If Kevin McEnery, MD, has one message for radiology, it is this: To improve service within the radiology department, you must have access to data from outside the radiology department. His admonition, however, is to make your interventions preemptive: “I do firmly believe that the best way to predict the future is not necessarily to create it, but to change it; you can either run from it or learn from it.”
Professor of radiology and director, innovation in imaging informatics, University of Texas MD Anderson Cancer Center, Houston, McEnery provided an inspiring—and game-changing—talk about his quality assurance work during the 2014 meeting of the Society of Imaging Informatics in Medicine in a session on “Quality Improvement Harnessing Informatics.” He outlined how to leverage enterprise data (and workflows) to drive change in the radiology department, and demonstrated how the coordination of scheduling activities could improve radiology performance and interactions with clinicians.
RIS/PACS was the first information system with enterprise image distribution capability in most institutions, but it has been usurped by the EMR, McEnery reminds. “The clinician’s workflow is not going to be what the radiology department wants it to be—it’s going to be the pattern that is driving workflow through the EMR,” he emphasizes. “Order entry will not occur in the RIS or PACS, it will occur in the EMR. Results notification will not be a radiology-based system, it will be an institutional-based system.
“That also opens up opportunities,” he adds, “because then you have centralized clinical information that you can in turn leverage for clinical workflow.”
While retrospective analytics is about yesterday, real-time analytics is about today, and predictive analytics is about what will happen in the future, McEnery favors preemptive analytics coupled with automated interventions that can change workflows before they have a chance to damage the patient or change the patient outcome. He calls it “proactively changing the patient outcome based upon informatics in real time occurrences.”
Tools, processes, and targets
There’s no magic bullet, when it comes to process improvement tools, he says. You will require databases and data, but not directly from your production systems. “You need data that is replicated, because you can create some really nasty queries that can wipe out your RIS system,” he advises.
It is important to understand and keep in mind the timeliness of the replication when considering a specific project. “That’s important, because if you have something that needs to be changed real time, a database that is replicated over night cannot be used for that purpose,” he says. “The timeliness of the data will actually impact upon the things you can impact and improve.”
McEnery advises doing an Internet search to find tools for analysis, such as dashboards. “There are a lot of them out there, you do not have to create this from scratch,” he says.
It is very important to have a method to distribute results. “If you are doing this work. and you are the only one who knows about these results, that is not going to change anything,” he says.
Whether you are looking within the institution or outside the institution, McEnery advises using the following methodology:
- Identify the issue you are trying to address.
- Define a metric to track the issue and set a specific goal to change that process.
- Try an intervention to improve the issue.
- Be prepared to do multiple interventions and track each of them.
- Implement the intervention and automate the process, so that you aren’t saying, “Oh yes, I forgot to run that query,” he advises.
- Continually monitor the metric.
Finally, when trying to determine targets for change, just listen, McEnery suggests. “When you are in a meeting and someone says, ‘We have to hire more FTEs to prevent a future patient safety incident, that’s something that needs to be changed,” he says.
Case study: Overtime
Another trigger to listen for is overtime. “Schedulers are working ‘overtime’ to update appointments: That was a buzzword for me to say something was wrong at our institution,” he shares, prompting a process-improvement project that involved accessing real-time enterprise data, preemptive analytics, and real-time intervention.
MD Anderson transitioned to CPT-based scheduling, meaning that two slots were generated rather than one for, for example, CT, chest and CT, abdomen/pelvis. For patients who required imaging