Doubling Down on Data: Meta-analyses of Productivity and Quality
Wayne DavidsonInfluenced by emerging technology and regulatory changes, the role of the radiology-group CIO has undergone a dramatic shift in recent years: Wayne Davidson, CIO of Quantum Imaging & Therapeutic Associates, Inc (Lewisberry, Pennsylvania), a 40-radiologist practice, says, “In recent years, the focus has really become efficiency because of background factors like declining reimbursement. That drives the business to try to do more with less, and that goal is laid on the shoulders of the IT department. How do we deliver the tools the physicians need to increase their efficiency?” In the environment that Davidson describes, data are paramount for the long-term viability of practices. “It’s an absolute must to collect and analyze every piece of information that comes through our practice,” he says. “It is an everyday event for someone to come to my office looking for a report. Because we get so many requests, we are working to develop a standard set of reports, issued on a routine basis: We’re constantly on the lookout for what our radiologists will need next.” Efficiency and Productivity In 2010, what they needed next was an informatics tool that would gauge productivity in real time, enabling radiologists to know whether they were on track to meet daily efficiency goals while aggregating data about the RVU levels that could reasonably be expected from each seat that the practice staffs. “We conceptualized the tool and outsourced the programming efforts, which we have now brought in-house for future releases and enhancements,” Davidson explains. Quantum’s radiologists currently select the exam that they are reading each time, allowing the tool to monitor their productivity by benchmarking it against targets set by the group. A planned enhancement will make the tool even easier to use by interfacing with the system on which the radiologists are reading to preselect the exam for them. “We designed the program to be very user friendly; it includes palettes of the radiologists’ top 20 studies for a given seat, but on occasion, they have to hunt for an obscure exam,” Davidson says. “With matching logic, it will all be done for them: They just have to acknowledge that it’s correct.” Davidson and his team also plan to develop a Web-client version of the tool (the current version is a thick client). “Moving to a Web client will make life a lot easier for the IT team’s members, who will not have to load and manage software,” he says. “It will also make future updating of the tool easier.” Clinical Quality Of course, no radiology group wants to sacrifice clinical excellence to the goal of increased efficiency, so quality assurance (QA) is another area where the IT team at Quantum Imaging has been hard at work, developing an innovative solution for peer review. “We traditionally had used RADPEER™ for peer review, but we recently developed our own internal QA program,” Davidson says. “We think it’s RADPEER on steroids.” The Quantum Imaging QA system enables the practice to build a real-time database of quality issues. That database provides information to the QA committee and to individual radiologists for the purpose of quality improvement. The system provides real-time feedback to radiologists when a QA issue is encountered. It also includes a unique feature aimed at enhancing report quality: a module for referring physicians. “Our referrers have the option to come in and conduct QA on our radiologists,” Davidson says. “We learn a lot from that about what they want to see in a good report.” Like the data that the practice gathers on efficiency, the QA data from the peer-review program are meta-analyzed. “We take it many steps beyond QA, looking at the report, the exam, and the radiologist; was it a miss, an error, or an omission?” Davidson says. “We look for patterns and recurring issues so that we can address them. We have a QA committee and chair, and they ensure that the quality of our reports doesn’t suffer because of our attention to productivity.” The ultimate goal of Davidson’s team is to bring all of these data together, in an integrated manner, to help the group’s radiologists and leaders promote clinical excellence and financial viability. “Billing data tell one piece of the story, productivity data tell another, and so on,” Davidson says. “We want to bring together data from disparate systems to give the big picture—in a single report.”
Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.