A team at Texas Children’s Hospital in Houston recently reduced its imaging (IMG) codes—which are used internally to define and keep track of procedures as they pass through various information systems—from more than 1,300 to fewer than 850.
How’d they do it? Lead author Lane F. Donnelly, MD, and several colleagues from the hospital’s department of radiology and department of information services explained their methods recently in Current Problems in Diagnostic Radiology.
First, the authors touched on the importance of IMG codes. “Standardization of naming and coding for imaging studies is important so that multiple electronic systems including the electronic medical record, imaging modality equipment, radiology information system servers, PACS servers, billing systems, diagnostic radiology workstations and radiology dictation systems can all effectively communicate,” they wrote. “It is the IMG codes and associated names that allow these systems to communicate about particular imaging examinations.”
While Current Procedural Terminology codes and International Classification of Diseases codes are defined at a higher level, IMG codes are defined by the organization itself. There is no easy “how to” guide that provides leaders with rules to follow; instead, the leaders write those rules themselves. The authors explained how this might seem like it simplifies things, but it can actually lead to a general sense of confusion.
“Lack of standardization and governance of code creation and naming can lead to multiple issues within an organization, including lack of clarity for referring clinicians when ordering examinations, inaccurate standardized report template autopopulation, inaccurate or incomplete study population of the radiologist reading work list or filters, change control, implementation of new systems, and other operational issues,” they wrote.
These are three tips Donnelly et al. shared for cleaning up IMG codes and reorganizing them at any institution, using their own experience as an example:
1. Create a governance structure.
Since their institution had never established a specific way to govern IMG codes, the team’s first step was creating a governance structure, which they called the Radiology Information Systems Control Group (RISCG). The RISCG could create, rename and delete IMG codes as its members saw fit, owning the entire process. Members included system administrators for the hospital’s PACS, physician leaders, and administration leaders, and the RISCG would meet each month to discuss various changes.
2. Review all existing codes and modify as necessary.
With the RISCG in place, the team established a new project known as IMG Clean Up. All IMG codes were reviewed and organized by modality, the names were standardized and unneeded codes were removed.
Making so many changes was obviously going to have an impact on the organization, so the authors had to then implement a plan for dealing with those changes. That’s where process-flow maps entered the picture.
“To help with the initiative, process-flow maps were created to define and outline the steps that needed to occur for each IMG code change,” the authors wrote. “Two workflow diagrams were created to document the process for submitting new proposed IMG codes or updating current IMG codes: operational and regulatory-influenced requests. This process was defined both for the IMG Cleanup project and for future IMG code changes.”
3. Plan ahead and reserve enough resources.
Trying to make such a significant change without properly planning ahead would be asking for trouble. Donnelly’s team smartly kept this in mind and made sure they had plenty of support staff on hand to help with the transition.
“When changing large number of IMG codes in batches, each individual imaging modality piece of equipment must be ‘touched’ to delete the old codes, make any changes to existing codes, and add the new codes,” the authors wrote. “In a large department with hundreds of pieces of imaging equipment, this is not a small task. Negotiation of adequate workforce support from biomedical engineering needs to occur during the planning phase of the process.”