In 2017, the South African private radiology chain Maine Radiology selected Sectra to provide a central enterprise imaging system to be used by four of the chain’s clinics. Utilizing a single common image archive and diagnostic application—in contrast to the previous set-up with separate systems for each site—would enable the radiologists to collaborate regardless of location. The main motivation for switching to Sectra, however, was the aim to have an imaging system that would provide a better flow in the radiologists’ daily work, a system that could increase productivity and reduce previous frustrations. To learn more about what flow in radiology diagnostics really means—and how the solution from Sectra enables it—we met virtually with Andre Bam, a radiologist specialized in head and neck disease. Andre is currently located at Cintocare Hospital, a head and neck specialist hospital and a branch of Maine Radiology. He collaborates closely with several colleagues at satellite branches as well as with the multidisciplinary head and neck team.
As a radiology chain, the shift to Sectra has enabled us to perform more work with less people, and with less stress among the radiologists. That’s a big win.
Sectra: Andre, can you elaborate on what the term “flow” means to you in your daily work as a radiologist?
Andre: Yes, of course. When looking at how an IT system can increase your productivity, it’s easy to fall into the trap of making a list of all the features you want, and let that be the only basis for your decision. We had made that mistake before and realized that we needed to take the entire user experience into account. Flow is achieved by optimizing the big picture and how all the functionality and applications are brought together to create a smooth workflow. I would say that a system that provides a good flow needs to support a few different capabilities, and all these need to work smoothly together.
What are the different capabilities that you believe create a good flow?
Well, since 2017 we have learned a lot. The capabilities that are important vary as we become more experienced and the system evolves. Currently, I would say that the most important capabilities that need to be provided and work together in the PACS are:
- Worklists and workload overview
- Speed and ease of use
- One diagnostic application for everything
- Integrated communication tools
- Structured reporting
- Smart tools such as lesion tracking and RECIST
- One platform supporting multi-ologies and multidisciplinary team meetings
In addition, there are three other important factors I would like to mention:
- Stability and high system uptime
- Good provider–vendor relationship
- High responsiveness of the support
In the not so distant future, I’m pretty sure that a tight integration with a marketplace and platform for AI applications will also be added to this list, but that’s something we‘re currently evaluating.
To make this more concrete, can you please walk us through these “flow creating” product capabilities and what you actually mean by each?
Sure, let’s start with the worklists and workload overview I get in the Sectra system. It allows me to see all exams across our four clinics and each individual radiologist’s workload. This helps me to collaborate with my colleagues and allows us as a group to help each other to manage workloads in an efficient way. For example, if one radiologist has a long backlog, I can easily help and pick exams from their worklist. The workload statuses are indicated, for example, by different colors for each worklist and exam, and it gives me a feeling that I’m in control.
The worklist overview also facilitates our planning and resource allocation, and it helps us to offer better service to referrers as we can see waiting times for different kinds of imaging exams, such as MRI, CT, etc., and which types of patients will visit us for examinations during the day.
I basically do all work using one diagnostic application—I have access to everything in one place. This is probably the most important factor when it comes to creating flow, in my opinion.
Moving on to speed and ease of use, what can you say about that?
The speed of the system is very important for our flow and it goes hand in hand with the ease of use when performing the review and reporting. The Sectra solution is very responsive, slick, and intuitive, and scrolling CT stacks, for example, goes very quickly. The number of mouse clicks is also much lower than with our previous solutions, and that saves me a lot of time—not to mention frustration. On the same topic, fast access to priors should not be underestimated. This is enabled by having all images stored in the central image archive, and they can be viewed on demand due to the system’s capability to pre-fetch related images.
That brings me onto the next capability, which is that I basically do all work using one diagnostic application—I have access to everything in one place. This is probably the most important factor when it comes to creating flow, in my opinion. Today, I can perform about 95% of my work from the Sectra application, which is a massive improvement in comparison to our previous systems where I had to use separate applications to access many of the tools I need, or even go to a separate workstation. Now, I have access to all the tools and information I need from one user interface, including reporting, advanced visualization, MIP, mpMRI, bone removal, and even patient data from the RIS in a banner.
Since I spend about a third of my time on reporting, it’s important that also the reporting and dictation tools are integrated into the diagnostic application. We changed from a RIS-driven to a PACS-driven workflow in 2017, which has simplified the reporting process considerably. With a PACS-driven workflow and integrated reporting tools, I can use both my monitors to view everything I need in order to report, without having to switch to the RIS or separate reporting applications. Today, I don’t need to use the RIS at all.
You also mentioned structured reporting. Can you say a few words about that?
I’m a big fan of using the integrated structured reporting templates that Sectra provides. I know it‘s a controversial topic, but for me it really helps to become more consistent and follow all new reporting schedules. It also helps the clinicians, since they are more familiar with standardized reports rather than free text. If you ask me, the key is the fact that they are integrated into the PACS and that measurements and quantifications can be populated automatically.
So far, it sounds like the key to a good flow is to minimize the number of context switches. Is that something that’s also related to the capability you mentioned about integrated tools for communication?
Yes, communication tools that are integrated with the diagnostic application are a must to achieve a good flow since they definitely make it easy to get in touch with colleagues. For example, the integrated chat functionality allows me to quickly ask a question to another radiologist or radiographer instead of having to pick up the phone or walk over to their room. That saves a lot of time. The chat has been especially valuable during the pandemic when many of us have worked from home—as well as from a social perspective.
Another useful communication tool is the possibility to insert links to specific exams or images in the reports to show colleagues exactly what I’m referring to. These links are also highly appreciated among clinicians, as they make the reports easier to understand and allow them to see the images.
It feels like I’m just naming a list of features now, but I want to stress that it’s how all these capabilities are integrated and work together that matters, and not each individual feature in itself. A good flow is created by how easy they are to access and use, and how results are presented and stored.
It was kind of surprising that you mentioned lesion tracking, since that’s such a specific feature. Why is that a capability you highlight as a way of enabling flow?
Because it helps me to provide better service to the referrers, something that I can’t stress enough. The referring physicians are our customers. The lesion tracking and RECIST functionality in the PACS allows me to tag and follow lesions’ progression and to visualize for the clinician or oncologist if the tumors have increased or decreased in size. It also creates a good overview, and I kind of feel more in control of the disease progression. It helps me to get an overview and to keep track, to ensure I have not missed anything. Previously, I had to do similar follow-ups manually by using screenshots. I don’t think I need to explain the disadvantages of that way of working.
In addition to lesion tracking, structured reporting, and links in the reports, is there any other functionality that helps you to provide better service to clinicians?
I would like to mention the workflow overview again as a key component. It has empowered us to provide a greatly improved service to referrers. And to the patients, actually. We have a lot of patient walk-ins, and I’m not exaggerating when I say that some patients request their reports five minutes after their exam. This was almost impossible to guarantee before, but now we can offer timely service and keep our promises since we have an overview of waiting times and workloads.
Moving on to the multidisciplinary team (MDT) meetings, what system support do you value here?
In our healthcare system, some MDT meetings can involve as many as 60–70 people. This of course makes both the preparation and the presentation of patient cases a top priority. These large meetings are incredibly expensive, as you can imagine. The big time savings we have made have been based on the fact that the Sectra solution supports multi-ology and MDT workflows, including images and reports from various disciplines, such as radiology, breast imaging, pathology, cardiology, etc. This means that we can use one system for presentation at the MDT, without having to switch between different applications. We can also use one system during the preparation phase since all participants have access to all cases before the meeting, either via the diagnostic application or by using Sectra’s universal viewer.
When it comes to preparing for an MDT, one thing I really appreciate is the possibility to simply “drag and drop” a case to the right meeting while I’m doing my review. That’s a huge improvement compared to our previous systems. For example, if I have a neck cancer patient and I know that the MDT will discuss the surgery, I can easily add it to that meeting and it will be accessible for all other participants, such as the surgeon and oncologist, to review and prepare. That saves a lot of time.
In addition, we use an app to capture photos using smartphones and to archive them into the Sectra system. This is a great feature, especially for the dermatologists, since they can use the same imaging platform and take photos during the patient’s appointment to spare them another visit—which turned out to be a huge cost saver.
If we understand you correctly, it’s the entire puzzle that creates a good flow and not the puzzle pieces themselves, since the flow is determined by the weakest link of the workflow?
Yes, that’s a good way to put it!
You also mentioned a few non-product-feature-related capabilities that were important. Could you briefly touch upon those as well?
For sure. Stability and a high system uptime are crucial; we of course rely on the system’s availability a lot. Downtime is something we want to avoid at all costs and so far, the uptime with Sectra has been extremely high—a significant improvement compared to our previous systems.
If it goes down, we lose a lot and flow is pointless.
A good relationship with the vendor is also essential, and the dialogue we have with Sectra concerning coming releases and new product improvements is very important to us. We do not want to end up with a system that stops evolving again. Lastly, the high responsiveness of the support is fundamental since issues will always occur and we need to get them resolved quickly. That’s crucial for us not to lose the flow.
One last question; you mentioned AI earlier—how will that further enhance your flow in the future?
Well, we’re currently evaluating Sectra’s marketplace and platform for AI applications. It will give us access to various AI tools available directly in the diagnostic workflow. This is something I really look forward to exploring in the not too distant future. So, let’s save that for the next interview.