Hartford HealthCare, Connecticut
Interview with Rafal Sadowski, Quality and Safety Manager at Midstate Radiology Associates, a Hartford HealthCare partner
Workflow is both the magic and the headache of radiology. Orchestrating workflow more efficiently is a win–win for patients, technologists, radiologists, and referring physicians. This was one reason Rafal Sadowski, Quality and Safety Manager at Midstate Radiology Associates, a Hartford HealthCare partner, spent time discussing the implementation of Sectra’s workflow orchestration software as a part of their enterprise imaging system.
Because requirements of workflow software were uncharted, Rafal worked closely with Sectra to configure the solution to best fit their needs. In this interview, he shares his experiences from implementing this software across the Midstate Radiology Associate sites, the efficiency and quality gains they have achieved so far, and the opportunities that exist in the future.
Hartford HealthCare (HHC) is Connecticut’s most comprehensive healthcare network with 30,000 employees and a total operating revenue of $4.3 billion. Its care-delivery system, serving 161 towns and cities at more than 370 locations, includes two tertiary-level teaching hospitals, an acute-care community teaching hospital, an acute-care hospital and trauma center, and three community hospitals.
Rafal: Our healthcare system is a large and complex network of radiology clinics and diverse types of providers across a wide geographical area. Having efficient workflow is key for us in offering high-quality radiology services to our surrounding providers. The entire operation is dependent on delivering services within a specific time frame after the provider has ordered the exam. To improve our services, we needed a transparent overview of our workflow.
Imagine when you order pizza delivery. You can follow the entire process from the selection of pizza type, when it is in the oven, when it is transported to your house, and finally, when the payment is made. I thought that if this is possible for a simple pizza mobile app, why couldn’t we have a similar system to follow the workflow of radiology exams?
So, we decided to replicate the concept of the ‘pizza app’ on our radiology workflow. We wanted an overview in real-time to provide information on the status of the patient, exam, and finally the signed report—every single second. For that to happen we had a dialogue with Sectra, who recommended the analytics dashboard tool from their workflow orchestration solution.
As previously said, HHC is a large health system involving hundreds of provider units creating referrals to multiple radiology departments. There are a lot of moving parts including many interfaces and multiple points of failure. This creates quite a complex IT environment and it has historically been a hurdle to create a workflow summary. It was not until we implemented the analytics dashboard that we got a transparent overview of the entire workflow.
To see the entire workflow on a single screen was like opening your eyes to see the stars for the first time.
In the past, we did not have a method to flag exams that were not meeting specific service level agreements (SLAs). If a patient or exam were delayed, it could take 6–7 hours before we knew there was an issue, and that led to unsatisfied providers and decreased our overall efficiency. Some SLAs are set to 48 hours from order to signed report, which makes delays detrimental. We needed to ensure we could identify issues in the workflow as soon as they occurred.
The tool is great, and it allows us to see our entire workflow from beginning to end. It offers parameters such as when the patient arrives, when the exam has started and finished, when the primary read is done, when the report is created, and lastly, when the report is vetted and sent to the Epic EMR and made available to our referring physicians. We can directly monitor and act promptly if an SLA is in risk of not being met. We now work more proactively instead of quenching fires reactively. I also like that it is very user friendly and all on one page.
Another benefit I would like to highlight is that the dashboard provides high transparency of the workflow. Without mentioning numbers, I can say that it has considerably improved both efficiency and the quality of the radiology services we provide, since we now can instantly identify if something is broken and react accordingly.
It is primarily the radiology coordinators—the persons acting between the radiologists, technologists and the providers ordering the radiology exams. We are looking forward to optimizing the process by including the emergency department so they may quickly follow reports on urgent cases. That will improve their ability to offer faster care to patients with life-threatening symptoms and hopefully save lives.
We want to expand the use of the dashboard to providers so they can track their patients. We also plan to invite the APRN (Advanced Practitioner Registered Nurses) to use the system. This will allow them to follow their patients in the radiology process and will take pressure off the technologists who receive patient-update phone calls.
We have had a great collaboration and dialogue with Sectra in implementing these solutions.
Yes, we have received quite positive feedback from users during our initial rollout. The tech QA tool, a new feature within Sectra PACS, allows radiologists to provide immediate feedback—both good and bad—related to the quality of a study. At a high-level, the radiologist feedback is automatically routed to the manager of the performing modality, which in turn allows the manager and technologist to identity opportunities for improvement. Feedback can range from excellent position or tight bolus injection to missed anatomy that needed to be displayed on the exam. We believe that all types of dialogue are necessary for technologist growth.
Previously, technologists and radiologists worked closer together, and radiologists could directly provide their feedback. As we continue to grow our practice, sometimes it is difficult to have timely face-to-face communication. The tech QA feature enables radiologists and technologists to have that feedback loop, which significantly improves learning and the quality of service that we provide.
Rafal Sadowski, Quality and Safety Manager at Midstate Radiology Associates
Both these tools, the analytics dashboard and the tech QA tool, are groundbreaking. They provide so much more transparency for technologists, radiologists, and providers. Solutions like these can significantly improve efficiency and quality in the services we offer, and there are so many more opportunities to expand these products in the future.
I would also like to highlight that we have had a great collaboration and dialogue with Sectra in implementing these solutions. For anyone looking to fine-tune their operations, I would recommend selecting a solution that can be adjusted to meet the requirements of a specific workflow, and a vendor that can be flexible and configure the solution to your needs.
