Project planning, training, measurement and sustainment: the successful implementation of voice recognition

Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.     

Enhancing communication in radiology using a hybrid computer-human based system

IntroductionCommunication and physician burn out are major issues within Radiology. This study is designed to determine the utilization and cost benefit of a hybrid computer/human communication tool to aid in relay of clinically important imaging findings.Material and methodsAnalysis of the total number of tickets, (requests for assistance) placed, the type of ticket and the turn-around time was performed. Cost analysis of a hybrid computer/human communication tool over a one-year period was based on human costs as a multiple of the time to close the ticket. Additionally, we surveyed a cohort of radiologists to determine their use of and satisfaction with this system.Results14,911 tickets were placed in the 6-month period, of which 11,401 (76.4%) were requests to “Get the Referring clinician on the phone.” The mean time to resolution (TTR) of these tickets was 35.3 (±17.4) minutes.Ninety percent (72/80) of radiologists reported being able to interpret a new imaging study instead of waiting to communicate results for the earlier study, compared to 50% previously. 87.5% of radiologists reported being able to read more cases after this system was introduced.The cost analysis showed a cost savings of up to $101.12 per ticket based on the length of time that the ticket took to close and the total number of placed tickets.ConclusionsA computer/human communication tool can be translated to significant time savings and potentially increasing productivity of radiologists. Additionally, the system may have a cost savings by freeing the radiologist from tracking down referring clinicians prior to communicating findings.     

Ultrasound and Dual-Energy X-Ray Absorptiometry Report Transcription Error Rates and Strategies for Reduction

PurposeRadiologists play an essential role in patient care by providing accurate and timely results. An error-free radiology report is an expectation of both patients and referring physicians. Software is currently available that can eliminate measurement and side types of errors while saving radiologists and sonographers time. The objectives of this study were to evaluate the potential reduction in report errors, estimate the potential time savings associated with implementation, and conduct a cost-benefit analysis of implementing two software programs.MethodsData on the number of measurement errors and side errors in ultrasound and dual-energy x-ray absorptiometry reports were collected, and the time required for data entry that the software would reduce was measured by report type. Generalized estimating equations regression was used to estimate error rates and data entry times and corresponding 95% confidence intervals by report type for radiologists and sonographers. Current wages and report volumes were then applied to the time savings to estimate the annual wage savings. Projected volume increases were applied to the annual estimates to generate a 5-year savings estimate.ResultsOverall, measurement errors occurred in 6% to 28% of ultrasound reports, depending on the report type. Side errors were rare. It was estimated that over 5 years, the software could save $693,777 in radiologist wages and $130,771 in sonographer wages, a total of $824,548 (range, $621,866-$1,039,714).ConclusionsThe use of data integration software would both significantly reduce errors in ultrasound and dual-energy x-ray absorptiometry reports and save a considerable amount of time and money.     

Improving medical imaging report turnaround times: the role of technolgy

At Southern Ohio Medical Center (SOMC), the medical imaging department and the radiologists expressed a strong desire to improve workflow. The improved workflow was a major motivating factor toward implementing a new RIS and speech recognition technology. The need to monitor workflow in a real-time fashion and to evaluate productivity and resources necessitated that a new solution be found. A decision was made to roll out both the new RIS product and speech recognition to maximize the resources to interface and implement the new solution. Prior to implementation of the new RIS, the medical imaging department operated in a conventional electronic-order-entry to paper request manner. The paper request followed the study through exam completion to the radiologist. SOMC entered into a contract with its PACS vendor to participate in beta testing and clinical trials for a new RIS product for the US market. Backup plans were created in the event the product failed to function as planned--either during the beta testing period or during clinical trails. The last piece of the technology puzzle to improve report turnaround time was voice recognition technology. Speech recognition enhanced the RIS technology as soon as it was implemented. The results show that the project has been a success. The new RIS, combined with speech recognition and the PACS, makes for a very effective solution to patient, exam, and results management in the medical imaging department.     

Characteristics of Federal Political Contributions of Self-Identified Radiologists Across the United States

PurposeAs federal legislation increasingly influences health care delivery, the impact of election funding has grown. We aimed to characterize US radiologist federal political contributions over recent years.MethodsAfter obtaining 2003 to 2016 finance data from the Federal Election Commission (FEC), we extracted contribution data for all self-identified radiologists. Contributions were classified by recipient group and FEC-designated political party and then analyzed temporally and geographically, in aggregate, and by individual radiologist.ResultsBetween 2003 and 2016, the FEC reported 35,408,584 political contributions. Of these, 36,474 (totaling $16,255,099) were from 7,515 unique self-identified radiologists. Total annual radiologist contributions ranged from $480,565 in 2005 to $1,867,120 in 2012. On average, 1,697 radiologists made political contributions each year (range 903 in 2005 to 2,496 in 2016). On average, contributing radiologists gave $2,163 ± $4,053 (range $10-$121,836) over this time, but amounts varied considerably by state (range $865 in Utah to $4,325 in Arkansas). Of all radiologist dollars, 76.3% were nonpartisan, with only 14.8% to Republicans, 8.5% to Democrats, and 0.4% to others. Most radiologist dollars went to political action committees (PACs) rather than candidates (74.6% versus 25.4%). Those PAC dollars were overwhelmingly (92.5%) directed to the Radiology Political Action Committee (RADPAC), which saw self-identified radiologist contributions grow from $351,251 in 2003 to $1,113,966 in 2016.ConclusionRadiologist federal political contributions have increased over 3-fold in recent years. That growth overwhelmingly represents contributions to RADPAC. Despite national political polarization, the overwhelming majority of radiologist political contributions are specialty-focused and nonpartisan.     

A County-Level Analysis of the US Radiologist Workforce: Physician Supply and Subspecialty Characteristics

PurposeTo explore associations between county-level measures of radiologist supply and subspecialization and county structural and health-related characteristics.MethodsMedicare Physician and Other Supplier Public Use Files were used to subspecialty characterize 32,844 radiologists participating in Medicare between 2012 and 2014. Measures of radiologist supply and subspecialization were computed for 3,143 US counties. Additional county characteristics were identified using the 2014 County Health Rankings database. Mann-Whitney tests and Spearman correlations were performed.ResultsCounties with at least one (versus no) Medicare-participating radiologist had significantly (P < .001) larger populations (197,050 ± 457,056 versus 20,253 ± 23,689), lower rural percentages (39.5% ± 26.5% versus 74.6% ± 25.6%), higher household incomes ($47,608 ± $12,493 versus $42,510 ± $9,893), higher mammography screening rates (62.4% ± 7.0% versus 56.6% ± 15.3%), and lower premature deaths (7,581 ± 2,085 versus 7,784 ± 3,409 years of life lost). Counties’ radiologists per 100,000 population and percent of subspecialized radiologists showed moderate positive correlations with counties’ population (r = +0.505-+0.599) and moderate negative correlations with counties’ rural percentage (r = −0.434 to −0.523). Radiologist supply and degree of subspecialization both showed concurrent positive or negative weak associations with counties’ percent age 65+ (r = −0.256 to −0.271), percent Hispanic (r = +0.209-+0.234), and income (r = +0.230-+0.316). Radiologists per 100,000 population showed weak positive correlation with mammography screening (r = +0.214); percent of radiologists subspecialized showed weak negative correlation with premature death (r = −0.226).ConclusionGeographic disparities in radiologist supply at the community level are compounded by superimposed variation in the degree of subspecialization of those radiologists. The potential impact of such access disparities on county-level health warrants further investigation.     

Off-site real-time review of remote ambulatory care obstetric and gynecologic ultrasound examinations: Implications to radiologists for managed care contract negotiations

We present a cost comparison of contracts to provide obstetric and gynecologic ultrasound (US) services to a managed care provider group (MCPG) and discuss the long-term implications of off-site monitoring of US procedures by video/voice technology to radiologists in competing for managed care contracts.During a 19-month period, 1,741 ultrasound examinations were performed for a MCPG in a clinic located 7 miles from our institution. The costs of different arrangements to provide this service and a 5-year cost analysis are provided.Based on the reported obstetric and gynecologic US caseload, annualized first year cost to the MCPG under the current contract was $183,945, compared with $252,000 under a prior contract. Without a contract, the cost would be $325,907.Our analysis shows that the use of the citywide fiberoptic network for remote monitoring of US examinations enables US radiologists to compete for managed care contracts and provides cost savings to payors.     

Corporate nuclear medicine: the implementation of a centralized management model

OBJECTIVE: A trend in corporate healthcare is the merging of small community hospitals with larger regional hospitals to expand the patient base. The purpose of this article is to illustrate the benefits of operating several nuclear medicine departments under a centralized management system, rather than operating many decentralized departments. The issues discussed are the development, financial benefits, operations, and structure of a corporate nuclear medicine department. METHODS: Seven nuclear medicine departments were integrated to form one corporate nuclear medicine department from a large hospital organization comprising seven different hospitals. The management team created the concept and advised administration. Training programs were designed and implemented, and committees were formed to ensure the efficient operation of the integrated department. All aspects of the department, such as scheduling and interpretation of studies, are managed at a central location. All technologists rotate to all hospitals. Success was measured by cost savings, study turn-around times, and evaluation of patient and employee satisfaction. RESULTS: It was found that establishing a corporate nuclear medicine department created a greater patient base by servicing a larger geographic area, and resulted in savings of $870,000 annually. Standardizing procedures and protocols allowed for consistency in patient care, an inpatient turnaround time of 24 h, and a dictated report turnaround time of 30 min. Employee relations and satisfaction remained consistent with a 4.76 out of a 5.0 leadership index rating. CONCLUSION: A nuclear medicine department with a centralized management system is a viable option for corporate health care. It is recommended for operations endeavoring to expand the patient base and improve the financial picture.     

Is there an association between radiologist turnaround time of emergency department abdominal CT studies and radiologic report quality?

The aim of this study was to assess for an association between radiologists' turnaround time (TAT) and report quality for emergency department (ED) abdominopelvic CT examinations. Reports of 60 consecutive ED abdominopelvic CT studies from five abdominal radiologists (300 total reports) were included. An ED radiologist, abdominal radiologist, and ED physician independently evaluated satisfaction with report content (1–10 scale), satisfaction with report clarity (1–10 scale), and extent to which the report advanced the patient on a previously published clinical spectrum scale (1–5 scale). TAT (time between completion of imaging and completion of the final report) and report quality were compared between radiologists using unpaired t tests; associations between TAT and report quality scores for individual radiologists were assessed using Pearson's correlation coefficients. The five radiologists' mean TAT varied from 35 to 53 min. There were significant differences in report content in half of comparisons between radiologists by observer 1 (p?≤?0.032) and in a minority of comparisons by observer 2 (p?≤?0.047), in report clarity in majority of comparisons by observer 1 (p?≤?0.031) and in a minority of comparisons by observer 2 (p?≤?0.010), and in impact on patient care in a minority of comparisons for all observers (p?≤?0.047). There were weak positive correlations between TAT and report content and clarity for three radiologists for observer 1 (r?=?0.270–0.362) and no correlation between TAT and any report quality measure for remaining combinations of the five radiologists and three observers (r?=??0.197 to +0.181). While both TAT and report quality vary between radiologists, these two factors were not associated for individual radiologists.     

The impact of tech aides in radiology

As the staffing shortage continues to impact radiology departments and outpatient imaging centers, managers look for ways to solve staffing issues internally. Lehigh Valley Hospital and Health Network investigated the feasibility of adding a position of radiology tech aide. This proposal was driven by a desire to improve retention of staff, improve employee satisfaction and reduce turnover. A 6-month pilot program was conducted at the network's highest-volume facility. One tech aide underwent extensive training and eventually began performing some of the tasks identified in the analysis. Each area within radiology worked with an intern to identify each step in its work process. Each step identified led to the question, "What happens if?" The workflow process provided a detailed look a the number of steps required for a technologist to perform a study from start to finish. In May 2002, the administrator submitted a project proposal to management engineering to evaluate radiologic technologists' workloads and identify tasks that could be performed by a tech aide. Activity-Based Management (ABM)--a process that emphasizes activities over resources--was utilized to study work activities. The analysis identified the appropriate tasks and revealed that 5 FTEs were needed to assist the technologists in all areas of radiology. A workflow was completed for each area within radiology. Some areas identified bottlenecks, which caused delays in the process and some redundant work for the staff. Data were presented to the network administration. Staffing realities, labor pool availability within the existing network staff, and detailed task identifications also were provided. A total of 5 FTE tech aides were approved. The final program included in-depth tech-aide training; effective and open communication between management and technologists; and a collaborative, education-oriented relationship between technologists and tech aides.     

Experience with a partnership program for cardiac surgery at a regional military medical center.

A Partnership Program between USAF Medical Center, Wright-Patterson (WPAFB) and Miami Valley Hospital (MVH), Dayton, Ohio, was created through CHAMPUS to provide cardiac surgical services for eligible patients. During the first year of this program, 82 patients underwent 89 percutaneous transluminal coronary angioplasty (PTCA) procedures. Sixty-one patients underwent cardiac surgery at WPAFB, 50 were referred to MVH due to ineligibility or other reasons, and five were referred to other military or civilian hospitals. The program has been successful with low morbidity and mortality (3%). Cost savings for PTCAs was $241,853 and for cardiac surgery was $462,046.     

PACS中显示设备的选择对于肺部孤立小结节诊断影响的研究

目的探讨选择不同显示器阅片时,对于肺部孤立小结节诊断准确性的影响。资料与方法显示器分别采用ViewSonicP75f (1024×768)及BARCO2MP1NT(1600×1200)。由2位(具有2年和8年工作经验)放射科医师对于39例后前位胸片进行阅片。阅片分两次进行,两次阅片间隔3周。每次阅片分别采用其中的一种显示器进行阅片,图像浏览器采用上海岱嘉公司的Unisight软件。阅片结果采用Rockit软件进行ROC分析,使用Excel2002绘制ROC曲线。结果2年工作经验的放射科医师采用两种显示器阅片时,结果具有显著性差异,专业显示器的诊断结果明显优于普通显示器。8年工作经验的放射科医师采用两种显示器阅片时,结果没有显著性差异。结论年轻医师应采用专业医用显示器进行阅片,高年资医师可采用普通显示器进行阅片。     

Case management of asthma for family practice patients: a pilot study

OBJECTIVE: Asthma is a chronic inflammatory disease of the airways that affects between 14 and 15 million persons in the United States. It is responsible for more than 470,000 hospitalizations annually and an estimated $6 billion in total medical cost. The Asthma Case Management Program instituted at our hospital is based on the concept of patient self-management. It involves patient education, a home treatment plan (HTP), and physician/nurse follow-up. This study was performed to determine whether an organized case management program improves outcomes and cost in family practice asthma patients. STUDY DESIGN: A prospective cohort study of 48 asthmatic patients was conducted with a retrospective review. Data were obtained from health, pharmacy, and computer records. PATIENTS AND METHODS: Forty-eight asthma patients, ages 1 year to adult, assigned to the Family Practice Department were enrolled in the Asthma Case Management Program. This cohort was offered asthma education from a provider trained in national asthma guidelines. Most of these patients received a coordinated HTP completed by their primary care provider. The asthma case manager initiated regularly scheduled nursing follow-up. Hospital admissions, emergency department and clinic visits, number of chest radiographs, and use of beta 2 agonists and anti-inflammatory drugs were recorded for a mean of 6 months before and 6 months after the intervention. Twenty-eight patients who had received the HTP as part of their intervention were compared with 12 patients who did not. A cost analysis was completed. RESULTS: All measured parameters showed favorable changes after intervention. Statistically significant decreases in clinic visits, chest radiographs ordered, beta 2 agonists, and oral anti-inflammatory drugs were obtained with the 28 patients who received the HTP. Six-month resource savings after intervention were estimated at $19,677.42 ($491.90 per patient). Ninety-three percent of these savings are attributed to those patients with the HTP. There were no statistically significant improvements and considerably fewer savings for those patients not on the HTP. CONCLUSION: A combined intervention consisting of patient education, a coordinated self-monitoring plan, and patient follow-up was associated with improved care and economic outcomes in this group. The greatest clinical improvement and resource savings are clearly seen in those patients who have received the HTP as part of their asthma case management. Every effort should be made to include the HTP as the central part of asthma case management.     

Integration of a Community Radiology Division into a Subspecialty-Focused Academic Radiology Department

IntroductionAssimilate a general radiology division into a subspecialty-focused radiology department at an academic medical center.MethodsThis Institutional Review Board-approved quality improvement initiative was performed at an academic medical centers’ subspecialty-focused academic radiology department, aiming to assimilate a general radiology division providing interpretive services for a distributed set of community ambulatory practices. An Oversight Committee charged by the department chair created a charter with unambiguous goal, timelines, clear decision-making, and conflict resolution processes. The Committee assessed the resources and clinical capabilities of the general radiologists, and the anticipated shift in exam volume from the community into subspecialty divisions. Primary outcome, percentage of targeted organ systems-specific interpretations by general radiologists based on assigned subspecialty division, and secondary outcome of report turnaround time (TAT) for all ambulatory exams, were compared before and after sub-specialization.ResultsAmong 10 general radiologists, 4.5 were assigned to subspecialty divisions; 5.5 continued to cover an independent general radiology practice in a for-profit delivery network. In the 5 months’ post-transition, a total 86.6% (11,668/13,477) of reports by the integrated general radiologists were within designated subspecialty divisions vs 23.9% (2,586/10,829) pre-transition (P < 0.01). There was no change in ambulatory radiology report TAT for non-urgent care center (UCC) or UCC exams pre- vs post-integration.DiscussionA quality improvement initiative with unambiguous decision-making and conflict resolution processes incorporated a general radiology practice (radiologists and exams) into a subspecialty-focused academic radiology practice without negatively impacting TAT metrics. Future studies would be needed to assess impact on quality of interpretations.