EHR-centered workflow leads to more efficiency, higher radiologist satisfaction

Centering a radiology department’s workflow around the electronic health record (EHR) can improve efficiency and make radiologists happy, according to a new study published in Academic Radiology.

“With implementation of a common EHR at our institution, our radiology department migrated from PACS-driven to EHR-driven radiology workflow,” wrote author Benjamin Wildman-Tobriner, MD, department of radiology at Duke University Medical Center in Durham, North Carolina, and colleagues. “In the former, reading worklists, examination information, and radiology reports were viewed in our institution's PACS. Patient clinical information was obtained via the EHR, which was housed in a separate application. The shift to EHR-driven workflow moved nearly all aspects of workflow to the EHR.”

To compare workflow before and after the shift to EHR-centered workflow at their large medical center, the authors compared CT examination ordering for 30 days before and after the big move. A two-week period immediately following implementation was worked in to give the staff time to adjust.

During the 30-day period before changing workflow, radiologists used an average of 9.5 ± 3.9 clicks, 6.3 ± 2.9 keystrokes and 52.4 ± 16.9 seconds to select a CT scan from the worklist and prepare it for ready for dictation (RFD) status. In the 30 days after changing workflow, radiologists used an average of 4.8 ± 1.5 clicks, 0.1 ± 0.3 keystrokes and 17.3 ± 9.5 seconds to go from selecting the CT scan to preparing it for RFD status.

“Following the change to EHR-driven workflow, more patient clinical information and examination specific data were available to the radiologist without the need for extra clicks or navigation through the EHR,” the authors wrote.

Seventy-three radiologists responded to a survey about PACS-driven workflow, while 63 radiologists responded to a survey about EHR-driven workflow. Overall, 54.7 percent of respondents described the ease of use of EHR-driven workflow as “very good” or “good.” Just 4.2 percent of respondents had the same answers for PACS-driven workflow.

Respondents were also more satisfied with EHR-driven workflow when it came to accessing information for a specific examination (70.3 percent vs 30 percent) and looking for relevant clinical information (81.3 percent vs 19.2 percent).

“The move to EHR-driven workflow represented a significant change for our department, and despite the typical trepidation that often accompanies a large technology overhaul, our survey results indicate an overall positive response to the shift,” the authors wrote.

Wildman-Tobriner et al. noted that each specialty has its own specific considerations, so what works for CT examinations may not necessarily always work for other departments. However, they wrote, the “marked improvement” in how many users ranked the system as “good” or “very good” was still significant.