Driving with the Digital Dashboard Lights On

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Screen shot source: Carestream Digital Dashboard
Recent requirements from the Joint Commission and the American College of Radiology (ACR) add to the growing number of quality demands being placed upon radiology departments. In an increasingly complex regulatory and financial environment, comprehensive quality management processes are essential. The digital dashboard holds the answers to today’s problems—if you only you dare to fully utilize them.

Fortunately, growing along with these regulations and the increasingly urgent need to closely track economics and operations are dashboard technologies that can assist with the deluge of data constantly streaming within a department. Adopting a digital dashboard in a radiology facility or department can help increase transparency for managers looking to keep up with their practice’s day-to-day operations and be a step ahead in making needed changes. It’s the dashboard’s job to track metrics such as physician productivity, staffing, referrals, scanner utilization, patient volumes and wait times, and much more—and the administrator’s job to change what isn’t working well.

Reduced costs, better resource allocation

Digital dashboarding uses data mining techniques to continuously, automatically process and visually display custom-set key performance indicators (KPIs) that provide operational data for a practices, departments or group facilities. Paul G. Nagy, PhD, associate professor of diagnostic radiology and nuclear medicine in the department of diagnostic imaging at the University of Maryland School of Medicine (UMD) in Baltimore, says dashboards not only give managers a greater holistic view of their practice, but also reduce costs and can improve productivity.

For example, the University of Pittsburgh Medical Center (UPMC), in a study led by Matthew B. Morgan, MD, and colleagues from early 2003 to December 2005, found that the use of an internal, integrated dashboard system decreased the average turnaround time for signing reports from 22.5 hours prior to integration to 17.7 hours after—a reduction of 24 percent. “There’s a challenge that a lot of professionals face in that there’s a lot of information coming in on both the system administrator and the clinical sides. Dashboards can be a relief to that. This is an attempt to get into a clinical picture to the workflow of the radiologist,” says Morgan, now an assistant professor in the department of radiology of the University of Utah School of Medicine in Salt Lake City.

“Using paper-based reporting mechanisms to see how practices are operating is like driving with your rearview mirror,” asserts Nagy. “If you look at existing practices, there’s a lot of time collecting data and not much time looking at that data since people are so exhausted from the actual act of collecting. With use of clinical information systems, we have the opportunity to leverage radiology business architecture.”

Using an in-house, web-based dashboard, Nagy and colleagues at UMD implemented a system they call RadDash three years ago that extracts data tied into patient and physician satisfaction measures from the radiology department’s RIS, PACS, CPOE and speech recognition systems. These KPIs include patient wait time, scanner access time, report turnaround time and modality efficiency among other coupled services across the department.

Nagy and colleagues conducted a 24-month study at UMD—presented at the Radiological Society of North American 2009 annual meeting—that found the average report turnaround time improved from under 10 percent of reports signed within two hours of completion in July 2007 to more than 45 percent of reports in June 2008 after adopting the digital dashboard.

“A lot of the reduction in our turnaround and patient wait times is a result of redistributing existing resources,” says Nagy. For patient wait time, the volume and types of orders were examined in conjunction with the time of day they were ordered and adjusted accordingly to make patient wait times comparable.

“Unless you understand your workflow, you could continually find a backup of patients at a certain time in the workday,” says Nagy. “By looking at what procedures you perform and the resources they require, you can redistribute your resources without spending more or using overtime and be more effective and deliver care without having patients wait as long.”

Jonathan B. Kruskal, MD, PhD, chairman of the department of radiology at Beth Israel Deaconess Medical Center (BIDMC) in Boston says that a manager also can define the goals for a digital dashboard so he doesn’t have to constantly watch it.

According to Kruskal, BIDMC’s system notifies an appropriate manager when a metric hits a level within the pre-set warning threshold. “The beauty of having a digital environment is that I can look at the red flags alerted to me through my smartphone and drill down into the data to find and manage the cause,” says Kruskal.

But is it quality?

Kruskal and colleagues at BIDMC have utilized an internally built web-based digital dashboard for the last six years. He believes that digital dashboard utilization can be a positive experience for any radiology department that takes a risk and places KPIs that include technical and physician metrics out into the open. “All that down and dirty data, like employee injuries, are indicators that most are afraid to display as they might worry about the medical consequences of the data on the facility and their careers,” says Kruskal.

However, Kruskal encourages quality and safety data transparency, as he believes that an appropriate use of a transparent facility will improve the quality of care and increase participation from physicians. BIDMC uses its web-based dashboard to show the department’s progress as it moves towards its annual goals. It’s also used as an anonymous peer review metric where data are linked up with national benchmarks and fosters an honest dialogue among physicians.

“Some of the information on a dashboard is not always comfortable, but a high level of transparency helps align everyone with the problems facing the department,” says Nagy. “The transparency helps promote camaraderie, indicating that everyone is on the same team and the department is moving forward.”

“Generally, I’ve seen the process take two to three years before physicians buy in and are reporting mistakes,” says Kruskal. “Unless you have a fair, open forum, a digital dashboard is hard to employ and use effectively.”

Morgan admits that metrics and KPIs are generally specific goals to be attained by a certain department. The dashboard is helpful to administrators who want to exert more influence over the clinical decision process and interdepartmental communication, since it’s like a messaging service overlaying workflow, says Morgan.

Kruskal warns the technology should not be adopted just for adoption’s sake, but as a means to achieve the practice’s visionary goals. In a yet-to-be published paper, Kruskal and fellow BIDMC  colleague Allen W. Reedy write that “[W]hen the quantity and range of indicators that are tracked increases, so too do the resources required to gather the information and the focus required to sift through indicators to select the most important measures to follow.  In contrast, a properly targeted and organized set of indicators will lead a leadership team to the most important problems or opportunities to be addressed. The best way to create the most valuable set of KPIs is to derive them from the strategic planning process.”

For Nagy, some quality initiatives are determined by outside regulations or they are internally driven based upon expectation of service and how UMD wants to optimize its resources. Nagy and Kruskal both stress that a digital dashboard is more effective when the metrics are taken as a whole. “At UMD, we look at all our processes through the lenses of quality, performance and productivity,” says Nagy. “But if you only look at productivity, you’re not going to align yourself to the organizational mission that you think you are. In combination, these lenses provide a holistic view to improve the facility; otherwise you’re pushing the problem to a different area instead of solving it.”

The compass

“Dashboarding is merely an empowering tool for management,” says Nagy. “It’s not the dashboard that drives the change in the organization—it makes the department more transparent. That allows management to be more effective and engaged in root causes of poor processes.”

However, if they are committed to leadership and desire to be introspective, managers would do well to adopt this technology, says Nagy. “Managers have consequently become far more engaged in understanding the art of delivering high performance in radiology because of dashboarding.  It teaches them not to shortchange the process.”