“Being able to carve up the work so there’s accountability and a better level of attention to high clinical priority cases gives us a powerful one-two punch.”
- Dr. Matthew Brady, M.D. Diagnostic Radiologist, Roper Radiologists PA Charleston, SC
Roper Radiologists PA
Improving radiologists’ efficiency and contribution to patient care across a radiology practice.
Change Healthcare Workflow Intelligence
- 56% fewer ED cases slip through the cracks (ones longer than 45 minutes to read)
- 75-minute improvement in average turnaround time (TAT) for outlier studies in the ICU
- 50% fewer ICU studies read after 60 minutes
- 26% less work done after-hours
- Accumulated savings add up to 600 hours per year
Roper Radiologists PA is a highly sub-specialized private radiology practice of 25 radiologists in Charleston, South Carolina. They read 300,000 diagnostic imaging studies per year
The Challenge: Improving Efficiency Across A Radiology Practice
"The loss of control over your workday is a problem for any physician no matter what your specialty," says Dr. Matthew Brady, "In radiology, if you're totally disorganized with an unstructured worklist, and you're overwhelmed every day, that's a terrible situation." As radiology workflow becomes increasingly complex, Dr. Brady's practice, Roper Radiologists PA, faced challenges familiar to private groups and hospitals across the country: Distributing and assigning studies, work-life balance, optimizing sub-specialist use, and handling size and volume growth.
To regain control, radiologists at Roper turned first to the traditional filtering capabilities of their PACS worklist, but soon realized its inherent limits. Dr. Brady describes the worklist path as "fraught with pitfalls, unless you have a way to evolve those lists. You see only a certain subset of cases, with no visibility of urgent cases on someone else's list", he says. Another constraint was the lack of sophisticated analytics, which limited the practice's ability to make data-driven adjustments as their workflow changed over time.
The Solution: A Dynamic Worklist Reflects the Practice's Clinical and Operational Priorities
Eventually, the practice separated the concept of diagnostic viewing from workflow management, and searched for a different kind of solution. An interactive, dynamic worklist to orchestrate their workflow and help them measure the results.
They selected Change Healthcare Workflow Intelligence. This flexible rules engine offers a sophisticated prioritization model to manage a complex reading environment. It assigns each study a numbered priority (from 1-99), and then sends studies to the most appropriate and available resource. The solution continually reprioritizes and escalates studies in real time until they're complete. All the data is tracked and time-stamped so it can be analyzed to see what's working and what could be improved.
The solution went live in July 2017, in a process Brady describes as "structured, comprehensive, and smooth," and Roper saw improvements almost immediately.
The Result: Immediate Operational Improvements
Hospitals and radiology practices often use average turnaround times (TAT) as quantifiable benchmarks for improvement. But according to Dr. Brady, "If you look at the math, you'll quickly see that average turnaround times aren't the most useful measurement." Instead, he contends, looking at percentile breakoffs is much more telling. "Percentages, not an average," he says, "because it's inevitable that you end up with long tails - occasional outliers which are read a lot later than the majority."
ED turnaround times are one example that illustrates this situation. Roper's median TAT for ED cases were already excellent; in fact, they read 50 percent of their cases in less than ten minutes and 80 percent of their cases were complete within 22 minutes. But the turnarounds for ED outliers – cases over the 95th percentile – was longer than 49 minutes. And as Brady emphasizes, "Since our median ED turnarounds are extremely short, our median ED may not seem like a big deal. But those are real patients waiting for their results." Roper used the flexible prioritization model to attack these cases, and improved the TAT of these outliers by 17 minutes.
Not only that, but according to Brady, attacking the outliers instead of the average also led to a better relationship with their ED physicians, because it eliminated the recall bias often associated with delayed cases. "No one remembers the 19 cases you read within 15 minutes," he says, "they remember the one that took 45 minutes."