Top Five Imaging IT Projects

Jon Copeland is CEO of Inland Imaging Business Associates in Spokane, Washington.

A Balanced Workload

Radiology Business Journal
by Cheryl Proval

Like many large radiology practices, Inland Imaging was struggling to balance workloads across groups and varied locations, to meet increased regulatory requirements for proof of quality, to respond to shifting payment models, and to increase the productivity of the partners. Beginning in 2006, Copeland began work on a streamlined, data-rich, Web-based workflow system that integrates with any RIS or PACS. “We started work in 2006 and did the implementation in 2008 and 2009,” he says of the practice’s enhanced communications system.

It was time well invested. In addition to other benefits, radiologist workloads are now distributed far more equitably, and workflow is smoother. Moreover, while Copeland considers the project to be complete, enhancements and the addition of features are ongoing. “We sold the system to a vendor, and it is doing great things with it that were beyond our abilities—like DICOM enhancements and other decision-support and office-based patient systems that we want or need, but did not have the capacity to build ourselves,” Copeland notes.

Problem: There was a need for an improved IT workflow infrastructure with intelligence beyond that of any single PACS, RIS, HIS, or other system, along with a need to provide a Web-based form that technologists and others could use to submit updates.

Solution: A streamlined, data-rich, Web-based workflow system was developed to function in multispecialty clinics, rural hospitals, major tertiary-care hospitals, and the practice’s imaging centers. The same workflow system and common subspecialized worklists are used for and by all technologists, radiologist assistants, dispatchers, and radiologists.

A three-tiered worklist allows a specific work assignment to be made to an individual radiologist, a shared subspecialty worklist, or a catch-all worklist for general-radiography exams. The system can track work RVUs, and we developed our own algorithm for daily equivalency of work performed.

Technology: The system uses Microsoft® .NET components and resides on a single independent server, integrated via our own interface engine. It is built on and supported for the Microsoft platform. It is designed to integrate with any RIS/PACS that supports integration.

Results: Since implementation, we have seen a 14% improvement in radiologist productivity. The ability to balance workloads quickly across the system has dramatically reduced variation in the work performed by radiologists. Before implementation, we had more than a 50% daily variation in work in some subspecialties. Variation is now less than 10%.

The system includes a scheduling and credentialing component that knows everything about our radiologists, including their subspecialties and what shifts they can work, in which cities. The system improves productivity, and there are quality-tracking functions. Our report-turnaround times have improved significantly due to our ability to balance workloads and identify exams by urgency category (routine, urgent, emergency, or stroke).

There is also a peer review, based on ACR standards, within the workflow system. We perform both retrospective and prospective peer review. The system helps to optimize technology investment and drive clinical and operation results that make a difference. Our radiologists have benefited from a balanced workday and from increased productivity, and they no longer waste time on administrative issues.

Conclusion: The rules of radiology are changing and will continue to change. It is critical, as a radiology group, to provide added value—including workflow systems—in addition to having accurate data to measure productivity and quality.