Analytics Can Save Radiology

August 20, 2015

This edition of the Business of Radiology series focuses on analytics in radiology.

Editor's Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.

It’s no secret that radiology is under the gun to validate its contributions to health care and prove its worth and what it brings to patients.

Today’s health care environment – the move toward accountable care organizations (ACOs), the specter of bundled payments, and the paradigm shift to value-based purchasing – has created a need for the field to demonstrate its quality, efficacy, and efficiency. To do that, many radiology practices are turning to analytics as a way to use hard data to show the benefits they offer.[[{"type":"media","view_mode":"media_crop","fid":"40604","attributes":{"alt":"Business of Radiology","class":"media-image media-image-right","id":"media_crop_7540501420836","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4191","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]

“Analytics in radiology is actually very important. Radiology cuts across a lot of health care lines – patient treatment, diseases, patient care, and diagnoses,” said Jim Hamilton, business manager and administrator for Medical Imaging Physicians in Dayton, Ohio. “The whole concept of analytics in radiology is huge, and the effect on radiology will be huge.”

Within the field, analytics falls into two groups: business intelligence (BI) analytics and clinical analytics. BI focuses on using analytics to improve the day-to-day workflow and business activities while clinical analytics can augment how radiologists and radiology practices serve patients.

Despite recognizing the need for using analytics, actually using the data is still a new concept. And, proper implementation of analytics will require careful planning on the radiology practice’s part, said Keith Chew, senior vice president and managing director of strategic positioning and consulting services with practice management and leadership organization Integrated Medical Partners.

“At this stage, analytics is extremely young for everyone in the industry. I think we’re still working on all of this,” he said. “The big point, though, is that you’re going to get started off and collect information from your system.”

Gathering Data
Radiology, fortunately, has many avenues for data collection at its disposal. Much of it is siloed, though, residing in RIS, PACS, electronic medical record (EMR), or clinical decision support systems. For example, radiologists’ interpretations are in the RIS, but clinical notes are in the EMR. The hard part, Hamilton said, will be integrating the information for the best possible outcome.

Stephen Willis, chief technology officer with medical imaging technology and business services provider Canopy Partners, agreed. It’s important for you, your colleagues, and your practice to have full access to all of the data relevant to operations as close to real-time as possible. Canopy offers its GRIP product – Global Radiology Information Platform – to help practices analyze data across systems, track productivity metrics, and create dashboards.

Before making any decision, however, make sure you have enough data at your fingertips. Choosing a course of action based on a handful of outcomes can lead to mistakes.

“A lot of groups stick their toes in the analytics water and start making decisions based on what they perceive as answers in the data,” he said. “But, they don’t understand the statistics or analytics principles well enough to have those decisions be guided by good theory.”

It’s also imperative that you recognize the difference between big data sets and ones that are actually relevant. Health care is notorious for having large amounts of unstructured and unreliable data available at the push of a button. For example, a dozen hospitals can collect data on their chest X-rays, but each one might call the study something different, making it difficult to know if you’re actually using the data correctly.

Depending on the size of your practice, though, compiling enough data in the right ways can be difficult. This is where an analytics partner – a vendor or company skilled in tackling and synthesizing large data sets – can be helpful.

“The first thing providers need to understand is analytics is a great deal more difficult and more intricate than most people believe or realize,” Chew said. “Many try to do analytics through spreadsheet programs. But, they need to move forward and find a partner that is knowledgeable in the analytics realm.”

A proper analytics partner should be able to collect rudimentary data while offering the ability to delve into deeper analysis as time goes on. One available tool, Pentaho, is an open-source BI application that can complete a wide spectrum of radiology-specific analytics, as well as tracking metrics.

One Hospital’s Experience
In an attempt to streamline its analytics use, Texas Children’s Hospital Department of Pediatric Radiology – a department of 30-board certified providers who complete 220,000 procedures annually – switched from manually trolling their data to using an operational advanced application specific to radiology from vendor Health Catalyst to scour the information.

The new system looked at and identified problems with average procedure durations, result turnaround times to referring physicians, and patient flow cycle time. Using that analysis, the department crafted and implemented solutions, saving an estimated $400,000. They also used the data breakdown to secure $1 million in new billable charges from two obstetrics practices.

BI Analytics
As the health care field continues to change, there’s a worry that radiology will shift from being a revenue-center to a cost-center. At the same time, the Centers for Medicare & Medicaid Services (CMS) is pushing for radiology to become more outcomes-based.

Before you jump into applying analytics to patient care, Chew recommended your first focus on how collected data can impact your business activities, such as handling patients, managing your equipment, and coordinating your personnel.

Patient Management: For example, the American College of Radiology (ACR) suggests analyzing patient wait times from registration through exam completion to identify whether there are any opportunities for improvement. If you have a problem with no-show patients, pinpointing hang-ups in how efficiently you move patients through your practice could shed light on how to fix this issue. You can also submit your data to the ACR’s General Radiology Improvement Database, a tool that tracks turnaround and patient wait times, as well as incident rates and other outcomes measures.

Equipment: You should also keep abreast of how well you’re using your equipment – are you maximizing what your MRI or CT machines can do for you? Even the most up-to-date hardware, when used incorrectly or ineffectively, can lead to long patient wait times and business losses. The proper business analytics tools can tell you now – rather than six months from now – if you need to make changes.

Personnel: BI analytics can also be used to modify your front-office activities, too, Willis said.

“You can expect to use analytics to make decisions on staffing and scheduling, quality initiatives, revenue cycles, and any governance initiatives,” he said. “Should you hire another radiologist? What kind? Analytics can help you find that answer.”

If you’re using analytics to improve the quality of your services, use that fact as a marketing and selling point with the hospitals you serve, he said. It will paint you as a proactive partner in meeting any federal government push for improved patient care.

Clinical Analytics
Using BI analytics will likely the improve patient experience as they move through your office, but clinical analytics could have a more direct effect on the care you provide, Chew said. When you have the best understanding about the services you provide, you can offer more accurate diagnoses, effective treatments, greater cost-efficiencies through patients who become healthier, and shortened hospital stays.

To make the best use of clinical analytics, however, you must first ensure you have normalized data. Your data metrics, performance comparison, and benchmarkings should all be in the same language. This can be a challenge if you work with multiple hospitals or health systems, as they frequently have their own ways of recording imaging studies. But, if you reach this goal, clinical analytics can offer a great deal of possibilities.

Referring Physicians: In many cases, hospitals that use computerized physician order entry systems can hone in on ordering patterns, and a clinical decision support system (CDS) can help you identify whether your referring physicians understand how best to use your services.

“CDS will help us see where nonradiologists need more education for appropriate ordering,” Chew said. “It will help us understand how to fine-tune and tailor care for entire groups of people. It will have a positive effect on population health.”

Natural language processing can also search through clinical reports for information that will strengthen your abilities to provide the best patient care. Overall, these tools bolster constructive feedback you offer your referring physicians.

“The only way we’re going to affect change is if we get to the patient level, and analytics is the way to do that,” said Medical Imaging Physicians’ Hamilton. “Radiologists might be the gatekeepers or consultants in educating hospital physicians or ordering physicians.”

Radiation Dose: The ACR also recommended using analytics to track radiation dose monitoring and reduction, contrast dose, and compliance with Meaningful Use and the Physician Quality Reporting System. You can either submit data to or glean data from the ACR Dose Index Registry or the IV Contrast Extravasation Registry to better determine how to make changes with your dosing

This type of tracking helps identify any variations in usage across hospitals and health systems, presenting an opportunity for increased standardization.

Population Health: Most recently, clinical analytics contributed significantly to how screening exams are used to identify patients in need of advanced services, namely those with lung cancer, Chew said. The U.S. Preventive Services Task Force reviewed chest CT and X-ray clinical data and changed the recommendations for who should undergo lung cancer screening.

Based on age and number of years smoked, current or former smokers are screened. The result: more lung cancers have been caught at Stage 2 instead of Stage 4, totaling an estimated $1 million in case costs savings over the next five to 10 years.

Patient Follow-Up: Historically, it’s been hard for radiologists to find out what’s happened with patients after they have read their scans. Work is underway, however, for you to be able to circle back with your referring physicians to see how your services contributed to their care, wrote Paul Nagy, MD, associate professor of radiology and radiological science at Johns Hopkins Medicine, in a 2013 ACR study.

In addition, he said, clinical data can help design patient satisfaction surveys that can maximize the quality of services you provide.

Ultimately, although radiology, overall, is still wading tentatively into deep, widespread analytics use, it’s clear that delving into the rich data that’s available on your business and clinical practices will have positive effect on your ability to provide the best services and stay financially solvent, said Worth Sanders, Canopy Partners chief executive officer. In fact, to ignore the potential of analytics would be a mistake, he said.

“There’s significant strategic value in analytics for radiology,” Sanders said. “Analytics can help you improve efficiency and effectiveness. But if you avoid analytics, you’re running the risk of losing contracts.”