The Insider's Primer: Taming the Workflow Beast

Five Facilities Tell How

Workflow is the No. 1 challenge facing radiology departments and imaging centers focused on efficiency. Those that tame the workflow beast can list numerous positive outcomes: better service to referring physicians, shorter report turn-around time, increased satisfaction among staff and patients, and a healthy bottom line. On the other hand, sites that struggle with workflow may find themselves in a downward spiral losing patients, partners and profits. This month, Health Imaging & IT visits a few sites to learn more about specific workflow challenges and solutions.

Challenge #1
Transitioning to paperless radiology in a multi-site setting

Oregon Health Sciences University (OHSU) of Portland, Ore., a teaching hospital and tertiary referral center that completes 250,000 imaging studies annually, solved many of its workflow problems eight years ago when it deployed Agfa HealthCare Impax PACS. Early this year, the hospital supplemented the project, integrating the PACS with Agfa Impax RIS. Administrative Director of Radiology Erwin Schwartz believes the technology could help the multi-site enterprise transition to paperless radiology.

“We are geographically challenged; we provide imaging services in 12 locations in eight different buildings. Communications and protocolling are problematic,” says Schwartz. The OHSU radiology department protocols all exams. The previous information system limited the department to paper protocols, creating a protocol workflow akin to film. That is, each digital study was tied to a paper protocol.

Impax RIS enables online protocolling; the radiologist can create the protocol as soon as the exam is scheduled in the RIS. Plus, Impax PACS integration allows the radiologist to view prior images and use the information to fine-tune protocols as needed. “It boosts efficiency and patient care,” explains Schwartz.

Challenge #2
Timing tech adoption to maximize gains

Salinas Valley Memorial Hospital in Salinas, Calif., postponed its digital image management deployment for five years, waiting until 2007 to implement McKesson Corporation Horizon Medical Imaging PACS. The hospital optimized the situation, using the lengthy planning period to talk to end-users, begin soft-copy review in digital modalities and thoroughly analyze digital workflow.

Several issues stood out as the radiology department surveyed the landscape, says Tom Burnside, divisional director of diagnostic imaging.  First-generation PACS lacked a solution for paperwork. That is, paper continued to follow digital images, resulting in sub-optimal workflow. Second, early PACS did not offer a one-stop shop. 3D, PET fusion and cardiac nuclear medicine studies were not integrated into early PACS workstations. “The specialized workstation disrupts efficiency,” Burnside says. Finally, certain workflows, such as the ED/radiology workflow, presented unique workflow challenges.

Salinas Valley Memorial Hospital went live with PACS in 2007, slashing report turn-around time from 24 hours to between two and six hours. Paperwork is minimized. Radiologists use McKesson ER Discrepancy Tracking to agree or disagree with initial ER reads in a single click. Plus, information is automatically captured in a database for review and quality assurance. An interface with the Meditech RIS automatically sends PACS data to the RIS for streamlined billing. The interface also enables sharing of clinical data such as lab results between the RIS and PACS, minimizing the need for physicians to log onto multiple systems to access information. Finally, specialized applications including 3D and PET fusion are available on the PACS workstation, eliminating the need for workflow-busting specialized workstations.

Challenge #3
Integrating multiple PACS in the rural setting

Radiology Consultants of Iowa in Cedar Rapids, is a 25-radiologist practice providing professional services at 12 hospitals. Business is booming with radiologists reading 450,000 studies annually. CIO Joe Moore explains the group’s workflow challenges. “We try to maintain the focus on imaging services. Some of our hospitals are located two hours away. Radiologists were spending too much time on the road traveling to different sites. Plus, each hospital is outfitted with different image management technology. Radiologists were forced to learn to interface with a variety of applications.”

The answer seemed simple. A single umbrella PACS could consolidate studies into one worklist to reduce travel time, enable subspecialty review and level workflow over the course of a day.

The practice turned to NeoTool NeoIntegrate interface engine and Philips Healthcare iSite PACS in March 2005 to consolidate workflow. NeoIntegrate provides interfaces between iSite and eight different RIS and voice recognition systems to deliver a unified workflow.

The new workflow is characterized by a single, combined worklist. Exams are listed in the order received and identified as STAT or routed to subspecialists as necessary. Results include:

  • 87 percent of final reports are completed in less than 60 minutes
  • 85 percent of ER reads are completed in less than 30 minutes
  • 50 percent reduction in radiologists’ travel

“If a practice is focused on outcomes, radiologists can’t bounce around to different systems. They need to remain in one system to stay efficient,” sums Moore.

Challenge #4
Adjusting for seasonal spikes

Florida Medical Clinic, a 13-site outpatient practice headquartered in Zephyrills, Fla., sees a 50 percent increase in the local population between October and April every year. During the winter months, scan volume tends to increase 25 to 30 percent, says Patt Hurley, assistant practice administrator.

In 2006, the practice tapped into technology to help address its workflow challenges, deploying Sage Software Intergy EHR, Intergy PACS and Intergy RIS. Exam rooms are wired and outfitted with workstations for reviewing patient images and data. Intergy provides a unified patient record to allow physicians at all sites to view clinical data and images, enabling clinicians to provide timely, informed care as patients move between sites.

The workflow benefits of the deployment extend beyond physicians. With RIS/PACS, technologists no longer print and hang images. Integration between the PACS and RIS results in cleaner, more straightforward billing. “Everything is automatically verified between the systems. CPT and diagnostic codes are matched before bills are sent out,” explains Hurley. The improved billing results in fewer denied claims, which, in turn, saves time and improves workflow.

Challenge #5
Upgrading efficient workflow

Children’s Hospital of Alabama in Birmingham, Ala., is an integrated workflow pioneer. Five years ago, the hospital turned to Siemens Medical Solutions MagicSuite as a platform for RIS-driven integrated RIS/PACS workflow. The initial adoption delivered significant workflow gains, but as image volume increased, the hospital sought a next-generation solution. Early in 2008, it deployed the answer via a transition to Siemens syngo Suite PACS. The new platform offers a number of features that deliver workflow advantages, says PACS Administrator Lynn Odom, including rapid image loading, integrated voice recognition and a high degree of customization.

syngo Suite slashes retrieval time for archived images from a previous high of six to eight minutes to a few seconds, and it allows radiologists to begin review as studies load. The improved image load speed, in combination with other features, translates into significant workflow gains. For example, the new platform features syngo Voice, which allows radiologists to sign reports via voice and then immediately auto-faxes the report to attending physicians. As result, the radiology department trimmed average report turn-around time from 24 hours to four or five hours.

Other features that pack a workflow punch include user-friendly, customizable hanging protocols that allow radiologists to configure data in a way that supports the most rapid review. syngo Workflow also allows online critical results reporting to eliminate manual pulling of reports, and the Interactive Documents feature streamlines ED Discrepancy Tracking. Radiologists can electronically check a discrepancy box, and results are automatically printed for follow-up by the emergency department.

syngo Suite is a solution that can grow with the department, says Odom. “I can tweak the system to solve various workflow challenges as radiologists, clinicians and techs bring them to my attention.”

Workflow wisdom

  • Most PACS can handle basic workflow. The challenge is the 10 to 20 percent of workflow that is atypical. Make sure to test systems to determine if they can handle the workflow that falls outside the typical, says Schwartz.
  • PACS and RIS represent an opportunity to change workflow. Don’t take paper methods and translate them to the electronic world. Look at the deployment as an opportunity to change workflow for the better.
  • Set your sights high; look for ways to squeeze every ounce of efficiency out of the facility or department.
  • Some sites don’t utilize full PACS/RIS integration, says Burnside. Constant communication between the PACS and RIS sets the stage for streamlined workflow.
  • Look for a solution that can grow with the facility or department. The wisest investment provides a platform to address current and future workflow challenges.

Meeting the challenge

Workflow challenges present in all forms. Some are unique to specific institutions; many are common across settings, but all are solvable. Great efficiency can always be gained. It requires a commitment to identifying the specific needs of the facility or enterprise, and researching various systems to determine the optimal solution. The answer may require various solutions working in concert and ongoing refinement. The results, however, are well-worth the investment as facilities that stay on top of workflow report better service and satisfaction among staff and patients and a healthy bottom line.