Streamlining radiology with intelligent workflows

Amy Thompson, a senior analyst at Signify Research, said radiology is at a key point post-pandemic, where there is a lot of uncertainty around rising costs, inflation and shortages of clinical staff. 

"We have seen that drive a greater desire in the market toward tools and products that support productivity and efficiency, so there has been a lot of vendor investment into how they can drive a more automated workflow, how can they automate follow-ups from patient reports or how to intelligently schedule patients," Thomson said. 

Other technology areas where vendors are introducing new ways to streamline workflow include patient self-scheduling, predictive analytics to help schedule patients based on the types of exams being done and optimization of imaging room use.

"The goal is to drive efficiency with your staff, your modality and your general resources in a time when they are all dwindling with staff shortages, more and more radiologists coming up for retirement post-pandemic, or they are just generally burned out from the pandemic. These workflow improvements help do more with less," Thompson explained.  

Workflow orchestration is addressing issues in radiology IT

One of the ways vendors are streamlining IT functionality is with workflow orchestration. This software automatically manages radiologists workflows and what cases they are given in the DICOM worklist. In many cases these systems use AI to sort out the specialty qualifications of each radiologist scheduled to work at that time and send them exams in need of their specific expertise. These systems also look at service level agreements (SLAs) to determine if an exam is nearing the end of the specified period when it needs to be read. Stat reads are sent to the top of work lists, while routine, easier exams are distributed evenly between radiologists to help prevent cherry picking. 

"We are seeing greater automation and the ability to use AI to do triage of the exams, or prioritizing tasks based on the preliminary read by the AI. But you are also seeing it being used with the relative value unit (RVU) of cases and knowing one-size does not fit all, because each case, depending on the complexity, may take three times longer. So the system can make those measurements and apply that logic to help reduce burnout and make it easier for load balancing," Thompson explained.  

Structured reporting demand is growing in radiology

Radiology free-form dictation of reports is part of the wider issue of unstructured data across healthcare. As healthcare IT systems become more sophisticated and AI is introduced, Thompson said healthcare organizations want be able to mine their data for additional business and clinical insights, population health, possible clinical studies, AI algorithm training, and other uses. However, it is difficult and more time-consuming to do this using unstructured data. So there is an IT movement across healthcare to structure data into common formats and taxonomy terms that can be searched later for specific information.

"This will really help healthcare maximize the value of the data it holds, including the potential downstream use of that data for AI and implementing precision medicine," Thomson said. 

While some PACS offer drop down menus of terms and phrases to help structure more of the data, newer systems are much more sophisticated and convert automated measurements into text or paragraph formats to help speed workflows. 

"When I say structured reporting, I mean truly automated structuring of the dictation of a radiologist, not just a template. This includes tools that can prepopulate the text of reports," Thompson explained. "We saw the presence of this type of structured reporting at the European Congress of Radiology (ECR) 2022, so it is a positive move of the market moving in that direction."

Enterprise imaging systems help expand beyond radiology to include other specialties

Enterprise imaging systems are designed to include all the image storage and reporting needs for ologies across a hospital or health system into one platform. This helps eliminate disparate siloes of data for each modality and department. This also helps achieve the larger IT goals of making patient imaging, reports and other data available to all clinicians who need it across the enterprise. It also facilitates easier integration of all data from all departments into the central electronic medical record (EMR).

While the main trend has centered on radiology and its ability to better share images and reports to all referring physicians, hospitals are interested in streamlining informatics systems to enable one platform to now help all departments. Cardiology is the second largest creator of imaging, reports and other data that need to be housed somewhere, so it is usually the first or second department merged into enterprise systems. This is then followed by pathology, where digitized slides and reports take up large volumes of data storage. All other departments then follow. 

Healthcare is migrating to the cloud to make remote access anywhere easier

In recent years, cloud data storage and sharing has become commonplace in all facets of life, and people have realized the security level of their data is good. As hospitals move away from paper files and film systems to 100% digital formats, it has rapidly increased server demand. At the same time healthcare IT systems are bombarded daily with cyberattacks by hackers and ransomware, so the need has become acute to better secure and backup all of a healthcare system's data. On top of this, the COVID pandemic accelerated many health systems to remote working, teleradiology and the need to share data across the internet quickly. All of these factors have made the movement ripe for migration to cloud storage and cloud computing systems. 

Some of the biggest health IT announcements in the past two years have been for partnership agreements between radiology IT vendors and Microsoft, Amazon Web Services (AWS) and Google to enable secure data storage, very high levels of cybersecurity and the ability to immediately scale data storage needs because of acquisitions. 

"IT vendors are becoming quite flexible and can deploy on whichever public cloud depending on the buyer's preference," Thompson said. 

She said on the EMR side, cloud computing has a lot of benefits because it is much easier to enable remote working and access to patient data from anywhere, which eliminates the need to bounce between different workstations.  

Read more or watch the VIDEO in Cloud storage helps solve radiology IT and cybersecurity issues.
 
While the above trends are being implemented into clinical practice, Thompson said you cannot completely change the architecture of PACS overnight. So, big strategic changes take time, sometimes two to five years, before they are completely integrated into a PACS enterprise system. Often it is just the iterative changes seen as part of that evolution at conferences like the Radiological Society of North America (RSNA), Healthcare Information Management Systems Society (HIMSS), Society of Imaging Informatics (SIIM) and the Association for Medical Imaging Management (AHRA).