When it comes to electronic communications for radiology, it’s all in the workflow, says Andrew Wells, MD, a radiologist with Hendersonville Radiological Consultants, an eight-partner practice that covers three hospitals in western North Carolina.
“You have to be able to receive information for workflow at the point of doing work, and you need to be able to create an outbound message where you are doing your interpretation—it’s got to be that convenient,” he asserts. “That’s a sticking point for workflow communication.”
Making that happen is a lot more complicated than it may seem, but 220-bed Margaret R. Pardee Memorial Hospital is making progress toward that elusive goal—efficient electronic communications in radiology. Eighteen months ago, the hospital deployed Synapse Communications with Tasks from FUJIFILM Medical Systems U.S.A., Inc., Stamford, Conn., streamlining intra-departmental communications within the hospital’s Synapse PACS environment.
“The communication tool that we have deployed electronically, in Fuji-speak, is called the Task, and it has eliminated the need for a technologist to find a radiologist to read a call report exam,” Wells explains. “We now have an electronic workflow.”
Instead of calling around to find a radiologist to read a stat case, the technologist creates an inbound message that is blasted to all radiologists who are reading, providing patient name, type of study, accession number and an icon that says ready to read call report. All radiologists see that and after they complete their current case, if they see that patient on an unread list, they open the case and read it next.
“I can open a window that completes the inbound message, and I can create an outbound message to the technologist that replies, ‘It’s read, the preliminary is a typed note, please find note and call to doc XY and disposition to patient,” Wells says. “There’s no searching for the radiologist to read the call report, and I don’t have to search for the technologist to accept the message: It’s done, please call the report.”
If a radiologist comes across a study with findings—incidental or otherwise—that a referrer should know about, he or she no longer needs to call the technologist and ask that the results be called to the referrer. He or she can create a call report and force a message to the technologist explaining that the study is a physician-declared call report and must be directly communicated to the physician. “Again, I don’t have to call around to send that message to the technologist,” Wells says.
Managing ED discrepancies
With intra-departmental electronic communications in place, Pardee Hospital is poised to extend similar efficiencies to communications outside of radiology with a new, upcoming version of Synapse Communications currently being tested at Pardee. The process of managing ED discrepancies at Pardee Hospital provides a good, real-world example of the challenges of communications between departments. Effective communications between the ED and the radiology department are critical to patient care and typically require a good deal of human intervention: Notes must be typed by radiologists, phone calls made and technologists engaged to deliver results to the ED.
Radiologists from Wells’ group read ED cases contemporaneously, real-time, inside Synapse PACS. With the implementation of Synapse Communication, the ED physicians—working with Synapse PACS open on their computers—see an icon pop up when a preliminary report is present. “We type ‘negative chest’ or ‘left hip fracture, no dislocation’, and the ED doctors get that electronically,” Wells explains. “When they see that icon, it is the visual ding—you’ve got mail—, without a phone call or piece of paper.”
ED discrepancies occur when the ED physician takes an initial look at, for instance, a radiograph and records a preliminary reading, Wells explains. “They have to tell you ‘negative chest’,” he explains. “If they tell me ‘negative chest’, and I report ‘left lower-lobe pneumonia’, then I know there’s a discrepancy, and I can act to send the next communication back to them.”
Two steps are then performed in the ED discrepancy workflow at Pardee Hospital: The radiologist records a typed note using the phrase “updated preliminary.” That note—identifying left lower-lobe pneumonia—occurs in the same place as the ED physician’s negative. However, best practices suggest acknowledgement of receipt, and currently that requires that either the technologist
Cheryl Proval is the editor of Radinformatics.