Science session studies productivity and workflow
The featured scientific session at SIIM 2007 in Providence, R.I., on Saturday was productivity and workflow. Several speakers covered a variety of topics related to making improvements.

Rock Young, RIS manager at the University of Maryland Medical Center, discussed his efforts to implement IT policies based on proven operational standards. IT practices enacted by financial institutions have proved successful, he said, and should be applied to radiology.

The fundamentals of business impact analysis (BIA) can help address specific problems, Young said. For example, you need to consider the cause, impact and cost of each problem. If there are problems with image acquisition, the cause might be dated infrastructure. The impact is slowed or even halted business operations. The cost can be calculated by adding up the reimbursement for all the exams that aren’t being completed. 

Another common problem is that exams are languishing within RIS/PACS. The cause might be insufficient notification tools. The impact is on timely reporting, more inquiries from referring physicians and a perception of inefficiency from referring physicians. The cost is delayed billing and radiologists’ time. In this case, Young created an undictated website to show outstanding studies. The website is integrated into the PACS environment and allows for reporting across all specialties. It didn’t long for the time to finalization for reports to improve.

Young said that anyone can use free, open source tools available on the internet to improve reporting metrics. “Focus on minimal disruption and always consider BIA,” he said.

A more focused “Google” type of search engine for radiologists would help increase their productivity, said Khan Siddiqui, MD, chief of imaging informatics and cardiac CT and MRI at the University of Maryland School of Medicine and the VA Medical Center in Maryland. “Physicians do Google searches but it’s more relevant for patients since more patients use the engine,” he said.

He and his team wondered if they could filter content so that radiologists can more easily search for information and reference it. That would include the ability to look up book sections online rather than requiring that radiologists spend time flipping through the pages of reference books in their offices. The key is to match people with relevant information, Siddiqui said.

Some say that the majority of information on the web is hidden behind forms, he said, so a special crawler is required to get information. Siddiqui and his team showed Google MIRC (Medical Imaging Resource Center) at RSNA 2006. However, this engine has very little content compared to the more than 10 million pages on regular Google. Siddiqui said work on the engine continues to add meaning to the elements on a web page, and add semantics to content pages via URL analysis, content ranking and content filters.

Jeffrey Breedlove, PACS administrator at Haywood Regional Medical Center in Clyde, N.C., reported on his facility’s experience with improving radiologist productivity through PACS automated reporting, voice recognition and network enhancement. After going live
with a PACS in August, 2004, and utilization review reporting in July, 2005, Breedlove said that his facility’s radiologist experienced faster turnaround times, quicker access to current and prior exams and fewer interruptions.

Going live with voice recognition took a lot of time and patience from everyone, Breedlove cautioned. But, now the report turnaround time average 30-40 minutes from the time an exam is ordered.

Breedlove and his team also made network enhancements to increase network speed and efficiency, and lay the framework for future equipment needs. He talked about honing in on one step in the process of restoring a case from the archive to save 15 seconds. When you consider all the studies that required restoration, those 15 seconds each add up to 333 hours a year.

Breedlove recommended to his audience that they use all the features of their PACS if they want to improve their productivity and workflow in all areas.

Nabile Safdar, MD, University of Maryland School of Medicine, said that with the increasing emphasis on quality in healthcare, reading room design often is passed over. One problem is that many people are quick to think that improving workspace design is just a way of pampering radiologists, he said. Since designing a good reading room isn’t in anyone’s job description, poor conditions are common. However, a room with shortcomings, such as being too dark or too light, can impact clinical care. Sub-optimal brightness, for example, causes fatigue which can lead to errors.

The reading room is “often the face of your practice,” Safdar said. “If it’s poorly designed, others will think that quality is not a priority.”

Many other fields have recognized that ergonomics and workspace setup is an area important to productivity and workflow, he said. Designing a reading room is challenging because highly variable tasks are performed there, from collaborative efforts to long periods of solitary work.

Safdar recommended that anyone who is experiencing less than ideal working conditions take on improving the design of the reading room. Everything from the chairs to the temperature to footrests impact radiologists, he said. Even small changes can make a big difference.

Parham Pezeshk, MD, Center for Evidence-Based Imaging at Brigham & Women’s Hospital, Boston discussed his facility’s experience with a notification portal used to improve radiology report turnaround times. There were two phase. The passive phase involved offering financial incentives for radiologists to finalize reports in less than 8 hours and less than 16 hours. The specifics on the incentive was worked out with the hospital’s administration. The passive phase resulted in 50 percent of reports being turned around in less than 8 hours and 80 percent in less than 16 hours. The next phase was the active phase. This involved an autopage system that alerted radiologists when a set number of reports was ready for finalization. Pezeshk said that the notification portal can be a very useful tool to improve report turnaround times.