The Epic electronic health record in its simplest form is a framework for documenting care, with finger strokes to keyboards replacing pen strokes to paper. But leading health care organizations continue to find more sophisticated uses for it, including making their work more responsive to the needs of both patients and providers.
A recent example at UCHealth is a new system for prioritizing orders for radiology imaging and interpretation. Gone are the ambiguous terms “stat,” “urgent,” and “routine,” which did little, if anything, to help staff and providers organize their work. The three vague words have been replaced by a numerical list that establishes priority for image ordering and interpretation, from lowest to highest, for the inpatient, emergency and outpatient settings (see box).
The problem with the traditional terms was simple, said Peter Sachs, MD, section chief of thoracic imaging for the Department of Radiology at the University of Colorado School of Medicine. Radiologists and staff often weren’t sure what they meant. Did “stat” mean the ordering physician wanted an ankle X-ray either taken quickly, or interpreted quickly, or both? How was “stat” different from “urgent”?
The result was widespread frustration that emerged in comments from the Provider Satisfaction Survey conducted in the spring of 2013, said Lorna Prutzman, RN, MSN, executive director of Cardiac & Vascular Services at University of Colorado Hospital.
“The system was broken,” Prutzman said. “There were no clear expectations.” In addition, she said, many “stat” orders were not actually needed quickly, leading to inefficiencies and potential delays in care for providers dealing with more serious patient cases.
Growing patient volumes at UCHealth demanded a solution, Sachs said. He noted that in fiscal year 2016, which ended June 30, radiologists interpreted some 908,000 images systemwide – about 2,500 a day. With new hospitals coming into the fold the next couple of years, that volume will only grow.
The new system is modeled after one implemented at the University of Virginia, which Sachs said he learned about it at an Epic user group meeting about 18 months ago. The UCHealth version, which added selections for outpatient orders, went live Feb. 2. It seeks to clarify the process, both for providers who order imaging studies and for radiologists who read and interpret them.
Ordering providers choose a radio button with specific descriptions of “patient type” designating the priority. The completed images appear in radiologists’ work queues, presorted by priority. For example, emergency and urgent inpatient cases get first priority for both orders and interpretation, except in disaster, trauma and alert situations, which take precedence. If an image study stays in a folder beyond a certain amount of time, the folder can change color to alert the radiologist that it needs attention.
“We’ve given the ordering provider transparency and an expectation of how quickly the interpretation will be done,” Sachs said. “We’ve tried to take the guesswork out.”
The new system has been favorably received by both ordering providers and radiologists, added Sachs. “There is a sense that we are doing a better job of meeting reasonable expectations for turnaround times,” he said. Prutzman added that the approach “acknowledges both parts of the process” – getting the image and interpreting it – and uses a common language and definitions for the priority list that all providers and staff understand.
Sachs credited teams working on Radiant, Epic’s radiology application, and Primordial Prism, which is software that translates information from the electronic health record to the radiologists’ workflows, for the success.
Next up is work to gather benchmark data to measure improvements in turnaround times, Sachs said. Prutzman is also interested in applying the same model to echocardiography images. That will require changes to Excelera, UCHealth’s cardiac imaging system, to provide benchmark data on internal turnaround times for reading echocardiography studies, she said.
“Our overall goal is to provide better care for patients as quickly as possible while interpreting the images correctly,” Sachs said.
The table below shows the priorities for ordering and interpreting radiology images at UCHealth hospitals.