Q&A: What CMIOs need to know about the radiology department
Common ground can unite disparate forces, even in a healthcare setting. Process optimization and meaningful measurements are two areas that are crucial to both CMIOs and radiologists, according to Hans-Peter Busch, MD, radiologist, professor and physicist. In a recent interview with CMIO, Busch, manager of the imaging center at Krankenhaus der Barmherzigen Brüder, a 600-bed hospital in Trier, Germany, said improved communication is also key to a solid working relationship between the CMIO and the radiology department.

Can you name a couple of things a CMIO needs to know—but might not know—about his or her radiology department?
CMIOs already understand that process optimization is essential—and attainable—in the radiology department. Efficiency will be increasingly important as payor models move from the fee-for-service model to payments that are tied to a course of treatment or even population health, as accountable care models are designed to achieve. By just performing good radiology, radiology departments cannot survive. They must be leaner than ever.

CMIOs need to know: How efficient is the radiology department? And what can they do to increase efficiencies further? My mantra is ‘measure everything,’ but there are a few figures that are key to help them determine what’s essential, what’s helpful and what’s unnecessary when implementing an optimization process.

Where should measuring start?
Measurable figures need to be defined beforehand—otherwise, generating figures is a waste of time. That’s where advanced RIS [radiology information system] comes into play. A basic RIS can help you view PACS and reports, but to measure productivity you have to have equipment for analysis.

A systematic utilization management survey is very important to prove how effective the process is working (measure – improve – measure – compare). It’s very important to measure the average daily workload and to adapt staff planning.

There are a lot of parameters to control in an imaging center. Some are very important, some useful, some nonsense. What you measure must have an influence on your decisions and strategies: Otherwise, it is a waste of time.

For example, whereas the patient’s quality of medical care is hard to assess in each case, the quality of service (employees, environment and organization) is commonly a representative factor for medical quality. A high quality of service is demanded not only by the patients and referring physicians but also by the health insurance funds (i.e., waiting times). The service quality can be measured and compared by figures (time parameters, patient experiences and referring physician surveys).

What can a CMIO/health IT department do to foster communication with radiologists?
The basis for successful management is intensive, open and systematic communication.

It's important for IT leaders to hear from the radiology department on a daily basis, to be "present." Regular meetings should be scheduled, in advance, for the entire year. A monthly conference should take place to discuss the actual situation with defined parameters.

CMIOs must be goal-oriented and have transparent and clear objectives, and radiologists must have full confidence in their abilities for a successful partnership. Most importantly, CMIOs must measure success in the areas of medical quality, service quality, and cost-effectiveness. It is important to continually optimize and re-evaluate the processes and structures.

Do you believe EMRs are being optimized with radiology (image exchange) in mind?
We are now forced by economics to engage in a new strategy: To think in total processes (and to pay for it) and not in single exam or treatment steps. This is a change in paradigm and of course a challenge for all.

There is a concern in the industry that radiologists do not have the infrastructure to separately invoice EMRs, so many radiologists have formed EMR groups internally or around their countries, partnerships or incorporations. This allows improved EMR organization for clinical, administrative and financial reasons.

On the clinical side, there are new tools out there that pull information from the EMR, radiological scans, patient vitals, etc., directly into the point-of-care patient monitor, so that’s an excellent step in the right direction. EMRs are the way of the future and an optimal configuration of HIS, RIS and PACS are necessary.

Are there initiatives or new technologies on the horizon that will require CMIOs and radiologists to collaborate?
The trend is already for greater collaboration—not just with CMIOs and radiologists, but with the CMIO and all hospital departments. In order to achieve full system optimization and improved patient care, we simply must communicate more and better and with the overall organizational strategy in mind. Incentives must be aligned and key pre-determined measurements of success must be understood by all so that they can be acted upon. This is crucial for success.