Paul J. Chang, MD, medical director of enterprise imaging at the University of Chicago, began his presentation at RSNA 2016 by saying his goal was to upset “everyone in the room” with his opinions on quality and IT. He said this with a smile, but he did go on to speak about quality in different terms than radiologists are used to hearing.
There might be a lot of buzz lately about quality in healthcare, Chang explained, but quality is a lot like a floor mat in a car. When someone purchases a car, the floor mats are not part of a separate transaction—they’re included as a part of the deal, without extra charge. And hospital groups view quality in the same way; they will invest in improved efficiency (the car), but they expect high quality (the floor mats) to be included.
“We value quality and pay lip service to it, but we don’t put money into it,” Chang said. “Even today, when I talk to people who run large systems, it’s ‘I need to cut costs.’ At the end of the day, these systems are about cost and efficiency. They value quality ... but it’s expected.”
This can make it difficult for a radiology group or department to significant improve quality. But Chang shared a solution that he has seen work again and again over the years: leverage IT resources to improve workplace efficiency—and watch as it improves quality at the same time.
The unreliable asset
Rule No. 1 when leveraging those IT resources, Chang noted, is that workflow should rely on humans as little as possible. We just aren’t efficient enough.
“Every other industry bends over backwards building IT systems to avoid depending on humans to remember to do things,” he said. “Humans are very good at a lot of things, but they are probably the most unreliable IT asset you have. We’re ‘down’ more than half the time, by the way; that’s not very good. And we’re terrible at remembering things.”
Chang went on to provide example after example of ways he has leveraged IT in his own career. In each case, efficiency was improved—which, in turn, improved quality.
For instance, Chang and his colleagues knew radiologists were receiving less and less context about patients as technologies were advancing. The solution? Use IT to extract all relevant information about the patient from the electronic medical record and automatically give it to the radiologists as they place orders.
Chang also saw that technologists would take up to 20 minutes to enter imaging protocols into equipment before each exam. At his request, the IT department worked directly with their vendors to tweak the equipment, making it so no human input was necessary. It made the department more efficient—and, yes, it improved quality as well.
“Instead of five to 20 minutes, it takes 500 milliseconds,” Chang said. “And does it work? It sure does.”
Yet another way Chang leveraged IT was implementing a system that allows radiologists to send short message services (SMS), or text messages, to other physicians—and when those messages are ignored, an alarm goes off until they are acknowledged.
“I can’t remember the last time I called the ER,” Chang said. “We have a busy ER, but we don’t call them. And they love it, because they don’t like our phone calls either.”
By taking advantage of his university’s IT department, Chang was able to make three different aspects of the imaging process more efficient. Quality might be a floor mat, but it’s a floor mat that can be improved—if you can properly leverage your IT department.
Chang’s presentation took place on Monday, Nov. 28, and followed sessions by Keith J. Dreyer, DO, PhD, and Richard E. Heller III, MD.