Change Management in Radiology-a Radiology Leadership Academy Course

-Humans resist change even positive
-culture trumps strategy
-sell problem before solution
-18% of GNP is spent on Healthcare, government pays for 50% of this
-unsustainable growth, some studies say this could be as high as 50% of our GNP in next 20 years
Challenges
-provide patient centered service-extend hours of operation, focus on patient safety-report on timeliness-give patients access to reports .
-take time to communicate with patients
Response
-embrace CQI
-account for org culture in planning
Culture, not strategy or vision is the most powerful force
-leadership needs to speak with one voice, walk the talk, involve input from all layers
-leadership is getting something you want done by someone else because he or she wants to do it-Dwight D. Eisenhower

-in 1990 1% of suspected appendicitis patients were CT scanned , 23 percent of appendixes removed were normal
-2007 only 1.7 percent of appendixes removed were normal due to rapid increase in use of CT to 91%

Radiology Leaders Institute

IT for Radiation Exposure Reduction
Open source dose tracking software
Radiance

-CT Techs are often scolded by radiologists for cutting something off in a study so often the scan more than is really needed just to ensure they get everything. If this field of view creep isn’t monitored with dose in mind it can lead to unneccesay higher rad dose exposure.
-default protocols can often be optimized to decrease dose exposure
-tackling the highest dose studies first is a way to make a quick impact
-dose exposure can also be reduced proactively using Decision Support software to guide providers to lower dose studies during physician order entry
-ACR national radiology data registry is a source to compare where your institution compares.
-49% of medical radiation exposure is from CT, 25% Nuc Med.
-Automated extraction system to query PACS for dose data for newer scanners that provide this in the DICOM data .
Link to reference for Radiation Dose SOPclasses:
radiation dose SOP classes

Medicalis was briefly mentioned in one of my Day 1 classes for its decision support capabilities. I stopped by the booth today for a demo and found a familiar face, Greg Masek, VP of Sales is pictured below. To learn more visit: Medicalis

Mike Hall, Sr. Director Software Customer Services (on right) and I

Helen F. Routh, Sr. Vice President, Cardiology Informatics & Enterprise Imaging Informatics (on left) Stacy Gillen VP, Software Customer Service, Philips Clinical Informatics (on right)

The Philips Booth at RSNA is huge as always! It seemed to take forever when I walked the perimeter to capture this panoramic view:

Philips Innovations Article-International Business Times

Philips/RSNA

Product Idea derived from Decision Support Presentation
– My idea is to create a WFL dashboard tool that would allow the Radiologist to quickly validate the appropriateness of the exam ordered for the clinical findings, allowing the Radiology Administrator to run reports showing if their referring physicians need education or decision support tools to help them order more appropriate exams driving cost reduction and raising facility imaging exam appropriateness and providing better patient care by reducing radiation exposure.

Decision Support
-Selection of imaging procedures is a key cost driver in Radiology.
This for the most part depends upon the education of the referring physician. Decision support in order entry can greatly assist.
-ACR appropriateness criteria- applies values for exam to a clinical condition.
Also includes a relative radiation level for each procedure.
-rather than allow a secretary to order the exam the physician is required to order the exam so she can receive feedback from the decision support order entry system to help them avoid low yielding exams.
-Virginia Mason uses a imaging decision support tool with check boxes to guide the ordering physician to order the correct exam.
– ER setting is challenging due to time constraints
-CPOE for radiology is a helpful way to integrate a decision support system into the workflow.
-Medicalis offers a decision support system based on Brigham and Women’s work.

Speaker quotes:
-Education is knowledge when you can’t use it
-Decision support is information you can use when you’re too busy to learn

-accuracy of decision support tool or radiologist separately aren’t as great as the synergy of accuracy when they are combined

Program to Enhance Relational and Communication Skills for Radiologists
This class wasn’t exactly what I expected but I enjoyed it very much. An interactive workshop on relational and communication skills by Harvard.
Giving Bad News
-must overcome possible communication barrier, relate to patient and deliver news so that patient can understand.
-establish expectations by asking why patient is being seen, find out what they are looking for.
-if Rads don’t connect with patient and require the primary physician to deliver news making the patient wait then they may feel abandoned and in limbo until they get results.
-give patient the option to review results with Radiologist or wait to learn results from Primary.

Relaying radiology dose to patient’s and their families
– relative uncertainty in determining effective dose is plus or minus 40 percent.
– when communicating with patients on dose it is helpful to relate to environmental exposure such as a trip across the country or hiking at high altitude where exposure is higher to the exposure of the ordered procedure
-ALARA is still best approach to radiation exposure
– CT machines are for the most part calibrated using adult phantoms.
-radiologists are often left defending the position of the ordering physician’s decision to risk Radiation exposure leading to the Radiologists also considering the ordering practiononer’s clinical effectiveness.
-Radiologist must sometimes be the gatekeeper when multiple exams are ordered multiplying the dose.