With imaging volumes down by nearly 50% at many sites and uncertainty about what will happen once the current restrictions are released, here are 20 steps you should consider so you can embrace the new normal in a positive way:
PACS consultant Michael J. Cannavo.
- Take the time to evaluate every aspect of your radiology facility's operation by assessing functional and operational workflow from patient check-in to check-out. What can be done better or differently? Do you have the right people doing the right jobs? What roles and responsibilities can be combined to make the department more efficient? You might also benefit from visiting other departments in the area so you have an idea of how other departments function and the things they do differently or things you may not do at all.
- Look at ways that you can streamline the radiology department operation. Using electronic preauthorization as one example, this allows you to take a process that typically averages 10-15 minutes and reduce it to a few seconds. Sending electronic registration forms to a patient's email to complete in advance and having them send it back electronically not only streamlines the check-in process but helps ensure that patient data is more accurate as well. Once the check-in form is received, it can then also be shared among various clinical systems without requiring front desk intervention.
- Make sure the PACS/enterprise imaging system (EIS) is set up to provide all the data needed by the radiologist before the current study is read. Interfaces to other clinical systems, including the lab, pathology, electronic medical records (EMR), and other clinical systems, are a plus and add value to the interpretation process.
- Take a closer look at how reading is currently done and can be done. Nearly every radiologist I have talked to enjoys working from home as a respite from hospital-based reading. Not only is the environment more comfortable but the interruptions are fewer and productivity is higher as well. With the exception of mammography, nearly every study can also be read remotely using off-the-shelf displays and PCs. And remote reading is much more widely accepted post-COVID-19. That said, most hospital administrators still prefer to have radiologists onsite so they can have one-on-one interaction with the technologists as well as perform consults with the primary care physicians (PCPs), specialists, and others. To them, the radiologist/clinician interaction provides a continuity of care that remote reading can't provide. While that is true, most radiologists discuss the majority of cases with specialists by phone more often than not and will continue to do so. This is just as easily done remotely as in person. Many systems also allow remote screen sharing, so the radiologist can show the specialist exactly what they are referring to. Face-to-face interaction, while preferred, is no longer a requirement.
- Groups might wish to reevaluate their use of after-hours services now that many radiologists have diagnostic-quality at-home reading systems (except for mammography). This would allow the group to return the additional revenue to the group rather than using a service.
- Outside teleradiology firms might solicit business from facilities you cover (those that are still in business after this, that is), so you have to be on guard. Get the group together and be able to clearly state the value you bring to the table in the event you are asked.
- The hospital may make overtures to the group to become a part of the hospital staff. Larger groups might still have the clout to stay on their own, but smaller groups may want to take a closer look at becoming hospital employees for the stability it offers ... or join a larger group. There are pros and cons for each of these considerations that should be looked at closely.
- If you don't have a list put together yet, identify who your key referrers are/were for each modality and put together a plan of action to reengage them. Expect up to 25% of them to no longer be in business. Also expect the rankings of referrers to shift significantly as well. Find out those who refer the cases with the highest profit margin, not just the highest volume (i.e., MRI and CT versus chest and mammography).
- A strong marketing plan that will ensure that existing referrers continue to use your services is going to be important in getting business back quickly. Not only do you need to get your name out to the PCPs but you also need to create an image with the patients as well. For patients, it can be something as simple as handing out N95 masks (there will be a continued need for these even if just for the common cold) or SpO2 meters (prices have fallen to less than $10). A thank you email or text message will be crucial as well.
- It might also be a good time to survey your referrers and see how the changes in the way they practice impact the services you will be providing and what they feel about the services you have provided to date. Even if they say that all is well, most will appreciate you asking. As a thank you to the referrers for their time, you should give them something they might use in the office that has your logo imprinted on it. These might include an Amazon Echo or other device.
- Review and revise your website and make sure you highlight features that appeal to your referrers and patients alike. Ditto on your Facebook site and any other social media sites you use. If you have no social media program in place, this might be a good time to consider implementing one.
- Look at ways you can input additional data into the viewing software, including EMR data, lab and pathology results, and others.
- Look at the version of software you have for your PACS/EIS, RIS, vendor-neutral archive, etc. Ask the vendor for a list of all the features available in the version you currently have installed and then compare what you actually have installed to what is available in that version. If the version you have includes features you haven't installed but are interested in, you might consider installing them now. Just keep in mind some might require a hardware upgrade as well, plus implementation costs, so even if the software is "free," it really might not be. Conversely, if there are features you rarely or never use, uninstall them now.
- Look at the version of software you have for your PACS/EIS, RIS, VNA, etc. If typical, you are at least a few versions behind the current version. Ask the vendor to compare the features available in the current version (version 4.X for example) with the latest available version (version 6.X). Look closely not only at the features offered in the latest version but also what you may lose that you need. If you are more than two versions behind, now might be the time to do the upgrade, including any hardware upgrades required to allow workstations to support the Windows 10 platform and Windows server 2016 (if the vendor supports it).
- Review your service contracts and see exactly what you are paying for and if anything can be deleted from the contract.
- Take a closer look at new technologies you have always considered but never implemented and evaluate the cost/benefits of the technology. This is especially important with patient and physician portals as well as new technologies like artificial intelligence (AI).
- Most people don't give much thought to security, figuring that a virtual private network (VPN) is more than enough to protect them. In most cases, that usually is enough against your basic security breach, BUT conducting a complete security review of your facility probably isn't a bad thing to consider. Start with password protection that may include the use of biometric authentication (fingerprint recognition), proximity badges, or other devices -- you have to assume nothing anywhere is safe. Security reviews should include firewalls, LAN and WAN utiltization, intrusion prevention, Web gateways, endpoint visibility and control, wireless, secure e-mail, switching, public and private cloud use, and even behavior analytics that can detect users who put your network in jeopardy. Most servers are usually fairly secure, but links to the modalities used to upgrade the software often can be an Achilles heel and need to be closely monitored. The same can be said of PCs and laptops not under the facility's local area network, specifically radiologist workstations used at home, especially if the workstation is used for different applications as well. Privacy safeguards, virus scanning, and other security protection should also be looked at closely and all devices scanned weekly with audit logs provided.
- Review your disaster recovery plan, looking closely at not just where data is stored but also the cost and time to replace the data on the archive you are using. The costs and time involved might be astonishing and is something better addressed now, before you need it, than when it is actually necessary.
- Telemedicine has gained a new foothold despite being around for over 20 years. There may be requests for more face-to-face remote conferences than ever before. With that in mind, you need to make sure that the workstations you are at have both teleconferencing and screen-sharing capability.
- If you are a vendor, you might consider taking advantage of this slow period to make any directional changes in terms of both your marketing and product development. You need to make sure that your product portfolio is well-balanced and that you are neither a one-trick pony nor a supermarket where the choices are too many to fathom. Also make sure your messaging is clear and to the point. Messaging is one area that would be best to outsource because, more often than not, you can't really be objective when you have been making and drinking the company's Kool-Aid for years.
The list may seem long, but most of the tasks should take a day or two at the most. Some of the tasks you can do on your own. However, for some (like those relating to marketing), you may want to solicit outside help. Just make sure if you do solicit help that they understand your specific market dynamics as they relate to imaging in particular, not just healthcare globally.
Michael J. Cannavo is known throughout the radiology industry as the PACSman. After several decades as an independent PACS consultant, he worked as both a strategic accounts manager and solutions architect with two major PACS vendors. He has returned to consulting to help facilities integrate various clinical systems, in addition to performing PACS optimization services, system upgrade and proposal reviews, contract reviews, and other items.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
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