emergency department studies are done in
less than 30 minutes.”
The PACS, from McKesson, pushes out
a physician worklist and shows any prior
studies related to the patient. Physicians
dictate their reports using an embedded
speech recognition tool and do their own
report editing, Wiggins says. The automa-
tion led to much faster report turnaround
time—pre-PACS reports used to take up to
16 hours to complete and file—and a higher
quality report.
Those technology-driven gains, Wiggins
says, has set the group up to contend with
the next market shift—more emphasis on
quality rather than just quantity. “We have
to focus on quality now,” he says. “We’ll have
to pit ourselves against other practices.”
In the current set-up, physicians review
prior reports completed by their colleagues,
and assign a quality ranking to them, based
on their accuracy to the procedure. The re-
view system is accomplished by a piece of
bolt-on software added to the McKesson
system, Wiggins says.
ogy exams. The college built the rules and
is working with a vendor, National Decision
Support, to market the product, which tar-
gets EHR vendors. Enhanced decision sup-
port in electronic ordering systems—the
point of origin for many imaging exams—is
a critical first step in improving imaging op-
erations and reducing waste, Allen says. De-
scribing his ideal workflow scenario around
image ordering, Allen says, “Radiologists
would answer the phone when the referring
physician has a question on the appropri-
ateness of an order. We would be the arbi-
ters. It is not something you make an RVU
for, but it would be a value-added service
that in the long run will be of more benefit.
Radiologists have to understand that in the
future, this is what we will have to do.”
To Allen, the future of radiology depends
on emerging technologies, such as personal
health records for patients and messaging
between referring physicians and radiolo-
gists. “Radiologists have all the technology
they need to get to images, and do their re-
ports,” he says. “But we need decision sup-
port for radiologist recommendations.” In
Allen’s view, the ideal order entry system
would include a chat button, or telephonic
connection, which would connect referring
physicians to radiologists. That consulting
role has been lost due to the automated
ordering systems in play now, he says. “In
order to provide the best care in the most
efficient way, we need to be in consulting
mode and be there from the beginning” of
the image ordering workflow, he says.
Quality orientation
Allen of the American College of Radiol-
ogy says such a quality orientation will be
imperative for the radiology practice of the
future. “We are promoting ‘efficiency,’ but it
should not be all about making more RVUs
[a measure of work output] or more dollars
per FTE. It translates to what we can do to
provide the highest quality of radiological
care in the fewest number of steps.”
A fixation on radiologist productiv-
ity serves no one well, contends Allen, a
member of Birmingham (Ala.) Radiological
Group, which includes 30 radiologists and
radiation oncologists. “Do we want to be
like Lucy in the chocolate factory?” he asks,
referencing the famous episode of the I
Love Lucy show. “That is crazy. We will push
ourselves into the corner with a bidding war
over price. We need to provide some other
value and I. T. can be a big part of delivering
the value that radiologists offer.”
Toward that end, the ACR has launched
ACRSelect.org, which provides embedded
decision support rules for ordering radiol-
Volume Still Matters
When it comes to imaging, Naperville, Ill.-based Edward Hospital is a busy place,
performing 80,000 annual X-rays alone, in addition to other MRIs, ultrasound, CT and
nuclear medicine studies. The hospital feeds all those imaging studies to a contracted
group of 17 radiologists at a local practice, says Ryan Garland, radiology coordinator,
who oversees the x-ray department, which runs 24/7. Garland’s department includes
45 radiology techs, of whom at least 12 are on duty at any given time.
To help streamline the department, Edward Hospital purchased a dozen wireless
digital radiography systems from Carestream. The systems include a cesium iodide
detector, which Garland says improves image quality and reduces dose by up to 60
percent. The digital units also enable physicians to review x-ray images in about five
seconds, as the image is taken, processed and displayed on the spot. And the fact
they are wireless makes the units more valuable in such areas as the OR, where it is
easy for cords—a common accoutrement to digital radiology detectors—to get in the
way of a sterile field, says Garland.
The new units replaced wireless computed radiography units from another vendor.
The old set-up required capturing the image on a cassette, which was then removed
and taken to a central department for processing. The old units were portable, but re-
quired more radiation. The Carestream units’ faster image production is a hit in the OR
with surgeons, Garland says. “If you have the patient under anesthesia, time is money.
Running the film back to process would take 4-5 minutes and we can eliminate that.
Surgeons can use the system right then and there.”
The wireless units dispatch images across the network the hospital’s PACS, from DR
Systems. But the techs that do the procedures still must go to tethered workstations to
review their work lists. That’s why Garland’s I. T. wish list includes hand-held computers
“which would allow us to bill patients and chart in real time on the go. We’re in the ER, the
OR, inpatient and outpatient. To not have to go to a desktop PC to do our job would let us
be more efficient.”
