and ER reports.
The practice is located in an area highly competitive in MRI, with seven magnets on the same stretch of road. The practice has realized 10 to 15 percent growth each of the last several years. And, since putting the dashboard in place, the group lost one radiologist and managed increased volume without replacing him or extending hours—thanks to a 35 percent increase in efficiency. “The synergy of the whole system is where you get a lot of this efficiency.”
Busch notes that a survey of referring physicians indicated that their biggest concerns were ease in scheduling exams and how fast they can get the reports. With a financial interest in some outpatient facilities, “we wanted to use our system as a market differentiator to boost the business. It’s been amazing for that.”
Busch anticipates the release of more portals designed for each of the stakeholders in the imaging chain such as radiology administrators, PACS administrators and IT folks. “In a competitive market, that gives you an advantage. It definitely makes a big difference on anyone interacting with it.” The newest role-based portals expected later this summer will allow for snapshots of the enterprise and a look at key indicators most important to each specific user.
Jake Nunn, director of Metro Region Imaging Services for Aurora Health Care, headquartered in Milwaukee, Wis., has been using Blue Ocean from Exogen since last December.
As a certified stroke center, Nunn has to carefully track critical test result reporting. For example, to comply with certification, head CT scans for stroke patients must be completed within 45 minutes of an order. The Blue Ocean real-time portal helps ensure that the test is happening in a timely manner. “If not, we can intervene to make them more timely.” If the test isn’t begun within 10 minutes of the order, the system offers an alert. If the study hasn’t begun within 20 minutes, the system provides a red alert.
“A retrospective dashboard can’t do that for you,” says Nunn. “Instead of me looking at a retrospective report telling me I missed two of these last week, here I have a tool that helps me prevent them in the first place.”
Nunn also appreciates Blue Ocean’s flexibility. “The way [the tool is] structured, it’s easy to meet the needs of different organizations. We’ll have evolving needs as we seek other accreditations or as other indicators become important to us.”
Blue Ocean has helped Nunn engage employees in helping to improve metrics. Rather than reviewing their performance retrospectively in a “big brother” way, administration and staff can partner to improve. “Staff can see problems as they are occurring and help us fix them. It’s a real different way to work,” Nunn says. “The concept has been to have it available in our control areas for each modality so that staff can see it and the charge person for the day can use it for scheduling and managing workflow.” Depending on the user’s responsibilities, he or she can focus on particular areas of interest and always be able to click down to actionable information.
A grip on growth
Aside from managing current operations, dashboard-like products can help businesses prepare for and track growth. Kevin Johnson, president of Midtown Imaging in West Palm Beach, Fla., has been using the Referral Marketing Manager from Integrated Document Solutions for more than three years.
“From a marketing strategy standpoint, I use it to track referrals,” he says, including managing the organization’s marketers. “Imaging is a referral-based business. If you don’t know where your referrals are coming from, you’re missing opportunities and revenue.” Midtown Imaging has grown by about 15 to 20 percent a year over the past three years. Thanks to focused marketing efforts, the group has been able to successfully open new facilities.
Johnson next hopes to implement a “leads manager.” “We have the ability to track, on any given day or month, where referrals are coming from. I’d like to see that information tied into our payor mix to assess profitability of those referring cases.” He has been working with IDS on a beta test program which continues to evolve and include such tools as report turn-around time tracking, trend and lead reporting and questionnaires. “By using this and exposing the information to managers and marketers, we provide the next generation of ideas through continual use.”
The future of digital dashboards promises even more capability. Even in just the next three to four years, “it will probably be unthinkable that people will be working without [a dashboard],” says Rik Primo, director of marketing and strategic relationships for the imaging knowledge management business of Siemens Medical Solutions.
He says the next step is data mining unstructured data. That ability would tie together problems such as a down scanner with a referring physician’s complaint about scheduling problems. Traditional systems might take weeks to alert administrators of a link between the two. Data mining would allow for earlier notification of problems and trends. Advanced computer algorithms can pick up subtle trends and patterns much earlier than current systems can. Database mining has been in use in other industries for many years, Primo points out. In healthcare, “data mining combined with portals will definitely make inroads. The fact is that most hospitals don’t even realize the potential of data mining for their operations.”
Yaniv Dagan, president of Integrated Document Solutions, anticipates even greater competition in the imaging industry in the future. “Demand is increasing and reimbursement is decreasing. Only the most sophisticated and well-organized organizations are going to be able to win the business and run those centers successfully.”
Since the number of facilities that offer MR and CT studies will only increase, “it’s the consistency level in customer service and how well you maintain your referral community that will make the difference. That requires that facilities respond daily, if not hourly, he says. “You need to thrive on information that comes in real time.”
|Dashboard Developments: Getting Proactive|
|Digital dashboards peer into the raw data underneath the various, disparate systems in use at most organizations, pulling the information and presenting it on screen, explains Charles Morris, senior engineering specialist for Agfa HealthCare. That’s important, he says, because most clients have very diverse IT landscapes with scattered information.|
And now that RIS and PACS have developed to a certain level of functionality, “people are looking to further improve uptime of these solutions and further improve workflow by making better use of them,” says Rik Primo, director of marketing and strategic relationships for the imaging knowledge management business for Siemens Medical Solutions.
Jennifer Beachel, product line manager for Carestream Health HCIS Business Management, agrees. “I think there’s a lot of pressure on system administrators to have virtually no downtime on equipment. That causes interruptions to workflow and costs hospitals money. They need to work toward as close to 100 percent uptime as possible.”
The ability to be proactive is a key driver of the interest in digital dashboards. “We’ve really shifted the role from being reactive to proactive,” says Beachel. “With this information automatically populating an easy-to-interpret interface, users can stay ahead of any potential bottlenecks. That’s going to help minimize system downtime and negative impact to workflow.”
Having data available on a daily basis, literally at the fingertips, lets users intervene before small problems become much larger. Waiting for quarterly reports, for example, means “you’re working blind for three or four months,” says Primo. “You are presented with information that is months old and it’s too late to do anything about it.”
Being proactive also helps when it comes time to expand or upgrade and you have to choose new hardware including network connections. “You have to have a plan for that and you can only plan if you’re measuring,” says Primo.
Another plus of the dashboard is the ability to simplify information for both radiologists and referring physicians. “A radiologist doesn’t have to be expert in RIS to read a RIS report or a specialist in how exactly to access the 3D programs because they will be defaulted in that portal,” Primo says. Referring physicians only want to perform a few tasks. Rather than being familiar with different PACS and RIS solutions at several different facilities, the information relevant to them can basically be served on a plate.
Yaniv Dagan, president of Integrated Document Solutions, says the digital dashboard, or portal, provides a 1,000-foot view. In busy radiology practices, information often is trapped somewhere between the RIS and PACS, he says. A portal shows users accumulated information from the various systems, allowing them to act immediately. In an era when many groups or imaging centers are being acquired or are consolidating, there is a need to centralize information and a dashboard is a good way to achieve that goal. “Most of our dashboards are dynamic and show a lot of information to the right user at the right time,” Dagan says.
Although radiology is more advanced than any other element of healthcare, Dagan says, “we still have a lot of fragmented pieces. We are definitely tuned more and more to making it all work in one piece. That’s the trend we see and what we are responding to.”