Dr. David Hirschorn

IT Matters - Radiology workflow orchestration

February 06, 2018
by Sean Ruck, Contributing Editor
In the last issue of HealthCare Business News, Dr. David Hirschorn, chief of informatics, imaging service line, at Northwell Health, talked about the background of radiology workflow orchestration and some of the workarounds that radiologists used to make the most of very limited information.

Major strides have been made to provide radiologists with the tools and information they need to be most effective in their roles. Fortunately, good radiologists already had a solid foundation for optimizing their use of workflow orchestration.

“Radiologists were always incentivized to communicate clearly,” Hirschorn says. “They weren’t interacting with the patient, but they were interacting with the doctor and poor communication could result in them losing their position.”

Big teams of radiologists working together have only become more common in recent years, so developing best practices for the social aspects of the role would be up to the radiologist, or perhaps he or she would be able to get guidance by networking outside of their facility. Communicating what type of information they needed was also a slow evolution, with more usable data trickling into EMRs over time.

“There’s definitely room for improvement. It’s only the beginning,” Hirschorn says. “Gathering information from the EMR has been very transformational for many of the radiologists I’ve worked with.”

For roughly a century, the patient chart was the crucial go-to. Doctors and nurses relied on that information and, therefore, it evolved to provide the information doctors and nurses needed. Since the patient wasn’t in front of the radiologist though, neither were the charts.

“By the time the radiologist came in, we’d see the image and very little info on why the patient was getting examined. So, with EMR, we’re not just getting access to that information. We’re having it served up on a silver platter,” says Hirschorn.

The EMR is providing the background that helps radiologists be a more integral part of better patient outcomes.

“We get the chief complaint, the history of illness and the problem list,” Hirschorn explains.

The running problem list includes if the patient is a diabetic, has cancer and other important issues to note. Medication and allergy information is also helpful, Hirschorn says. He says it’s also key to providing a working diagnosis. For example, did the patient come in for a fracture? For chest pains?

“It’s much better. There are fields I want every time and I can quickly access them now. There’s also other information I’d like to know, depending on why the patient was there,” Hirschorn says.

If the patient’s information points to a certain problem, an effective EMR will present the radiologist with the other information relevant to the exam they’re reading.

“When a radiologist sees certain findings on the exam, there’s an ACR assist. When you see a nodule on the lung, it’ll tell you the information you should gather and provides the best practice guidelines,” Hirschorn says. “Nuance and MModal have already started building their systems. The American College of Radiology has it. It will walk you through questions. Does the patient have a history of smoking? But I wonder why I’m being asked. Why doesn’t that information get pulled from the EMR? Those bridges aren’t built yet.”

According to Hirschorn, machine learning is improving as well. The information is increasingly being fed into algorithms with more accurate results as to the chance of the nodule being cancer, for example, and what to do next. The purpose of the radiologist is to provide information on diagnosis and prognosis, using the best tools to extract that information.

“Our experience [with workflow orchestration] was that it was definitely worth a fair amount of money because of the perceived benefit to load balancing and remaining competitive,” Hirschorn says. “I can search the other systems and open directly from those PACS. All I’m doing is retrieving the information and it puts it onto your screen. That’s probably the best solution since I can go in with the current case and view priors.”

Working through a system that provides a window into other PACS, the data is still located in the other PACS, but radiologists can view it using a system they’re trained on and familiar with.

Hirschorn advises hospitals to rethink their existing workflow if they’re contemplating a new system. Don’t just look into your current systems and coalesce into one big system. Think big. Use the technology. What would you do if you could do anything?

“The nature of a workflow orchestrator is flexibility. That’s not true of the other systems we’re used to using. PACS and RIS and dictation systems have many strengths, but flexibility is not their primary strength. Don’t try to fit the needs of your workflow into the orchestrator. A good workflow orchestrator should flex to meet your needs.”