Q&A: How workflows are evolving—and how radiologists can keep up

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 - Tessa S. Cook, MD, PhD
Tessa S. Cook, MD, PhD
Source: pennmedicine.org

It’s no secret that workflows in radiology are changing. A number of factors are impacting interpretation volume, while cutting-edge technologies are transforming how radiologists work.

Tessa Cook, MD, PhD, assistant professor of radiology at the Hospital of the University of Pennsylvania and Director of the Center for Translational Imaging Informatics, has been focused on improving workflows and tapping into analytics to increase efficiencies. She’s written and spoken on the topic on numerous occasions, and is currently working with colleague Hanna Zafar, MD, MHS, on the  Automated Radiology Recommendation Tracking Engine (ARRTE), a tool to help specify the modality and timing of follow-up for indeterminate and suspicious lesions.

Health Imaging recently spoke with Cook to get her insights on how workflow have changed in recent years and what technologies are essential on the road ahead:

How have workflows in radiology changed in recent years?

Tessa Cook: In recent years, the volumes have increased and those have definitely brought workflow challenges to radiology. One of the things that happened in the last 10 to 15 years has been the introduction of voice-recognition, PACS, virtual elimination of transcription…the majority of folks are trending towards electronic solutions. As part of that, we have been able to accommodate more volume, and the combination of more volume—or electronic solutions enabling more volume leading to the need for more electronic solutions—has really been one of the biggest changes in workflow.

That increase in volume no doubt presents challenges. What are some other hurdles related to imaging workflows?

TC: That extra workload has demanded us to be more efficient and more productive. Now, because there’s increased input at the beginning of the pipeline, if you will, we still need to keep up.

One of the challenges that the more senior radiologists will quote you is they never used to be the report editors. They used to dictate onto tape, since a transcriptionist would make sure [the report] was all correct and send it back to them to sign off. Now, when we dictate “male,” voice recognition may insert “female” into the report. That reliance [on transcriptionists] making sure the report is accurate for sometimes very simple things is now falling on the radiologist. That causes inefficiencies.

Another thing that we spend inordinate amounts of time on is trying to get hold of referring colleagues. Sometimes it is easy and sometimes it is extremely difficult, and it can really throw your workflow and efficiency for a loop if you’re spending time on the phone.

Other challenges include navigating a variety of electronic systems. There may be multiple places you have to look for information so that electronic transition that has given us a lot more information is also adding a number of potentially time-consuming steps to the job that we do.

On the topic of technologies, some may be increasing time burdens, but others are essential to efficient workflows. What capabilities are absolutely needed today?

TC: Customizable work lists. It’s pretty easy to say that if a study is ordered stat, it should be put at the top of the list. If it is not ordered stat, to put it below the stat cases. But there’s much more nuance and complexity to that.

For example, we at Penn are a level I Trauma Center, so we have our trauma cases, we have our emergency department cases, we have our inpatient cases—which could be stat cases or not—and then we have our outpatient cases. Even with our outpatient cases, you have patients that have doctor’s appointments later that day coming in the morning for imaging; their study needs to be interpreted by late morning or early afternoon. That’s because their physicians, in an effort to make it convenient for them, have set up both imaging and clinic appointments on the same day. That makes a lot of sense, but we need our work lists to communicate that, otherwise we have no way of knowing if one outpatient actually needs to get interpreted before some other outpatient. Smart work lists are absolutely critical.

[Communication is] something we spent so much of our time on. There are a lot of solutions out there, both electronic and otherwise. Establishing asynchronous communication with referring providers is usually about noncritical findings. If there’s an acute bleed or a similarly urgent finding, you pick up the phone and call, but for findings like pulmonary nodules and incidental