Trend Tracker | Redefining Workflow with IT

In the eyes of radiologists, (the) image is everything. But to everyone else involved in the care of patients, the work that occurs before, during, and after the evaluation of the images is everything. Scheduling, patient info, orders, referrals, billing, reports - all depend on accurate and timely information that must be tightly linked to the images and patient record. Yes, all data must be secure and private, while remaining instantly accessible.

A huge annual investment in research and development of imaging equipment and contrast agents seeks to continually improve the ability of physicians to diagnose and treat diseases and disorders. New 64-slice CT, 3T MRI, digital x-ray, capsule imaging, PET and OCT systems - each of these devices produce images that are better than what we had just two or three years ago.

The work of radiologists also has changed in this period, as they are no longer chained to a lightbox - instead it's now a high-tech chain in the disguise of a workstation. New tools for radiologists also include imaging software - a little bit of CAD, and some occasional 3D and simple image processing - now that a fellow is no longer required to translate the user manual for clinical applications.

However, the introduction of computer networks and image archives - PACS - has begun to change the current focus in this market. Leading-edge thinking is now concentrated on workflow, not images. This brings healthcare IT into every discussion regarding product selection. So, vendors, the question is - got IT?


Common problems are now easily fixed with IT solutions, if you make sure that all components of your equipment and work have the necessary capability to support it.

  1. Multiple entry of demographic data. How many times should the patient's name be entered into any system? The only correct answer is once, but a better answer is never (it should be selected from a list).  So, no matter where the patient makes first contact with a system, every supporting system involved in the episode of care should have the patient demographic data driven to it. The vision is no more keyboards, just a mouse as your sole PC interface. DICOM Modality Worklist is an important feature of any imaging modality, but IHE Scheduled Workflow support is now the current standard for enterprise support.
  2. Access to reports and results. Everyone wants to know the status or outcome of a study, instantly, even if the results are preliminary. Every time I have a relative receiving imaging exams, I ask the tech for their quick call - most of the time, I learn what I need to know, which is confirmed a day later through official channels. Email and web access to reports makes this go faster, just make sure that status reporting is part of your work process.
  3. Unnecessary repeat studies. All studies on the network should cut this down to almost nothing.
  4. Resource management. If you want to buy a new CT scanner or jettison an old x-ray room, you need data to back it up. Similarly, your superstar docs and techs may be carrying some slackers in your organization. Again, let's see the performance data. Previously, gathering the data was more trouble than it was worth. Today, a few clicks and you're done, assuming you've built this into your current systems.
  5. Billing. Anyone who misses this opportunity to have charges posted automatically, based on procedures completed and reports issued, is in need of a transfer - to the non-profit sector.
  6. Data gathering and analysis. Clinical trials, registries, outcomes monitoring - all these efforts depend on simplified gathering and export of relevant data, so the systems need flexibility to support these requirements, especially as they are expected to only grow in the future.

If you thought DICOM was the answer 10 years ago to the question of open vs. closed imaging systems, then it is once again time to wake up and ask the same question about your networks - are they closed or open to the need to have a free and coherent flow of information that supports the delivery of patient care in today's networked and mobile society?

RSNA and HIMSS are moving aggressively to develop and demonstrate the benefits of IHE (Integrating the Healthcare Enterprise) integration profiles, which can be used to solve problems. But the burden is now shifting to users and vendors to use IHE and other tools to solve problems. They are the ones who must decide if they want the full benefits of a move to enterprise level networks and the changes in work processes that can be achieved. This is far more substantial than an integrated RIS/PACS decision - it requires a global look at the entire process of radiology, which starts long before the phone call to schedule an exam.

The current headlines of choice for pushing aggressive investments in healthcare IT are a desire for electronic healthcare records (EHRs) followed closely by a promised reduction in medical errors. But the real story for hospitals with tight operations and limited budgets are the significant productivity and workflow benefits that can be achieved via a smart and tactical approach to using networks and IT. If you want to do more with less - get IT.

Douglas F. Orr is principal of J&M Group. Send Trend Tracker questions and comments to