SIIM: Chang—How to kill paper + survive in the new healthcare model

DALLAS—Radiology is drowning in paper outside of the reading room, Paul J. Chang, MD, vice chairman of radiology informatics at University of Chicago School of Medicine, acknowledged during an educational session at the annual meeting of the Society for Imaging Informatics in Medicine.

Truly paperless radiology and closed loop imaging may represent the ideal survival strategy for radiology. The PACS 3.0 era has arrived, said Chang, who defined the concept as meaningful innovation for meaningful use. Imaging, however, may be stuck in a 2.0 model with efficiency halted at the reading room door.

In the relatively plush fee-for-service days, radiologists had it easy, according to Chang. They were the doctors’ doctor. The radiology reading room provided a town hall for medicine. Clinicians started their days in the reading room. “There was direct computerized physician order entry (CPOE) and we knew clinical context because we collaborated every day.”

PACS killed that model, said Chang. Now, radiology needs to leverage IT to return its role as the doctors’ doctor. “There is no way to improve efficiency and quality except by massively leveraging IT.”

Although conventional wisdom recognizes radiology as the most IT-savvy shop in healthcare, radiology suffers from IT immaturity, according to Chang. “We need advanced workflow to support enterprise value, comprehensive collaboration, business intelligence and analytics and connecting with the health consumer.”

At University of Chicago, Chang and his team focused on re-engineering workflow to up efficiency, improve quality and safety and cut costs. The team analyzed the entire imaging process and realized efficiency starts with the ordering physician and his or her interaction with radiology. They focused on eliminating paper at all points.

Despite CPOE, the department contended with an onslaught of faxed orders from outside physicians. To get rid of faxed paper, the department replaced its fax machines with a fax server to eliminate paper at its entry point without propagating it through the workflow.

It also implemented an array of digital processes, including digital protocolling, a lead technologist worklist and technologist portal. The central idea, said Chang, is to avoid scanning because the limiting factor in imaging throughput is the technologist—not the scanner. By upping techs’ efficiency and reducing manual paper-based tasks, the department can recoup lost efficiency and demonstrate value as well as safety.

Ultimately, killing paper breathed new life into the department. The closed loop imaging project yielded a nearly 70 percent reduction in technologists’ time, offering the department new options to cut costs and improve service.