Roundtable discussion: Driving clinical quality with operational efficiency, pt 1

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Two mandates are driving U.S. healthcare policy: improving quality and reducing costs. At vRad, leadership has embraced these concepts and integrated them into its corporate mission, driven in part by the strong relationship between Chief Medical Officer Benjamin Strong, MD, and Chief Information Officer, Shannon Werb.

ImagingBiz spoke with both professionals recently to discuss how they collaborate to drive operational efficiency while ensuring high clinical quality in radiology. The interview was so fruitful that we will feature only the first half of it in this issue and the second in a subsequent issue of Medical Imaging Review.  Part I focuses on the efficiency side of the equation, and Part II will drill down into specific clinical quality initiatives.

Let’s start with the “e” word—“efficiency.” Why do physicians historically consider it such a dirty word?

Strong: There is no doubt they do—it’s based on a fairly reasonable assumption. When someone says ‘efficiency’, they usually mean hurrying a task, or doing it faster in any case. Most doctors correlate that sort of external pressure with doing a poor clinical job—less patient interaction and less time to consider the implications of test results or physical exam findings. It’s easy to understand the reaction since efficiency has been foisted not only on radiologists, but also on many other clinical specialties.

But what’s interesting is that with radiology that correlation falls apart. To us, efficiency means eliminating unnecessary non-clinical tasks our doctors would typically perform. By eliminating the non-essential time segments in the workflow, we enable our doctors to do what they do best—be radiologists and interpret diagnostic images. vRad does not shorten the actual time radiologists spend interpreting an image or thinking about it, actively. In fact, we allow them to make better use of that time: their ability to focus on the actual medical task at hand is greatly enhanced because we have eliminated distractions that are essentially non-medical.

When we apply efficiency rules, we eliminate mouse clicks, we eliminate the frustrations and delays associated with acquiring additional patient information or prior studies. We also eliminate unnecessary dictation of objective study information into a given report.

Shannon does efficiency carry baggage in IT?

Werb: Typically, technology personnel look at efficiency—or creating efficiency—in association with a reduction in workforce. Oftentimes, we focus on automating redundant tasks, as indicated clinically. We also can do that across various parts of the business, putting in technology where human beings are present or making the process—the workflow that people are leveraging—more efficient, which in the end can result in needing less people. 

We work really hard at keeping the technology personnel focused on the upside of what we are trying to create here. I believe efficiency drives better quality, as Ben indicated, by reducing the distractions of the physician, taking out the identification of the objective information that we can automatically pre-populate, so they are focused in the areas they should be—and maximizing the time their eyes are actually on the images they are interpreting.

Likewise, it’s enabled a business like ours to grow. We hired north of a hundred physicians last year. We would have had to bring on more of them if we were not focused on creating greater efficiency in the platform and driving better quality. We would have needed more physicians and more support personnel. 

So, if there is baggage associated with efficiency, it’s typically around reducing workforce; however, we have successfully grown the business, added physicians and made them more efficient. So for vRad, efficiency is less about reducing workforce and more about making our workforce more productive and valued clinically, thanks in part to technology.

Is there a contradiction here with improving both quality and efficiency, or is there a relationship between the two?

Strong: It’s more about the appropriate application of efficiencies. For example, when they dictate a report, most radiologists, have to say the name of the procedure, the anatomic region that was scanned, whether or not it had intravenous or oral or rectal contrast, whether there were reformats, reconstructions, what the prior study available for comparison is and what it stated.  All these are purely objective information, and hence unrelated to