Scheduling: if your RIS cannot, perhaps your HIS can

As the services radiology departments provide have proliferated--new modalities, additional procedures--the scheduling process has become more complex. Radiology departments have been criticized by referring physicians and their staff for difficulties they encounter when scheduling patients for procedures. In light of managed care and increased competition for outpatient services, scheduling systems should be designed with the referring physician's office as the prime customer. Vanderbilt University Medical Center (VUMC) has devised a collaborative, hospital-wide system for scheduling. The same system is used by The Vanderbilt Clinics, which refer a significant number of outpatient procedures to VUMC. The radiology department has tailored the system to its technical requirements, and clinic staff members can access the system directly to schedule patient appointments. Minor adjustments were made during implementation of the process. Now, appointments are made efficiently by the clinic staff, and other systems, such as the film library, are benefiting from better information and organization. VUMC has changed the scheduling process of the radiology department to reach the customers who actually promote the radiology practice. Communication between the department and the clinics has improved and a spirit of teamwork is growing.     

Ineffective Leadership

Radiology leaders can have a profound impact on the success and working environment of a radiology department, promoting core values and inspiring staff members to achieve the organization’s mission. On the other hand, ineffective leaders can have a devastating effect on a radiology department by impairing communication among members, undermining staff commitment to the organization’s success, and stifling the development of other staff members and leaders in the organization. One of the most important investments a radiology department can make is in identifying, cultivating, and promoting new leaders. The authors describe 13 habits and characteristics of new leaders that lead these individuals to address situations in both ineffective and counterproductive ways, impeding the performance of a radiology department and its capacity to play a meaningful role in shaping the future of radiology. New leaders must continually learn and improve their leadership skills if they are to avoid the destructive habits of ineffective leaders and successfully overcome the challenges facing radiology today. Senior leaders may also benefit from understanding the pitfalls that make leaders ineffective and should strive to continually improve their leadership skills given the critical role of leadership in the success of radiology departments.     

High availability web-based image distribution

When a health system implements a picture archiving and communication system (PACS), film is no longer the preferred medium of image distribution from a radiology department's perspective. The goal is for the department to be 100% filmless sometime after the installation. However, implementing change can be difficult, and getting to that goal of 100% is sometimes never achieved. Sutter Health has come close, with 90% of studies being filmless. A primary reason lies with the distribution method of providing access to images.     

Picture archiving and communication system (PACS): A progressive approach with small systems

PACS represents the natural evolution from working with digital modalities (e.g. CT, US, MRI, CR) towards a global digital environment where the film based activities are progressively replaced by their digital counterpart. The advantages of the technique and the drawbacks of the first implementations are described, as well as the recent advances in terms of technology, architecture, medical integration and cost-effectiveness. The so called ‘second generation’ PACS concept is presented with its features: modular architecture, progressive implementation, multi-vendor environment, integration with the Hospital Information System, standardization. This approach is particularly suited for progressive implementation in an existing hospital, in contrast to the possible topdown construction of a filmless radiology department, as a project for a totally new hospital. The implementation into the university hospital AZ-VUB is described as case study.     

How to improve the quality of patient care and still save money in the radiology department.

1, A pediatric radiology department at an institution such as Minneapolis Children's Medical Center is a true microcosm of the gigantic radiology department of a general hospital. Our positive experiences with IMACS discussed above should be even more profound and profitable for the larger medical institutions. 2, IMACS did improve service and communications among radiologists, referring clinicians and the hospital staff. Both the old and new images needed for review and comparison are presently available for the clinicians on the nursing stations as soon as the current studies have been completed. 3, IMACS allowed us to reduce the number of films lost, misplaced or misfiled and reduced the interpretation delays by keeping all the films in the radiology department. This has resulted in improvement in the overall productivity of the radiology staff and the referring clinicians. 4, The cost of IMACS was paid for through additional revenue capture, increased productivity and a decrease in the expenses in the radiology department in less than one year. These benefits should continue for several more years without the need for any additional expenses. 5, Despite these initial successes, there are several issues which must be addressed before total computerization of the radiology services and a "filmless" radiology department can be created. A. The speed of an available workstation is totally inadequate for the day to day clinical use.(ABSTRACT TRUNCATED AT 250 WORDS)     

Managing the film library: what to do until the panacea arrives

Today's imaging departments are complex and often decentralized. Despite such growth, the film library is often overlooked and minimally planned for. The oversight may come from the anticipation of picture archiving and communications systems (PACS), considered by many to be the panacea for film management, but in reality, still only a concept, or at best, in its early stages. Since most departments do not anticipate going filmless for many years and others expect to continue hard copy imaging at a 20 to 30 percent rate, managing the film library remains an important issue. In general, film librarians' daily work remains labor intensive, despite attempts to automate some tasks. Yet when cutbacks are made, this support staff is often cut. One way to deal with service and expansion issues in the film library is to stop and evaluate the situation, assess the decline in the level of service, and determine what issues need improvement. Managers should gather information, analyze the data and listen to all interested parties to be sure they understand the overall problems, often best done by someone from outside the department. Analyzing and evaluating work processes, even observing the design of work areas, can be useful in understanding productivity inside the department. An invaluable way to gather data is to listen to those who carry out the daily tasks and those who use the services. Until their needs are understood by management, further changes will have minimal success. When a list of issues is assembled, managers should establish a team to review and prioritize them. Team members will need to understand departmental long-term plans before making recommendations. While every library's operations are unique, a key problem remains lost films. Policies and procedures for removing films must come from hospital senior administration, while managing film within the department is everyone's job. With the chaos under control, managers will be ready to face the challenge of electronic imaging.     

The 1987 Gordon Richards memorial lecture: the future of radiography--cassetteless or filmless?

A six-year experience of the first cassetteless radiology department has shown that it produces considerable improvement in speed and efficiency of patient handling, reduced physical labor for the technician, and substantial financial savings, amounting to approximately one third of the total non-medical budget. This is contrasted with the potential cost of a totally digital (filmless) department. The digital acquisition devices and their image processing systems are considerably more expensive. Image display comparable to conventional radiographys (for example the full-sized chest film) is markedly inferior in resolution and totally prohibitive in cost. Image storage and recall of the same amount of data as currently handled by the conventional department are presently beyond the capabilities of any commercial communications system, and the potential cost is completely unacceptable. Projections of the imminent advent of the filmless department are grossly over-optimistic, whereas the development of cassetteless systems offers an alternative route to improved patient handling and increased cost-efficiency.     

Enriched Audience Engagement Through Twitter: Should More Academic Radiology Departments Seize the Opportunity?

PurposeThe aim of this study was to evaluate use of the microblogging social network Twitter by academic radiology departments (ARDs) in the United States.MethodsTwitter was searched to identify all accounts corresponding with United States ARDs. All original tweets from identified accounts over a recent 3-month period (August to October 2014) were archived. Measures of account activity, as well as tweet and link content, were summarized.ResultsFifteen ARDs (8.2%) had Twitter accounts. Ten (5.5%) had “active” accounts, with ≥1 tweet over the 3-month period. Active accounts averaged 711 ± 925 followers (maximum, 2,885) and 61 ± 93 tweets (maximum, 260) during the period. Among 612 tweets from active accounts, content most commonly related to radiology-related education (138), dissemination of departmental research (102), general departmental or hospital promotional material (62), departmental awards or accomplishments (60), upcoming departmental lectures (59), other hospital-related news (55), medical advice or information for patients (38), local community events or news (29), social media and medicine (27), and new departmental or hospital hires or expansion (19). Eighty percent of tweets (490 of 612) included 315 unique external links. Most frequent categories of link sources were picture-, video-, and music-sharing websites (89); the ARD’s website or blog (83); peer-reviewed journal articles (40); the hospital’s or university’s website (34), the lay press (28), and Facebook (14).ConclusionsTwitter provides ARDs the opportunity to engage their own staff members, the radiology community, the department's hospital, and patients, through a broad array of content. ARDs frequently used Twitter for promotional and educational purposes. Because only a small fraction of ARDs actively use Twitter, more departments are encouraged to take advantage of this emerging communication tool.     

Radiology integration in a multi-hospital system.

In 1989, Salt Lake City's Intermountain Health Care (IHC) began a process to reduce costs and streamline processes. Divided into four geographic regions, IHC consists of 24 hospitals and 100 clinics, a 400-member practitioner-physician group, and a staff of 23,000. IHC determined that three Salt Lake Valley hospitals, part of its Urban Central Region, must become one entity with shared management and a reduced staff to cover operations at all three hospitals. Management of the three radiology departments were charged with creating an integration process for the three hospitals. Two directors were selected to manage radiology and meet the outlined goals. Difficulty arose when one director needed to make changes in a facility managed by the other. The directors found that structuring by modality allowed them to plan for all three facilities, standardize equipment purchases and create integrated rather than departmental programs. As consolidation was taking place in top management, employees worried what the resulting changes meant for their jobs. Many were unfamiliar with the concepts of team structure and continuous quality improvement. Various courses and meetings were held to educate staff members and bring them up to new standards. Most successful were the meetings that allowed staff from different facilities to come together and share ideas. Although travel was an issue, these meetings quickly helped move the integration processes forward as peer relationships were developed. Employees were recruited for cross-training and new staff worked wherever needed. As they began to share data, the three hospitals identified best-practice and internal benchmarks. IHC is now ready to hire a single director to manage the radiology departments at the three Salt Lake Valley hospitals.     

Beyond culture and regular staff meetings.

Joining the radiology department of a New York City hospital, I learned that if I fostered employees' self-respect and self-reliance, they would do a good job. I believed the staff would achieve maximum performance levels when I understood the culture of the department and could work with staff members beyond regular staff meetings. More than anything else, understanding the department culture influenced my style of management. To keep the lines of communication open, department supervisors and attending radiologists meet biweekly with the chairman of radiology to discuss current and anticipated problems. Often, these meetings are charged with new ideas and excitement. An in-services program to educate and motivate employees on the job was another ongoing process, with radiologists and radiology administration working together. In-service presentations emphasized learning by using actual cases. Believing a seminar's effectiveness can be measured by its relevance to staff members, I gave a seminar on financial techniques and explained stocks, bonds, mutual funds, IRAs, 403B, 401K and multiple retirement options. Technical and clerical staffs are unionized so management and union delegates now meet to identify mutual concerns under the hospital-initiated labor management meetings. To meet additional goals, my department closely monitors the QI of the most important aspects of care-waiting times, turnaround times of radiology reports and satisfaction of both physicians and patients. In the creative atmosphere I brought to the hospital, I was able to teach staff members to reach for goals they had considered beyond them.     

Image display in the operating room: eliminating the barriers in the transition to filmless radiology

As hospitals endeavor to transition from film-based radioloogy to electronic or filmless radiology, one limitation is an effective means for accessing the electronic image archive during surgical procedures. The dependency on using reference images during surgical procedures is a critical function. Scott & White Memorial Hospital in Temple, TX, has been progressively moving toward an electronic paradigm for access to medical information. As the radiology department began to eliminate film as a medium for image presentation and image archiving, it was realized that the hospital needed to provide an electronic solution for the display of images in the operating room (OR) as reference during the surgical procedure. The goals in this project were, therefore, multifold: provide electronic access to images and image files directly within the operating suites, eliminate lost films, and reduced delays caused by lost or unavailable films. The end solution utilized the same Web-based software for all devices, but varied the hardware to meet the individual's or group's needs. The success in this project was not contained to cost savings in radiology, which was realized by reducing film library personnel and eliminating films printed specifically for the surgical environment, but also in greater magnitude for the hospital in improving efficiency of the OR support staff and by directly stimulating a reduction in the average OR time needed for the surgical procedures.     

Introduction to digital medical image management: departmental concerns

OBJECTIVE: The objective of this article is to provide an overview of the considerations that are faced when a film-based imaging department transitions to a filmless practice. Both departmental and enterprise issues will be discussed in the context of a single geographically confined campus. CONCLUSION: A successful transition to a filmless practice results from applying imaging informatics principles and using established standard, appropriate change management practices, all coordinated by a team of representative stakeholders.     

Gradual PACS adoption

For more than a decade, radiology professionals have hoped that picture archiving and communications systems (PACS) would improve efficiency and reduce costs. However, pioneer PACS systems were extremely expensive, and they didn't always meet their users' needs. Recent changes mean that PACS are more accessible. Advances in technology have resulted in decreased costs and increased computer power, and many radiologists recognize that they must consider new tools, such as teleradiology, to compete. There are roughly five classes of digital image systems used by radiologists: modality clusters, on-call review and teleradiology, remote primary diagnosis, mini-PACS and PACS. Even though hospitals seem to view PACS as inevitable, the challenge is to manage PACS implementation economically. One answer is to install PACS incrementally. Once teleradiology and mini-PACS are in place, they can be used as the building blocks of full-fledged PACS. Because PACS have a broad impact on healthcare facilities, careful planning is needed. Design your system to support future, as well as current, applications. Another important planning step is to set goals for improved efficiency and cost reduction.     

Year 2000: status of picture archiving and digital imaging in European hospitals

The aim of this study was to compare the degrees of implementations of full and departmental Picture Archiving and Communication Systems (PACS), the usage of mini-PACS and to compare digital image equipment implementation rates in the countries of the European Union plus the Czech Republic, Cyprus, Malta, Norway, Poland and Switzerland. The degree to which Digital Image Communications in Medicine version 3.0 (DICOM 3.0) protocols are available for data exchange by different digital image equipment is surveyed, to assess underlying PACS preparedness. A questionnaire with an addressed reply envelope was posted to the heads of radiology of 1594 hospitals in 19 countries in early 2000. Data returns were obtained from 17 countries. This indicates considerable variation in PACS implementation and preparedness between European nations. Possible reasons for this are discussed. The highest rates of PACS implementations have been in Austria, Norway and Sweden. Received: 19 June 2000 Revised: 11 August 2000 Accepted: 11 August 2000     

Building a leadership team that works

Radiology administrators often are challenged to do more with less. In today's fast-paced work environment, leaders must be creative. They must surround themselves with good people in order to successfully achieve their organizations' goals. Once a radiology administrator is satisfied and comfortable that he or she has, the right staff involved, a leadership team can be formally establislished. Howard Regional Health System established an Imaging Services Leadership Team with a vision to provide leaders for the staff to "follow," just as team members learn from the radiology administrator. In addition, team members are vital in assisting the radiology administrator in managing the department The process of building the team consisted of 3 steps: selecting team members (the most challenging and time-consuming component), formalizing a functional team, and putting the team into action. Finding the right people, holding regular meetings, and making those team meetings meaningful are keys to a successful leadership team. The implementation of the team has had a positive effect on imaging services: the number of procedures has increased, the team is used as a communication tool for front-line staff, front-line staff are becoming more comfortable with making decisions.     

Developing an orientation program.

When the local area experienced tremendous growth and change, the radiology department at Maury Hospital in Columbia, Tennessee looked seriously at its orientation process in preparation for hiring additional personnel. It was an appropriate time for the department to review its orientation process and to develop a manual to serve as both a tool for supervisors and an ongoing reference for new employees. To gather information for the manual, supervisors were asked to identify information they considered vital for new employees to know concerning the daily operations of the department, its policies and procedures, the organizational structure of the hospital, and hospital and departmental computer systems. That information became the basis of the orientation manual, and provided an introduction to the hospital and radiology department; the structure of the organization; an overview of the radiology department; personnel information; operating procedures and computer systems; and various policies and procedures. With the manual complete, the radiology department concentrated on an orientation process that would meet the needs of supervisors who said they had trouble remembering the many details necessary to teach new employees. A pre-orientation checklist was developed, which contained the many details supervisors must handle between the time an employee is hired and arrives for work. The next step was the creation of a checklist for use by the supervisor during a new employee's first week on the job. A final step in the hospital's orientation program is to have each new employee evaluate the entire orientation process. That information is then used to update and revise the manual.     

Process modification and emergency department radiology service

Our purpose was to demonstrate the impact of changes in technology, staffing, and departmental processes on service levels in emergency department (ED) radiology. We also attempted to determine if report turnaround time affects ED patient throughput. Radiology performance was evaluated before and after the modifications of processes integral to the interpretation of ED imaging. Picture archiving and communication system, voice recognition (VR), staffing, physical site, work flow, and administrative modifications were undertaken over ∼2 years. The average time interval from the exam completion to report signature was 5,184 min (standard deviation (SD) of 1,858 min before the implementation of VR and other modifications of ED radiology processes). In post initial modifications, it was 150 min (SD, 169 min) and 157 min (SD, 215 min) in post additional modifications. The percentage of the signed written reports available in less than or equal to 60 min was 0%, 27%, and 40%, respectively. Ongoing improvements are needed to increase the service levels for ED radiology. Further improvement will require collaboration and adjustment with the ongoing assessment of metrics.     

Radiology Architecture Project Primer

The rapid pace of technologic advancement and increasing expectations for patient- and family-friendly environments make it common for radiology leaders to be involved in imaging remodel and construction projects. Most radiologists and business directors lack formal training in architectural and construction processes but are expected to play significant and often leading roles in all phases of an imaging construction project. Avoidable mistakes can result in significant increased costs and scheduling delays; knowledgeable participation and communication can result in a final product that enhances staff workflow and morale and improves patient care and experience. This article presents practical guidelines for preparing for and leading a new imaging architectural and construction project. We share principles derived from the radiology and nonradiology literature and our own experience over the past decade completely remodeling a large pediatric radiology department and building a full-service outpatient imaging center.