Pay for performance (P4P) in medical imaging: the time has (finally) come.
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Humans↗
Biomedical subjects
Bruce I Reiner
Publications and source records attributed to Bruce I Reiner.
Quality assurance: the missing link.
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Clinical Trials as Topic↗
Multi-institutional analysis of computed and direct radiography: part I. Technologist productivity.
PURPOSE: To assess whether it is feasible to measure and compare work-flow times across institutional variations, and to apply such a comparison to technologist productivity in the performance of general radiographic examinations with computed radiography (CR) and direct radiography (DR). MATERIALS AND METHODS: The study received internal review board exemption. Participants were informed about the study and willingly participated. Observational time-motion analyses were performed at four sites at which CR and DR are used concurrently. The time taken by the technologist for patient preparation, positioning, exposure, and postacquisition processing, and for the examination as a whole, was recorded. Data collected reflect unique elements at each clinical center, and no standardized work flow was imposed. Work-flow performance times were correlated with each site profile. Preliminary statistical analyses included examination of distributions of original and combined variables. Descriptive statistics were presented as means or frequencies, depending on whether the data were continuous or categorical. Continuous variables were compared by using the Student t test. Timing differences between CR and DR for each clinical center were compared, and all data were analyzed by using commercially available statistical software. RESULTS: For all four study sites, statistically significant total examination time differences were observed when comparing CR and DR (P < .001). The single step in the examination that was found to be the largest contributor to time difference was postacquisition processing, which accounted for 30%-100% of the total time difference between the two technologies. The most time-efficient sites were those that had in-room postacquisition processing capability and fully functional integration with the radiology information system. Investigators at two study sites compared times for two-view chest radiography only, and those at the other two study sites compared times for multiview general radiographic examinations. Only the results of two-view comparisons were reported for each site. CONCLUSION: Overall technologist time was significantly shorter when performing tasks associated with DR than when performing comparable tasks associated with CR, a difference that appears to result largely from technology configuration, staffing, and patient management.
Efficiency↗
Multi-institutional analysis of computed and direct radiography: part II. Economic analysis.
PURPOSE: To compare economic aspects of equipment configurations, productivity levels, and patient waiting times in the performance of computed radiography (CR) and direct radiography (DR). MATERIALS AND METHODS: The study received internal review board exemption status, without the need for informed patient consent. Data from four study sites were used to calculate the CR-DR crossover point (defined as the point at which the cost-effectiveness of DR equals that of CR) and CR-DR annual cost differentials. Analyzed variables included equipment and operating costs, examination volumes, and productivity. A program was developed to simulate patient arrival times, number of patient examinations, and patient waiting times on the basis of average annualized parameters for each of the four clinics. Sensitivity analyses were conducted to assess utilization rates and determine cost optimization. Utilization rates were compared with the number of excess long-stay CR patients (ie, patients who spent more than 30 minutes waiting in the radiology department prior to CR examination) and with the cost (per excess long-stay CR patient who waited more than 60 minutes) averted by using DR. RESULTS: Excess annual costs for DR over CR at the four sites ranged from $50,757 to $75,303. At extrapolated levels of economic penalties for long waiting times, the crossover point at which the DR cost became justifiable was when CR capacity utilization rates approached or exceeded 80%. CONCLUSION: In the current practice environment, with capacity utilization rates well below 80%, CR is likely to be a more cost-effective technology for the majority of general radiography providers.
Costs and Cost Analysis↗
Defining the PACS profession: an initial survey of skills, training, and capabilities for PACS administrators.
The need for specialized individuals to manage picture archiving and communications systems (PACS) has been recognized with the creation of a new professional title: PACS administrator. This position requires skill sets that bridge the current domains of radiology technologists (RTs), information systems analysts, and radiology administrators. Health care organizations, however, have reported difficulty in defining the functions that a PACS administrator should perform-a challenge compounded when the tries to combine this complex set of capabilities into one individual. As part of a larger effort to define the PACS professional, we developed an extensive but not exclusive consensus list of business, technical, and behavioral competencies desirable in the dedicated PACS professional. Through an on-line survey, radiologists, RTs, information technology specialists, corporate information officers, and radiology administrators rated the importance of these competencies. The results of this survey are presented, and the implications for implementation in training and certification efforts are discussed.
Administrative Personnel↗
Addressing the coming radiology crisis-the Society for Computer Applications in Radiology transforming the radiological interpretation process (TRIP) initiative.
The Society for Computer Applications in Radiology (SCAR) Transforming the Radiological Interpretation Process (TRIP) Initiative aims to spearhead research, education, and discovery of innovative solutions to address the problem of information and image data overload. The initiative will foster interdisciplinary research on technological, environmental and human factors to better manage and exploit the massive amounts of data. TRIP will focus on the following basic objectives: improving the efficiency of interpretation of large data sets, improving the timeliness and effectiveness of communication, and decreasing medical errors. The ultimate goal of the initiative is to improve the quality and safety of patient care. Interdisciplinary research into several broad areas will be necessary to make progress in managing the ever-increasing volume of data. The six concepts involved are human perception, image processing and computer-aided detection (CAD), visualization, navigation and usability, databases and integration, and evaluation and validation of methods and performance. The result of this transformation will affect several key processes in radiology, including image interpretation; communication of imaging results; workflow and efficiency within the health care enterprise; diagnostic accuracy and a reduction in medical errors; and, ultimately, the overall quality of care.
Humans↗
Evolution of the digital revolution: a radiologist perspective.
The transformation from film-based to filmless operation has become more and more challenging, as imaging studies expand in size and complexity. To adapt to these changes, radiologists must proactively develop new workflow strategies to compensate for increasing work demands and the existing workforce shortage. This article addresses the evolutionary changes underway in the radiology interpretation process and reviews changes that have occurred in the past decade. These include a number of developments in soft-copy interpretation, which is migrating from a relatively static process, duplicating film-based interpretation, to a dynamic process, using multi-planar reconstructions, volumetric navigation, and electronic decision support tools. The result is optimization of the human-computer interface with improved productivity, diagnostic confidence, and interpretation accuracy.
Humans↗
The cutting edge: strategies to enhance radiologist workflow in a filmless/paperless imaging department.
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Efficiency, Organizational↗
Filmless radiology at the Baltimore VA Medical Center: a 9 year retrospective.
The transition from conventional film based to filmless operation at the Baltimore VA Medical Center in 1993 was successful and has resulted in a number of clinical and economic benefits. The subsequent integration of the Department of VA hospitals in Maryland into a single network, the VA Maryland Health Care System, resulted in the opportunity to establish a 'virtual' radiology and nuclear medicine department. This integrated department is based upon a wide area network in which outlying medical centers utilize a central HIS/RIS and a central commercial Picture archival and communication system (PACS) as well as a VA 'home grown' image management and communication system, the VISTA imaging system. The creation of this virtual radiology/nuclear medicine department has resulted in additional savings and improvements in clinical care. The benefits of the PACS were made possible, to a large extent, by the high level of integration of the PACS and medical modalities with the hospital information and transcription systems. Our experience suggests that it is absolutely essential to integrate the PACS into the patient's electronic medical record in order to maximize efficiency and clinical effectiveness of the system.
Baltimore↗
SCAR Radiologic Technologist Survey: analysis of the impact of digital technologies on productivity.
As medical reimbursements continue to decline, increasing financial pressures are placed upon medical imaging providers. This burden is exacerbated by the existing radiologic technologist (RT) crisis, which has caused RT salaries to trend upward. One strategy to address these trends is employing technology to improve technologist productivity. While industry-wide RT productivity benchmarks have been established for film-based operation, little to date has been published in the medical literature regarding similar productivity measures for filmless operation using PACS. This study was undertaken to document the complex relationship between technologist productivity and implementation of digital radiography and digital information technologies, including PACS and hospital/radiology information systems (HIS/RIS). A nationwide survey was conducted with 112 participating institutions, in varying degrees of digital technology implementation. Technologist productivity was defined as the number of annual exams performed per technologist full-time equivalent (FTE). Productivity analyses were performed among the different demographic and technology profile groups, with a focus on general radiography, which accounts for 65-70% of imaging department volumes. When evaluating the relationship between technologist productivity and digital technology implementation, improved productivity measures were observed for institutions implementing HIS/RIS, modality worklist, and PACS. The timing of PACS implementation was found to have a significant effect on technologist productivity measures, with an initial 10.8% drop in productivity during the first year of PACS implementation, followed by a 27.8% increase in productivity beyond year one. This suggests there is a "PACS learning curve" phenomenon, which should be considered when institutions are planning for PACS implementation.
Data Collection↗
Technologists' productivity when using PACS: comparison of film-based versus filmless radiography.
OBJECTIVE: The objective of this study was to assess the impact of filmless operation and computed radiography on technologists' examination times compared with conventional film-based operation and film-screen radiography. CONCLUSION: Compared with conventional film-screen operation, filmless operation using computed radiography was associated with a significant decrease in technologist examination times in the performance of general radiographic examinations. This decrease in technologist examination times in a filmless environment offers the potential for increased productivity with resulting personnel savings and improved operational efficiency.
Efficiency↗
Accuracy of interpretation of CT scans: comparing PACS monitor displays and hard-copy images.
OBJECTIVE: The purpose of this study was to determine the relative diagnostic accuracy of radiologists in the interpretation of CT scans using a computer workstation in comparison with using film. MATERIALS AND METHODS: Four board-certified radiologists with extensive soft-copy experience interpreted 117 CT scans in four anatomic regions using films displayed on an alternator and images displayed on a four-monitor workstation. The radiologists were asked to interpret the scans in their usual fashion and were aware that both the time required to review the study and the accuracy of the reports were being assessed. The radiologists' diagnostic impressions were compared with those of a consensus panel and scored for accuracy. RESULTS: Soft-copy interpretation using computer workstations was found to produce statistically significant improvement in combined measurements of sensitivity, specificity, and overall accuracy for chest, brain, and chest-abdominal CT scans compared with film interpretation. CONCLUSION: PACS (picture archiving and communication system) offers radiologists the potential for improved accuracy in CT interpretation compared with traditional film-based interpretation.
Brain↗