Lessons at the Intersection of Quality Improvement and Informatics
Wednesday, Nov. 30, 2016
Radiologists are under increasing pressure to demonstrate the value they provide. In a Monday session, "Mission Critical: How to Increase Your Value by Mastering the Intersection of Quality Improvement and Informatics," presenters offered some suggestions for radiologists and their practices.
Developing a quality improvement plan
David B. Larson, MD, associate professor of radiology at the Stanford University Medical Center, walked the audience through a case study illustrating that in order to achieve quality improvement, informatics is necessary — and critical — but is not nearly sufficient.
This case study involved a quality improvement initiative at Cincinnati Children's Hospital (where he practiced at the time). "We realized that we just weren't getting adequate clinical histories from our referring physicians," Dr. Larson said.
In this case the radiology department turned to its radiologic technologists for help. "They already speak with our patients and families, and work for us and with us," he explained. "So they should be able to provide us with more control over what information we are getting from referring physicians."
Dr. Larson and his colleagues decided that a good clinical history protocol should contain three elements: what, when and where. Simply put, clinical histories should describe the nature of the medical event and symptoms, when and for how long it occurred, and where in the patient's body it occurred.
Working with technologists, the quality improvement initiative went through four phases: launch, support, a transition to sustainability and, finally, maintenance.
An initial audit of clinical histories found that 38 percent met the "who, what, when" criteria. By the end of the 15-week improvement phase, that percentage had increased to 92 percent.
"The main point here is that you just can't take data and translate that into improvement," Dr. Larson said. "Data is just a relatively small piece of it."
Leveraging tools to drive value
In another presentation, Samir B. Patel, MD, director, Value Management Program, Radiology, Inc., reviewed the kinds of quality improvement tools that are available for radiologists.
"A lot of things we require to demonstrate value require technology," said Dr. Patel. "I'm in a private practice and we don't have the time or the infrastructure to do things ourselves, so we have to rely on the vendors. RSNA is the perfect venue to talk about this because we have all the vendors here," he said.
Dr. Patel discussed how radiology departments and groups should be investing in technologies that can increase value, such as structured reporting and tools that can be integrated into PACS, including peer review and critical test results communication.
For example, he noted that the PACS his practice uses has integrated a tool that can identify radiology exams with gender mismatch information. "Not only do we track this, but every weekday we fix all the gender discrepancies from the previous 24 hours before the bill gets sent out," he said.
Radiologists should also consider investing in technology tools geared toward structured reporting, Dr. Patel said. His practice uses a CT structured reporting template that enables CT technologists to access a radiology report prepopulated with the study type, technique and patient history taken from the EMR.
This saves time and resources, improves radiology and technologist workflow, and reduces radiologists' reporting deficiencies. "This is all available now," Dr. Patel said. "We didn't magically modify the technology, we just leveraged what the technology provided us."
Understanding the relationship between informatics and quality improvement
In a third presentation Alexander Towbin, MD, of Cincinnati Children's Hospital Medical Center discussed lessons for radiologists about how informatics drives quality improvement projects.
The first lesson, Dr. Towbin said, is that all informatics projects are quality improvement projects, but most quality improvement projects are not informatics projects.
Second, a radiology department should always start a quality improvement project with the end in mind, but never start it with a solution.
"There are always a number of ways to get to a solution, but if you think you know the answer, you'll end up being wrong," Dr. Towbin said.
The final lesson is that technology does not fix a bad process, but it can simplify a good process.
"Informatics is a tool, it's not the answer in quality improvement," Dr. Towbin concluded. "You need informatics to help gather data, and maybe simplify or systematize a process. But informatics is not going to be the answer for everything. You have to do the work first."