Disruptions in Radiology:
As concluded in recent articles written by Drs. Kansagra, Yu, Mongan, and others, it could be said that there is a silent killer in the Radiology Suite - and it’s being revealed as distraction and disruption of the radiologist. Increasingly, radiologist are complaining they are unable to achieve a high-efficiency reading rhythm due to phone calls, emails, instant messages, interactions with patients and referring providers as suggested by the articles. I believe the research falls short by not implicating legacy and poorly written software, UI Design, and other back-end technologies like protocols, and database as having shared culpability.
I would like to submit to the researchers that “under-performing legacy technologies” contribute equally to the problem of distraction and lead to a loss in quality and efficiency.
Having evaluated the inefficiencies by taking measurements of what contributed most to the problem, I concluded the number one offender to be “latency in loading images” typical with legacy PACS technologies, - followed closely by poor integration of disparate systems leading to laborious workflows and missing details necessary to read uninterrupted.
The main issue with poor image loading performance is that it causes a repetitive distraction in-between each and every exam inflicting tremendous pain and frustration on the radiologist. In many examples the radiologist use the incessant load time sequences to step away, grab a cup of coffee, take a call, and respond to an email - never able to achieve a solid reading rhythm necessary to read high volumes safely.
During a project I recently completed with a large outpatient chain it occurred to me what negative impact these distractions must have on the radiologist brain and if there was research on the topic. What’s the impact to be in a constant state of distraction (frustration) while being forced to accept it as the norm every day? Today, radiologists are being asked to work longer shifts, nights, weekends, read more with less, take calls from referring doctors, and see more in-person with patients - all to remain relevant in the modern day reorganization of the healthcare landscape. Radiologists have enough to do - this is a problem for Health-IT, and Software Engineers to solve.
Upon concluding my assessment I knew there was much to do, so I decided not to accept the industry conclusion that this was the best we could achieve. I went to market to find the solutions that could eliminate the distractions using technology and simple workflow changes.
What I came up with… (Complete end-to-end solution)
- Visage 7 - Enterprise Imaging (Diagnostic Viewer) Platform with server-side rendering technology that has negligible load time even on the fly) “Don’t Blink you may miss it load”
- Primordial Prism - Advanced Worklist customized for each Radiologist
- Home grown application for all clinical support documentation (Insurance, Histories, Prior Reports – All in a single pane of glass)
- Fuji Synapse RIS
- PowerScribe 360 (with full integration)
- Dell VNA - Vendor Neutral Archive (3YR onsite with Cloud Archive No-Delete)
Post implementation, we immediately realized tremendous improvements in throughput, and radiologist satisfaction, not to mention a reduction in staff to support the same volumes. Radiologists were now able to read for all specialties anytime-anywhere including MG, TOMO, ABUS, MR/PET, PET/CT, and ECHO minimizing the need to jump around to advanced diagnostic stations for breast, PET, or 3-D a common disruption in typical reading environments. Studies now load immediately in the Visage 7 thin-client viewer automatically with priors along with patients histories, and necessary datasets to support diagnosis.
The new radiologist workflow uses Primordial Prism to assign and present reading queues to radiologists using full customization parameters along with auto launching features that launch Visage 7, PS360, and custom Document Viewer from a single click so radiologist are able to achieve reading requirements with minimal software UI and workflow distractions (delays).
These improvements enable the reading radiologist to read contemporaneously and effortlessly by eliminating study load times and the associated distraction of latency. Additionally, through tight integration of the selected software many of the other typical workflow distractions (calling around for cases, missing paperwork, releasing reservations) were either eliminated or reduced to acceptable levels keeping the radiologist in the seat and in “THE-ZONE”.
I believe approaching the challenge of distractions within the radiologist workflow from the radiologist perspective goes a long way in solving the problem. Treating the workflow as an exercise in LEAN or Six-Sigma by working the constraint aids in improving end-to-end throughput for the organization.
I accept and appreciate research in the area of distractions completely and look forward to seeing more research as it pertains to deficient UI, legacy technologies, data-delay, and it's impact on radiologist efficiency, productivity, and efficacy.
References 1. Yu JP, Kansagra AP, Mongan J. The radiologist’s workflow environment: evaluation of disruptors and potential implications. J Am Coll Radiol. 2014;11(6):589-593. 2. Balint BJ, Steenburg SD, Lin H, Shen C, Steele JL, Gunderman RB. Do telephone call interruptions have an impact on radiology resident diagnostic accuracy? Acad Radiol. 2014;21(12):1623-1628. 3. Kansagra AP, Liu K, Yu JJ. Disruption of Radiolog