Imaging Innovation on a Budget

November 10, 2016

Radiology practices get creative when it comes to innovating with limited resources.

Imaging is no stranger to innovation. Coming up with new ideas, methods, or devices that offer greater value has been at the very core of imaging’s history. From the accidental discovery of X-rays in the late 1800s that led to the implementation of medical X-rays to today’s latest advanced imaging procedures that offer alternatives to surgery; innovating to create safer, more effective, or new services for patients is an industry standard.

Yet, such innovations can be costly and time prohibitive.

Most imaging practices have wish lists of all the ways they would innovate if they could meet budget approval. Seasoned leaders know the struggle all too well; creating large scale innovative change through the addition or replacement of equipment often requires system consensus and involves lengthy annual capital approval, while mid to small level purchases such as blanket warmers, new protective lead for staff, or computer monitors offer huge patient and staff satisfaction value but chip away at monthly operational budgets that offer little overages for optional items.

Challenged by today’s market that demands innovation to create visibility, differentiate services, and elevate experience, practices are finding effective ways to achieve new successes despite shoestring budgets. Doing more with less when it comes to product, process, or organizational innovations involves leveraging available resources, creative thinking, and a bit of manual labor.

Imaging leader organizations have even created healthy competition and grant funding around low budget innovations. Inspiring leaders to think outside the box, the Radiology Business Management Association (RBMA) offers Quest Awards to honor low budget marketing excellence while the Put Patient’s First Grant through the Association for Medical Imaging Management (AHRA) encourages practices to submit great ideas to improve safety and patient care offering a grant to the lucky winner.[[{"type":"media","view_mode":"media_crop","fid":"53774","attributes":{"alt":"Radiology innovation","class":"media-image media-image-right","id":"media_crop_1265463638570","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6737","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":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"iDesign/Shutterstock.com","typeof":"foaf:Image"}}]]

Improving Friendliness and Functionality of Services Is at the Heart of Product Innovation
Joseph Tunney, RT(R), radiology manager at Northwestern Center for Orthopedics in Chicago, has spent the last twenty years innovating, as needed, to supply his orthopedic surgeons and patients with a consistent level of service. He often uses his own time and Home Depot resources to create new ways of improving his aging imaging equipment. Performing 35 to 50 imaging exams daily as well as extremity MRI scans, Tunney says: “If something affects my ability to do the exam or affects patient care, it needs to be fixed quickly.”

Relying heavily on orthopedic specific equipment that typically has an extremely long life span, Tunney replaces things as needed. Tried and true methods for his practice’s knee specialist include the use of a Merchant knee device to visualize the kneecap in a non-weight bearing, muscle relaxed state. Offering fewer false positives, Tunney returned from a day off to find the 30-year-old wooden device crushed by the X-ray table. Substituting a sub-optimal view that day, his surgeons were understanding but Tunney needed a quick fix. A new device would cost almost $1500, was not made the same, and could take weeks to arrive.  By the end of his work day, Tunney had a plan.

 “It was like woodworking 101. I took the broken pieces to Home Depot, they measured and cut new wood for free. I bought $3.00 worth of screws and went to work reconstructing it,” he said. Taking a half of a day at most, Tunney’s creativity and quick action resulted in little down time and refreshed equipment without the hefty price tag.

He would put these same skills to use again in 2014 when movers lost essential rods used to hold the leg rest in place on their Lunar Artoscan MRI extremity unit during relocation of the practice.

“Without the rods, patients could not sit comfortably without their leg falling out of the machine and extremity positioning was difficult,” Tunney said, while he stressed that poor image quality along with the overall patient experience was a huge issue at stake. “They don’t make that version of the equipment anymore so the vendor would have to do quite a bit of searching to find replacement rods,” Tunney said. Using bungee cords connected from the leg rest to the back of the chair, the chair works better than ever now. It’s safe, stable, and comfortable for the patients,” he said.

Improving the Way Information Is Delivered Doesn’t Have to be Costly
Innovating around technology-rich platforms is also a growing trend to streamline processes. Tunney quickly learned that his clinic’s orthopedic PACS would not communicate with the medical records system without a $10,000 upgrade. Solving the problem through a content rich exported Excel spreadsheet from his EMR, Tunney could transfer the Excel report to the digital X-ray system and upload patient information without timely data entry or additional cost.

With an abundance of information at the fingertips of imaging leaders, leveraging existing technology to improve processes that meet the Joint Commission’s 2015 requirements for CT dosage incidents and reporting was something Michael Bohl, MHA, CEO of Radiology Group PC, SC, in the Midwest, could deliver. Responsible for three imaging centers as part of a joint venture with Genesis Health System, two of those centers offer CT. Bohl quickly went to work to determine whether his practice’s participation in the ACR’s Dose Index Registry (DIR) could work as a cost-effective solution to the JC requirement.

Using over 10,000 studies that Bohl’s group had in the DIR, Bohl said: “He needed to be able to make sense of the information he was receiving back.” Skilled in Access and Excel tools, Bohl aggregated the data into respective categories, created protocols to establish upper thresholds, and created expected dose ranges for every CT study that allowed reports to be automatically generated with final dose incidents without staff having to change their workflow or the investment of a costly third-party platform.

Not to be confused with the XR-29 standard that came out around the same time, Bohl said his imaging practices that print out dose management incident logs and use that to meet the JC standard are missing the point. XR-29 provides dose alert before the scan is performed and can be overridden. The JC wants to look at a patient’s final dose along with your system’s policy regarding dose incidents.

Expanded now to the hospital system’s seven other CT scanners, Bohl said using the DIR combined with his automated reports performed quarterly, created a robust and meaningful CT dose review program that is cheap, effective, and meets the JC’s requirements. Done for the cost of being in the dose index registry, Bohl said: “There is no reason not to be in it. It’s a balanced program and we did it ourselves.”

Organizational Innovations Can Be Fun, Engaging, and Inclusive
Using one’s own staff as a resource to innovate around organizational efforts is free, inclusive, and offers fun opportunities to engage staff.

“Starting from the inside out is key to promoting organizational innovations focused on the patient and family experience,” said Mike Suddendorf, marketing director for Riverside Radiology and Interventional Associates.  As a member of the ACR’s Patient- and Family-Centered Care Commission, Suddendorf helped his group’s outpatient imaging center staff of ten engage with each other and patients in an entirely new way. He interviewed staff and physicians individually about their personal patient care philosophies and what gets them excited, which followed with a photo session.

“There is something about capturing the image of a person that makes them feel recognized, important, and makes them more aware of their relationship with the organization,” Suddendorf said.

Using simple poster making techniques, craft store frames, and complimentary artwork, Suddendorf said it took about two full days of work to complete the photo project. Combined with simple greenery, he beautified the space with staff photos and quotes, which created an immediate change in the organizational energy. Conversations were immediately started with patients and staff engagement peaked. They even walked a bit taller.

“The pictures serve as a daily reminder of what they have committed to and the unique opportunity they have to make a difference in the lives of others through little acts of kindness,” he said.

Measuring the success of his project through a simple Survey Monkey tool, which doesn’t have to be complex and provides simple ways to measure staff accountability. Suddendorf said it can be as simple as asking, “Did we greet them with a smile and warm welcome?  Did we thank them for choosing us? And did we deliver an experience that we’d want ourselves or for a loved one?  It’s really that simple.”