UMass Memorial Health Care wanted to drive quality improvements within radiology services for its system of hospitals and clinics. By implementing Conserus Workflow Intelligence, they were able to address quality and communication gaps that occurred from clinical, technical and financial standpoints.

An automated peer review workflow is helping drive quality improvements and peer learning. An effective and potentially lifesaving system is in place to communicate critical results with referring physicians. Interaction between the ED and radiology is streamlined through the use of central mailboxes that help ensure there are no unnecessary delays. And the workflow for billing and coding is improving revenue, while ensuring the system can effectively address audits.

Challenges

UMass Memorial serves patients in central New England through its network of hospitals, clinics and the 1,600 member UMass Memorial Medical Group. With over 600,000 radiology studies performed annually, they wanted to implement more effective and automated work processes in several areas, including feedback on image quality for technologists, peer review and communication of critical findings as well as optimize their revenue by automating some billing and coding workflows.

In order to improve the quality of images received from the modalities, UMass Memorial rolled out the Technologist QI workflow. “Imagine a case had motion problems or was mislabeled - to give feedback, we had to track down the tech who performed it,” said Steven J. Baccei, MD, Vice-Chair of Quality, Patient Safety, and Process Improvement, Department of Radiology at UMass Memorial Medical Center. “In a network as large as ours, there are many technologists and multiple locations where we’re taking x-rays and doing cross sectionals. It was time consuming to find the person who performed the study.
                           
In addition, the system of peer review at UMass Memorial needed strengthening. With no automated process for assigning or monitoring reviews, making measurable improvements to quality was next to impossible.

From a billing perspective, messages from coders to the radiologist or technologist were sent via email, often creating delays in responses that resulted in delays in billing. The status of these issues could only be tracked by the staff member who initiated the original inquiry.

Answers

For the UMass Memorial radiology department, Conserus Workflow Intelligence was the tool that helped them solve some of these problems. “McKesson was very receptive to understanding our workflow,” said Baccei. “They worked with us to develop specific workflows so we could accomplish what we needed.”

The rules engine uses UMass Memorial’s own guidelines as triggers to automatically escalate and communicate status. Automating these processes helped reduce response times and assured cases no longer slipped through the cracks.

“For example, previously, when we communicated a critical finding, it might have been via email,” said Baccei. “We have added a  mandatory  read receipt to that process  So after 24 hours, if we haven’t gotten one, (the system) notifies our front office staff and they call the provider’s office to close the communications loop. This critical results communications is one of the most beneficial changes that we’ve done,” said Baccei.  “It has saved lives for sure.”

The solution is flexible, which lets them create a system that works with their internal schedules and processes. Previously, when ED physicians ordered radiology exams late in their shifts, the results might arrive back after they had already left, resulting in unnecessary delays.

Thanks to Conserus, results are now sent automatically to specific email boxes which are monitored regularly. This process accelerates diagnosis and treatment.

Conserus also provided UMass Memorial the means to implement a formalized peer review process. They were able to create an organized, automated workflow that ensures any discrepancies are identified and corrected quickly. It also provides data to drive continuous quality improvements.

When two new community hospitals joined the UMass Memorial system, the Conserus Workflow Intelligence system was quickly made available to their physicians and radiology departments. The system is scalable, and so it was easy to roll out the established processes and integrate the new facilities.

Results

Conserus Workflow Intelligence has enabled UMass Memorial to streamline its workflow and improve quality processes. It gave this health system the opportunity to formalize and update policies that now drive a more efficient system.
In the new critical results communication, the system assigns different categories of urgency. Red indicates a 60 minute turnaround or highly urgent finding. Orange is a 24 hour notification and yellow for up to seven days.

Before Conserus, communications required “picking up a phone or reading an email. We really had variable compliance in that,” said Baccei. “Despite radiologists knowing what they needed to do, it didn’t always happen because it was cumbersome.”

“We’ve made great strides  in our critical results reporting,” he said. “It allowed us to get a better handle on the status of our quality area.”

Automating the communications resulted in an increase from just 2,500 alerts annually to nearly 8,000 during the first year.

The solution also contributed to culture change by elevating the importance of quality measures. UMass Memorial now possesses the capability to measure results and drive continuous improvement across their health system.

“(By using this system, it) says these things are important to us,” said Baccei. “We’re going to be following up on them. We’re going to be talking to you when we notice deficiencies, whether it’s in the technologist QI, peer review or in billing.”

Now, UMass Memorial can drive quality improvements and efficiencies across its network of facilities, while incorporating its community hospitals and centers more closely into the system.