The worklist on steroids

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The lack of distributed reading solutions for practices covering multiple clients has caused a good deal of pain over the past five years and in response, practices have brought forth some interesting solutions, both ugly and elegant. Many vendors, including traditional PACS vendors, showcased new worklist solutions meant to meet this need, but we also saw the emergence of a new category of companies specializing in radiology workflow.

Compressus has been offering and refining it's virtual worklist, called MedxConnect for at least five (and probably a few more) years, and now McKesson is offering the solution as The Reading Network. The worklist offers the ability to filter studies in a variety of ways, including by subspecialty and urgency. It also can pull prior studies from participating providers based on bandwidth as early as 12 hours before a study is performed, using rules to winnow only the relevant studies. It is a web-based application with edge servers at each major location.

Compressus' Janine Broda maintains that the ability of the technology to enable institutions to share images is not the problem. "It is politics and the sharing of the data," she says. As providers begin to understand the quality implications of image sharing, they are likely to be more amenable to data exchange. Broda says that a radiology practice that covers a hospital participating in an image exchange network in Tacoma, Washington, went from pulling 350 priors per month to 4,500 a month.

Originally based on a sophisticated radiology decision support tool built at Brigham & Women’s by Ramin Khorasani, MD, Medicalis showed a greatly expanded workflow platform this year that provides the federated worklist/workflow piece (acquired last year from the IT-forward super practice in Spokane, Inland Imaging), as well as operations/analytics, and the aforementioned decision support piece. The workflow is based on assigned “buckets” that are specific to each user, explains Medicalis’s John DeLong. Rules-based, the system manages clinical priority, credentials, core statistics (RVUs, number of studies), and the all-important service-level agreements.

The Medicalis workflow solution also features three engines for decision support, scheduling, and workflow, built on top of an analytics platform and an integration platform. Nice touch: Since referrers are more likely to have had the last patient encounter than the radiologist, insurance information is integrated into the web-based physician portal.

DeLong says the RIS of yore has become disintermediated as the workflow needs of radiology have become increasingly complex. “What is left is an anemic skeleton originally created for billing, with a clinical workflow overlay,” he says.