Quality Improvement in Radiology

When it comes to quality and value within radiology, the ability to achieve positive results consistently relies heavily on collaboration and inclusion within the patient’s care experience, according to industry experts during the Quality Improvement Symposium at RSNA 2016.

Combining the value proposition within radiology of doing the right thing for the right patient at the right time with a patient- and family-centered care experience and cost awareness, Ella Kazerooni, MD, MS, director of cardiothoracic radiology at the University of Michigan, said, can make radiology providers the common champions of value.

“Pretty much everybody in this room has been a patient, is a patient, or has a friend or family member who is a patient,” she said, asking the audience to step away from their health care shell and imagine the impact, apprehension, and loss of control every patient feels walking through the doors of their health care provider.

“How would you want to interact with your health care system, your radiology department, and your providers?” she asked. “What would you want to know?”

The Evolution of Radiology Quality Performance
“Health care has changed tremendously at a pace that continues to accelerate, leaving physicians struggling to find value and drive quality improvement without knowing exactly where they are going,” Kazerooni said. She acknowledged a shift away from the “chaotic, doctor-knows-best” culture that existed up through the early 70s to the “standardized, fast-paced” culture of “one size fits all categories” which involves large data access and the beginnings of quality improvement accountability experienced into the 2000s. Today’s world is moving towards a place where, “we are now drilling towards individualized care whether it’s  personalized, precision medicine using data analytics or personalized patient- and family-centered engaged care, we as radiologists are trying to figure out how to keep up with this evolution,” she said.

Current competition, both within and outside of radiology, that offer imaging-based services or threaten automation are drivers for radiologists to differentiate and distinguish themselves. Threatened by groups that demonstrate their value through marketing, she said, “Radiologists should be re-associating themselves with their patient base and directing care for patients.”[[{"type":"media","view_mode":"media_crop","fid":"56238","attributes":{"alt":"Qualty improvement in radiology","class":"media-image media-image-right","id":"media_crop_6782988836623","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7063","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: 133px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©phoelixDE/Shutterstock.com","typeof":"foaf:Image"}}]]

Radiology has evolved into a team culture that provides a continuum of care. Every person on the team that interacts with the patient should be part of a quality improvement project, from the front desk to the technologist and the physicist.

“Quality metrics are now externally imposed and we have an accountability to respond to them,” Kazerooni said. She named HCAPS scores, billing accuracy, developing high quality reports, and exam appropriateness as examples of quality drivers that are becoming directly tied to certain physician reimbursement models as well as referrer satisfaction.

Patients’ Perception of Quality is Different than Ours
“Value in health care is quality plus service over cost,” she said, or more precisely, “value equals what you get for what you are willing to give or pay.” But what radiology providers’ perceptions of value are has not been aligned with what patients say is important to them. Ninety percent of what a patient finds valuable during their experience involves the non-medical aspects, according to Kazerooni’s work with the ACR’s Patient- and Family-centered Commission (PFCC). Defining value in today’s patient-centered world involves asking patients the right questions and involving them in solutions.

The PFCC has patient members consulting, advocating, and speaking openly about their experiences. Kazarooni said that most patients want to be able to speak to a radiologist about their results if necessary, they wanted to be engaged and a part of the decision making, and they wanted patient portal access to their health records electronically. Excellence in service is important, from interactive communication tools to follow up thank you notes from radiologists, patients want the level of customer service they would receive from other service industries.

What Will Radiology Patients Demand in the Future?
Looking to the future, James R. Duncan, MD, PhD, FSIR, vice chairman of quality and safety at the Mallinckrodt Institute, expects patients by 2025 to want more and better from every aspect of health care. Including better integration, better tailoring to the individual, more transparency, and more predictable outcomes.

Duncan said we will be working with more patient data than ever before, generated by electronic sensors including smartphones with attachments, wearables, and imaging bedside devices. “We will face a potential medical data overload with an anticipation of data doubling every 73 days by 2020,” he said, concluding, “health care has a big data problem. We are drinking from the firehose.” Automated data collection systems like Watson will improve how small, meaningful pieces of data can be grasped from such large sources to help make clinical diagnosis, he said.

“During stressful times, humans want to interact with humans because there is a need for empathy,” he said, sharing that improved machinery will combine forces with humans, not replace them.

Stronger predictive business analytics will be able to find value and quality encoded within patterns of care. Duncan predicts that future patients will demand itineraries that explain their health care journey with a series of expectations and predictions that provide a timeline back to normalcy.

Measuring quality and value in 2025, Duncan said: “we must look at care as a sequence of events, bring evidence that our message was accurately received, decoded, and used to solve the problem in an efficient and effective manner while having a direct impact on outcomes.