For the team at Roper Radiologists PA (RR) in Charleston, South Carolina, organization plays a pivotal role. And in 2017, the practice found itself at a bit of a crossroads. They wanted more advanced tools at their fingertips for assigning reads and filtering worklists, but they felt limited by their available tools.
Matthew J. Brady, MD, a diagnostic radiologist with the practice, says they wanted to take a more worklist driven approach, but didn’t want to micromanage every last movement of their 25 subspecialized radiologists.
The practice had been orchestrating workflow using traditional PACS filtering capabilities, which proved to have several limitations. “The downside of some worklist driven flows, is that there’s not enough visibility across the group”, Brady says, “And you start hearing issues like, ‘There’s not enough work on that list.’ or ‘My list is always super busy and nobody helps me finish it.’ On the other hand, if you do not fragment the work, then there isn’t enough individual accountability.” IT administration was also a constant challenge; making straightforward changes simply took too long. “From an IT standpoint, it was a headache to dig in and edit discrete variables on the set of PACS filters for each individual radiologist and get it all correct,” he says. “That approach was very problematic.”
In order to achieve their goals of improved prioritization, data-driven assignment, and simplified administration, RR turned to Change Healthcare Workflow Intelligence™ in July 2017—and hasn’t looked back since.
By installing Change Healthcare Workflow Intelligence, Brady says, the team has been able to provide more value to their hospital partners. They’ve reorganized their worklists to better distribute the studies that come in, each read is being matched with the most appropriate radiologist, and satisfaction with case assignment is higher than before.
The software’s prioritization capabilities, in particular, have helped RR’s radiologists. Organizing reads can be complex, with each case coming with its own context and backstory, but the software allows each study to be sent to the right radiologist at the right time.
“This solution allows up to 99 assigned levels of prioritization, and a given case can escalate among them as needed,” Brady says. “You can group ER patients and escalate them over time, and you can define different categories of inpatients who are more clinically urgent, like ICU patients. Even some outpatient cases that aren’t necessarily urgent can be prioritized above other outpatient work—maybe the doctor requested a same day call with the results, for example.”
That RR can make this many changes—and make them quickly—has been crucial for the entire team. “The one-two punch of carving up the work that needs to get done so that there’s accountability while also giving an even better level of attention to high-priority cases is really powerful,” Brady says.
He adds that the implementation allowed them to attack their work differently. While they’ve always been subspecialized, the practice is more focused now. “I know groups three to four times the size of ours that aren’t as subspecialized as we are,” he says. “That’s because we’re using Change Healthcare Workflow Intelligence.” For example, they were able to use the prioritization model to assign all ER studies to a specific worklist, which creates what he describes as “a palpable sense of relief. In our prior approach no matter where you were, you always had some component of the ER looming over you, but now you know exactly when you’re responsible for it. It makes your workday more predictable when you are covering the ER, and dials down the chaos when you are not.”
Attacking the tails, one read at a time
Brady has been using the data available from the solution to track his practice’s turnaround times since it was implemented, and he’s happy to report that it’s making a significant difference. For instance, even though RR always delivered quick turnaround times, they still wanted to improve, particularly for the slowest cases—the ‘tails,’ as they’re commonly called.
“The smart way to look at turnaround times is to look at tails,” Brady says. “You want to look at percentile break offs—the percentage of cases you finished by a certain time—and not averages. It’s inherent in this work that occasionally cases are read later than the vast majority. So, we really wanted to attack the tails, particularly because those cases can skew the perception of service.”
RR had made significant improvements in this area since implementing Workflow Intelligence. The last 5% of ED reads were taking over 50 minutes to complete, but after implementation that timeframe shrank to 32 minutes.
Their hospital partners and referring physicians have certainly noticed the difference, Brady says. “Before, our radiologists were getting a lot of phone calls from urgent care sites saying, ‘I need my result, is anyone reading this case yet?’,” he says. “But now, those calls have literally gone to zero.”
Change Healthcare Workflow Intelligence also had an unexpected impact on ICU cases. Before implementation, the last 5% of ICU reads took over 145 minutes - almost two and a half hours - to complete. This ICU tail dropped to 70 minutes after implementation. And, notably, these improvements didn’t come at the expense of the less clinically urgent cases. Median TAT for other inpatient cases remained the same, and the 5% tail even improved by 36 minutes.
“I was shocked to see drops in 80th and 95th percentile tails for ICU and routine inpatient work,” Brady says. “And it was a rapid and sustained change, which was great.”
In addition, specialists at RR stay until all outpatient studies are read and completed for the day; since implementing Change Healthcare Workflow Intelligence, the team is spending 26 percent less time in the office after normal daytime hours. This improves each employee’s work-life balance, and helps minimize the risk of burnout.
Strong customer service
From a customer service perspective, Brady says working with Change Healthcare through the implementation was overwhelmingly positive.
Being longtime users of Change Healthcare’s PACS, RR’s radiologists were already familiar with the company, but the team was still impressed by the depth with which their questions were answered and the way their needs were addressed. The Change Healthcare team made numerous site visits, setting aside as much time as necessary on each occasion, and developed a custom prioritization model that fits the practice’s specific needs.
“I’ve been involved with multiple ‘build and go-live’ scenarios with vendors, and Change Healthcare was very structured and engaged,” he says. “In fact, our relationship with Change is so strong that we’re spending a lot of time working together on the things we can do with all of this data we’re generating. They’ve been very helpful.”