The Missing Link: Discussion of the Evolution to Value Based Radiology in an Academic Setting

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Anne Hodge
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1 The Missing Link: Discussion of the Evolution to Value Based Radiology in an Academic Setting Travis McKenzie DO Akash Joshi MD Amy Patel MD John Lohnes MD University of Kansas Wichita ACR Meeting 2015 TM

2 Disclosures The authors have no actual or potential conflict of interest in relation to this presentation.

3 Purpose Discuss initial efforts to transition to value based radiology in an academic setting. Review the principles of Imaging 3.0 TM. TM

4 Background Desired goal of implementing Imaging 3.0 TM by adding value to radiology services. Initial focus was to improve reporting efficiency for emergency department (ED) reports. Metric was turn-around-times (TAT) for finalized ED reports. Reporting 12 months worth of data and experience during implementation.

5 Metric The mean turn-around-time (TAT) measured as the time from the point of completion of imaging to the time of finalized report. Benefits Simple metric. Easy to understand, track, and communicate. Drawbacks Does not include time from ordering to completion. Many variables (e.g., complexity of study and quality of reports) are not taken into account. While decreasing TAT in ED setting is valuable, other clinical scenarios/studies may lose quality if too much focus is placed on TAT.

6 Method Emphasis was placed on clear communication and consistent feedback of goals and metrics. Metrics of mean TAT were provided to staff on a monthly basis to measure progress.

7 Roadbumps In an academic setting, residents may be viewed as the limiting factor for implementing value-based radiology. Initially with the existing workflow, the TAT improved by 25% (176 min to 134 min) over the first 7 months. After resident involvement and buyin, TAT improved dramatically by an additional 48% over the next 5 months (134 min to 64 min).

8 Adapt Residents became actively involved in the project. Resident s proposed a workflow change. Straight forward and negative ED studies would be approved to attending without a formal checkout. Formal checkout as needed for more difficult studies depending on resident/attending comfort level. PACS user interface was also modified to accommodate an efficient workflow for reading ED studies

9 Mean TAT (Min) Results It is not the strongest or the most intelligent who will survive but those who can best manage change. --Charles Darwin 250 ED Mean Turn-Around-Time (TAT) TAT decreased an additional 48% after implementation of changes No significant improvement in first 5 months. Questions remained whether this was appropriate metric in academic setting. Re-emphasis on goals and metrics were made. Implementation of resident-attending and PACS workflow changes Months

10 Potential Applications of Imaging 3.0 Clinical Decision Support based on ACR appropriateness criteria with radiologist input when necessary to ensure appropriate exam is ordered at time of ordering. Resident involvement and integration into multispecialty care team, especially when directly involved in patient care such as placing/managing a chest tube or abscess drain. Create direct and instant feedback loops from ordering providers to improve the quality and clinical value of reports. Structured reports with automated reporting protocols for critical results to both the ordering provider and patient. Provide real-time mobile alerts and report access for finalized reports. Automated reporting of adherence to imaging protocols. Forecasting of busy times with staffing schedule adjusted accordingly.

11 Potential Applications of Imaging 3.0 Make radiation dose information and education available to the patient and ordering provider. Automated extrapolation, interpretation, and communication of quality metrics. One example is the use of TAT to track timeliness of reporting. As the infrastructure becomes more robust, increasingly accurate and meaningful complex metrics will be possible (see table). Examples of more complex quality metrics % of CT scans which are negative for a specific dx (e.g., CT stroke protocol). % of MRI studies with motion degradation reported # of negative renal sonograms with a positive CT within 30 days # of repeated CTA PE studies for insufficient contrast bolus. Endless other applications

12 Conclusion There is a concerted effort being made by the radiology profession to transition to value based radiology. The academic setting provides unique challenges and opportunities in this transition. Our experience demonstrates that clear goals, appropriate metrics, consistent feedback, and adaptability are crucial in implementation of value based radiology.

13 Conclusion (cont.) Additionally, resident/fellow acceptance and involvement in Imaging 3.0 should be considered an invaluable resource rather than a stumbling block to value based radiology. Indeed, they may be the missing link to a successful transition. Our experience provides vital lessons and encouraging results that should be translatable to implementation of other value based radiology opportunities.

14 The Missing Link: Discussion of the Evolution to Value Based Radiology in an Academic Setting Thank You!

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