They've got I.T. Goin' On
Nanda Kirpekar, Manager, RadIT
Utilizing the portal, radiologists and administrative staff can access tools that facilitate communication within the department, saving time and increasing efficiency. As one example, RadClinInfo allows group emailing of specific imaging sections, groups of faculty or house staff, administrative staff, or various combinations of the above, through a simple yet flexible user interface. Another example is the ability of faculty to request audiovisual, presentation, or I.T. support, as well as photo radiology services, online with the click of a button.
Among the many customized tools offered by RadClinInfo, there are several administrative applications to track and analyze workflow indicators, such as a faculty time-away tracking system. This not only streamlines and standardizes the process of requesting time out of the office, but also allows one to determine how many staff people are away at any given moment or over periods of time.
Under the “Clinical” section of the portal, an entirely different set of applications are available. Some applications allow radiologists and administrative support staff to access vital clinical systems as well as quality assessment monitoring tools. For example, in a single session on his or her PC, it is possible for a radiologist to view exam results in the RDR, analyze patient images through MagicWeb, which gives web access to the PACS, access information in our document imaging system, and determine the location of every clinical staff person in the department at any given moment through a comprehensive house staff and attending scheduling subsystem.
From the Clinical menu, it is also possible for the radiologist to initiate a process to communicate urgent, clinically significant or discrepant imaging findings to the relevant clinician, while simultaneously documenting that such contact was made. This application, called the “Follow-up Queue,” allows the busy radiologist to hand off this mundane but critical function to the department’s clerical staff. It ensures that important clinical information is received by clinicians in a timely fashion, relieves the radiologist of this time-consuming duty, provides documentation of the notification, and greatly strengthens compliance with departmental communication policies, all of which significantly aid quality assessment efforts. The Follow-up Queue also comprises part of the department’s RDR, supporting retrospective analysis of this important patient safety activity.
Another tool within the clinical realm, the “Critical Test Results” function has recently been launched. This tool allows the reporting and tracking of truly emergent diagnoses, such as a pulmonary embolus, tube malposition, or bowel obstruction. It also allows the radiologist to document exactly how and when he or she communicated this critical information to the patient’s physician. The data entered by the radiologist is then accessible in a manner allowing tracking and analysis of all critical test results entered for a given time period or by a particular radiologist. Again, this is a valuable tool to ensure compliance with quality care guidelines.
Lastly, another important quality assessment application has recently been deployed — the “Quality Assessment and Patient Safety Report Card.” This subsystem pulls together, in one web-viewable “executive dashboard,” many different clinical volume and quality indicators, facilitating departmental oversight of quality and safety. Examples include case volume, the time from study completion to contact with a referring clinician in critical cases, the number of interpretative discrepancies discovered in random, doublereviewed cases, and the number, type, and outcomes of adverse events. These metrics can be further broken down into more specific categories, such as a comparison of occurrences between the different imaging venues in the NYU system.
The positive response to all of these initiatives is already evident. For instance, the Follow-up Queue has been used more frequently each year since its inception: 86 times (Year 1), 791 (Year 2), and 1767 (Year 3, and still counting). These applications are under continual refinement, promising further increases in granularity. The power of such quality assessment tools cannot be underestimated, as they provide a quantifiable, data-driven means to assess an individual radiologist’s compliance with patient safety standards and the highest quality care goals, as well as metrics for determining the department’s overall success in meeting such goals.
Certain RadIT special projects are also designed to meet the needs of researchers at NYU. One example is the Neuroradiology Research Patient Registry, a web application developed in response to needs identified by several neuroradiology faculty members. The application was created as an interdisciplinary database that credentialed personnel can use to view data points on subjects enrolled across various neuroradiological research projects. The application stores subject demographics, MRI data, clinical parameters, relevant treatments and interventions, and follow-up information on study subjects. An interesting aspect of the application is its ability to automatically “troll” diagnostic exam results in IDXrad for relevant clinical MRI results on these research subjects. Such results, if found, are preliminarily attached to the particular patient record in the registry, and an email is automatically sent to research personnel prompting them to log on to the registry and decide whether to keep the result in the registry. This saves hours of time manually tracking down the occurrence of clinically initiated studies on research subjects and improves the overall accuracy of research efforts.
Not surprisingly, RadIT has also developed special projects that play a role in the education and training of residents and fellows in the Radiology Department. One such web application, the “Radiology Resident Exit Quiz Generator,” was designed to automate and administer “exit quizzes” to residents after their completion of clinical rotations. RadIT collaborated with the Pediatric Imaging group, the first section to create a system for administering the quizzes, a previously time-intensive process. The faculty members of a section first create a pool of discrete cases, using a visual editor that affords intuitive manipulation of their component questions, images, and text blocks. Then, on demand, a group of cases specific for the resident’s year of training are randomly assembled into a customized exit quiz for each resident. After submission, these quizzes are automatically graded by the software. This useful educational tool is slated to be launched in all sections in the Radiology Department.
Another educational tool developed by RadIT is a web-based teaching file. Faculty or house staff members create cases composed of one or more images, video files, and downloadable articles, all tagged with clinical and/or other relevant information, ACR codes, and keywords. These cases are then available to Radiology house staff and faculty throughout the institution, with retrieval supported via an extremely flexible search method that can select cases by imaging section, modality, ACR code, keywords, or any of the other data stored within the case. There are more than 2,000 cases in the teaching file so far, and more are being added every week.
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