Optimizing Interventional Care at UMMC: A Case Study
Jeff KnoxInterventional-radiology departments are facing increasing demands to justify costs, measure outcomes, and prove value in a competitive clinical environment. Though they are often managed alongside their diagnostic-radiology counterparts, the reality is that interventional-radiology departments have more in common with cardiac catheterization, electrophysiology laboratories or endoscopy than with diagnostic-radiology departments, according to Jeff Knox, MS, RT(R)(CV), CRA, director of operations and asset manager for the department of radiology at the University of Maryland Medical Center (UMMC), Baltimore. Karen Finnegan“Diagnostic radiology is very transactional, by comparison,” Knox says. “Interventional radiology is much more patient centered. It’s a continuum experience: Some of the patients are seen in our outpatient clinic by a radiologist; the patients are always assessed pre-procedure by a nurse, physician’s assistant, nurse practitioner and/or a radiologist; post-procedural care and instructions are given; and some patients have follow-ups in our outpatient clinic.” Fifteen years ago, the interventional-radiology department at UMMC implemented an informatics solution developed by the Society of Interventional Radiology and aimed at streamlining the complex processes inherent in handling a high volume of interventional procedures. The HI-IQ product, now distributed by ConexSys, enabled the department to manage its outpatient scheduling and inventory better. When UMMC began using HI-IQ, the high cost of interventional supplies was an easy target for hospital administrators with their eyes on the bottom line. Karen Finnegan, MS, RT(R)(CV), chief technologist for interventional radiology at UMMC, says, “As the field developed from diagnostic to interventional, our inventory was becoming more expensive. We had to do a reconciliation process every six months, and to do that on paper was very tedious.” She continues, “In the beginning, we used HI-IQ to automate that process, so everyone would know what we had on hand, in terms of products.” Today, further integration has made efficiencies in billing and ordering possible. Finnegan says, “The list of inventory produced by the system goes downstream to billing, so the product comes out of inventory, generates a bill, and can go to automatic reordering.” Unique Requirements UMMC’s interventional department includes eight vascular radiologists, three neuroradiologists, 30 registered nurses, 16 radiologic technologists, four patient-care technologists, and three schedulers (one for inpatients and two for outpatients). The department handles 11,000 vascular procedures and 4,800 neurological procedures annually. “We’re the group that manages the patient completely—they’re referred to us for treatment, and we’ll manage them until that treatment is complete,” Finnegan notes. That means longer patient encounters encompassing a broad array of clinical needs, Knox says. “I come from a cardiac background, and I was used to one organ and one set of tools you needed to have,” he observes. “I thought that was a lot—until I came to interventional radiology. I had no idea how big an inventory could be, or how extensive and expensive. It’s very complex.” With this growth in the number of procedures performed, and the concurrent expansion in the clinical management of patients, the way that the interventional-radiology department aggregates and manages its data has also evolved. Knox explains that traditional information systems for hospitals and their radiology departments often fall short of meeting the needs of interventional radiology. For instance, because diagnostic radiology doesn’t include the inventory necessary for interventional procedures, the typical RIS is not built to track utilization easily. “Like everyone in health care, we want to be cost effective,” Knox says. “HI-IQ gives us the tools to look at who is doing what, how long it’s taking, and which inventory items are used.” This information empowers the interventional department in its discussions with the hospital concerning budgets and planning. He says, “We can value our inventory at any time, and our staff scans in used inventory, which reduces the on-hand counts of the items.” Patient Management and Satisfaction Patient satisfaction is becoming increasingly critical to health-care providers, and managing patients can be a particularly challenging proposition in a complex department with many moving parts. “Every hour, for patients with cancer (for instance), is precious,” Finnegan says. “They don’t want to wait three weeks for an appointment. Anything that allows us to tighten our processes and fit in more patients helps reduce the time they have to wait.” For that reason, UMMC uses the data from the HI-IQ system to chart its room use and patient throughput, applying lean techniques to identify and address any bottlenecks. “The patient’s flow through the department should be a smooth process for a great patient experience,” Finnegan says. “To increase satisfaction, we’re trying to identify problems in our admitting process, and the HI-IQ data provide us with information we can analyze to evaluate admission times.” To this end, UMMC also recently integrated its RIS with the HI-IQ system, so that the latter can manage both outpatient and inpatient scheduling. Knox also observes that outcomes data are likely to become accessible to patients in the near future; having those data at its fingertips will enable UMMC to position itself well in an increasingly consumer-driven health-care marketplace. “Patients are very Internet savvy,” he notes. “They want to see who has done these procedures, and what are their outcomes. We can give that information to our physicians, and be sure that, eventually, it will be published where patients can access it.” Minding the Gaps Finnegan and Knox conclude that the HI-IQ system fills the gaps where many other health-information systems stop. For instance, they note, RIS platforms fall short when it comes to measuring the length of interventional procedures. For this reason, UMMC’s interventional department plans to leverage HI-IQ’s time-stamping capabilities to begin and end procedures in its RIS. This, Knox notes, then triggers technical- and professional-component billing for the procedure. Billing for interventional procedures can be particularly complex because of the wide variety of instruments and technologies used in interventional procedures. “HI-IQ has a body-part–based environment for billing, so if you’re doing a liver exam, you drill down into the CPT® codes for liver procedures,” Knox says. “We can set up the bundled CPT codes that go together for billing. You can’t tell people what to charge, but you can at least guide them to the right section of the CPT codes. Dealing with this can be tough when you need to move patients through; using HI-IQ makes things flow more easily.” Being more compliant will enable the department to save both time and money, he says, while being able to measure the department’s value with a single system positions it well for an uncertain future in health care. “We’ll already know our cost of doing business,” he says. “When reimbursement ratchets down in the future, we’ll have a better idea of where we can save.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.