Strategies for Closed-loop Radiology Workflow with Speech-Driven Documentation and Communication

Commercially-available Clinical Radiology Support

Nationally, it is estimated that 20 to 30 percent of currently performed High Tech Diagnostic Imaging (HTDI) exams are medically unnecessary or inappropriate.

This is due, in part, because many HTDI exams are currently scheduled without the benefit of a standardized, evidence-based, decision support tool.

After a yearlong pilot program, in which more than 2,300 physicians from five Minnesota medical groups, five health plans, and the Minnesota Department of Human Services used e-Ordering (defined later) to order high-tech diagnostic imaging exams, it was found that the exams ordered with evidence-based decision-support technology had an increase in medical appropriateness versus orders initiated without it. The pilot also showed that using decision-support appropriateness criteria (defined later) in the physician’s office reduced patient exposure to unnecessary radiation, and contributed to a 0 percent increase in HTDI scans ordered in 2007 (following an 8 percent increase in Minnesota in 2006). N.B. During the time of the pilot, an estimated $28 million in healthcare cost savings was reported.

Going forward, Nuance’s RadPort, an electronic, evidence-based, decision-support (e-Ordering) solution is going to be used to support a statewide initiative to help ensure Minnesotans only receive medically appropriate high-tech (MRI, CT, PET and nuclear cardiology) diagnostic imaging (HTDI) tests.

Derived from the American College of Radiology (ACR) Appropriateness Criteria, and designed in conjunction with Massachusetts General Hospital, RadPort’s scoring methodology is continuously reviewed and updated by a panel of clinical and radiology experts.

RadPort combines the clinical information provided by the referring physician at the time of ordering with patient demographics to produce a “utility score” for the examination requested.

Click here for a discussion of appropriateness criteria and utility scores.

A high score indicates that the information provided strongly supports the use of the requested imaging test. A low score indicates that the request may not be appropriate. As a result, RadPort displays alternate procedure choices with corresponding utility scores of other relevant and appropriate exams.

In the event of a low score, RadPort provides clinical reference material designed to educate the referring physician so as to ensure appropriate ordering in the future.

Nuance Healthcare manages radiology as a single, end-to-end or closed-loop process. This approach gives radiologists and administrators a continuous view of the order from diagnosis through results process, which allows for analysis that can drive improvements at each stage.

The benefits of closed-loop radiology are evident: saving time, money, and resources, improving patient safety and care, and better clinical documentation.

Click here for an overview.

Click here for info on RadCube, a comprehensive, yet flexible, data warehouse for multi-dimensional business analysis and visualization tool. RadCube is another key application in the Nuance portfolio of imaging documentation and communication software.

RadCube merges OLAP and web architecture. This radiology-centric solution allows its users to perform highly complex clinical and detailed business analysis on your data in mere seconds using a simple drop-and-drag interface. By integrating advanced On-Line Analytical Processing (OLAP) techniques and Natural Language Processing (NLP) with one's unique institutional data, RadCube provides ways to visualize, analyze and optimize healthcare delivery to each patient. With RadCube, you can explore information from various business, clinical and research perspectives or identify trends, opportunities and potential issues quickly with familiar visualization techniques. You can analyze all operational aspects of your business including: Business Productivity, Quality Assurance, Utilization Management, Throughput Analysis, Communication Management, Evidence-Based Radiology, Advanced Data Mining Techniques, Trending and Forecasting, and Benchmarking.



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Click here for info on applying “Six Sigma” principles to the radiology process.

Click here for an early article of mine on “Six Sigma”

A link to this article is also available near the top of "My [partial] bibliography" at the bottom of this blog.

Finally, click here for a brief introduction to i2b2, an open-source calable informatics framework that enables clinical researchers to use existing clinical data for discovery research and, when combined with IRB-approved genomic data, facilitate the design of targeted therapies for individual patients with diseases having genetic origins.

Counter-Intuitive Considerations -- When You're Automating a Business Process That Includes A Human Workflow

This blog is currently addressing business processes, human workflows, etc. However, at the very bottom of this page appears my bibliography [partial] with prior articles on topics like cost benefit analysis, six sigma, service level agreements, etc

To reconcile these two, sometimes opposed approaches to system design, I recommend the following talk (in a one-hour video) by John Seddon, an occupational psychologist. Just click on the image below to watch his January 03, 2010 presentation.



In the course of his talk, Seddon refers to the 2008 Wiley book



Customer service, often a human task, they assert, is only needed when an organization does something wrong -- eliminating the need for service is the best way to satisfy customers. To be successful, organizations need to treat service as a data point of dysfunction and figure what they need to do to eliminate the demand.

You decide!

From my [partial] bibliography - Six Sigma, Monte Carlo Simulation, and Kaizen

From time to time, I've made reference to "My [partial] bibliography" at the bottom of this blog. One of the articles cited near the top of this list, Six Sigma, Monte Carlo Simulation, and Kaizen for Outsourcing, recently drew some complimentary feedback that I've pasted here {this is unabashed self promotion}:

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Here's a small section from the article:

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