Go With the Flow Optimizing Voice Recognition to Streamline Radiology Workflow

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Go With the Flow- Optimizing Voice Recognition to
Streamline Radiology Workflow

• Kim Wilson, MD
• SAVAHCS
• Tucson, Arizona

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Teleradiography

• Reading from my home office for past 4 years
• Space constraints
• PACS 2 monitors, 1 keyboard, 1 mouse
• Dictaphone 1 monitor, 1 keyboard, 1 mouse
• Total space about 5 x 7 feet

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Workflow issues

• Manager settings
• Custom lists
• Health Summary
• Incomplete reports
• Workload credit
• Organization of studies
• Report templates
• Results reporting

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Optimize manager settings

• Mouse settings

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Manager settings
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Manager settings
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Manager settings
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Manager settings
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Manager settings
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Manager settings
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Manager settings
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Custom lists

• Organize based upon workload of Radiologists
• Defined by
• Patient demographics (Inpatient)
• Exam type (Chest x-ray)
• Modality type (CT)
• Combination of above (ED CT)
• Easily identify workload
• No need to search unread list for case

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Custom lists

• Use as a readlist (automatically preloads the
  next case on the list- opens the next case when
  you close the current)
• Stat and urgent exams should go to the top of the
  list
• Stat studies will automatically be read next
• List must be sorted by urgency
• Can use the same readlist all day
• Can change the sorting options on the fly

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Using the readlist my preference

• Keep the prompt to send dictation information to
  VR- otherwise you lose control of when the report
  opens.
• Disable the prompt to confirm closing a case
  one click will close a case and open the next.

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Sorted by urgency
or exam type
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Selection readlist

• Studies with multiple linked CPT codes may not
  open with optimal hanging protocol using the
  regular readlist
• The CPT code listed at the top will be used to
  determine hanging protocol
• Select the CPT codes you want to use to open the
  cases (one per grouped exam)
• Create a new temporary list- re-sortable

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Review a list of exams to be read
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Select the cases preferred for hanging protocol
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Create the Selection Readlist
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Resident read-out

• Using the Recent list, a resident can read out
  their pre-dictated exams using a selection
  readlist
• Future patch will allow each Radiologist to have
  their own list where any case interpreted by them
  will be listed

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Resident read out

• Click on Recent list
• Sort by reader

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Selection Readlist
ltshiftgt to highlight a number of studies at once
Click on
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Read out
Right click on the open exam to Open the
requisition Open the dictation
Click on readlist
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Health Summary

• Created in CPRS- any user can have a custom list
• Created by choosing components of the medical
  record
• Quick access to medical correlation without
  needing to log into CPRS
• Can determine when to call the clinician- missed
  finding- and avoid calls- the pneumonia was
  documented in the Emergency Dept note.

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Health Summaries
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Radiology Health Summary

• Allergies
• Problem list
• Last 5 progress notes
• Labs
• Creatinine
• CBC
• Lactate
• AFP
• Pathology
• Surgical reports
• Discharge summaries

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Emergency Dept Health Summary

• ER notes x 5
• Primary care note X 5
• Surgery consult
• Cardiology consult
• All labs last 30 days

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Surgery/ Pathology Health Summary

• Surgical notes (all)
• Pathology results (all)

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Medicine reconciliation Health Summary

• Allergies
• Current medications

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Incomplete reports

• Recent list
• Displays all cases in interpreted status with
  the initials of the Radiologist
• Waiting for exam list may have older case
• Need someone (QA/QC designee) to run an
  incomplete exam list at intervals to identify
  cases without reports, and check for failed
  Powerscribe reports
• Custom lists can include cases with no images to
  help identify problem cases

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Incomplete reports

• Identify repeat offenders to see why cases are
  being marked as interpreted
• Simultaneous dictation of two unrelated cases may
  not work on Powerscribe, although it lets you do
  it. There is a fix for this.
• Setting Dont mark a case as interpreted unless
  the dictation was sent to VR.

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Workload credit

• Extremity exams
• No bilateral CPT code (except for hips, and
  standing knees)
• Remove bilateral modifier option

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Organization of studies

• Link exams as a printset to display and dictate
  them simultaneously
• CT Chest/abdomen/pelvis
• Radiographs of the pelvis and hip
• Transabdominal and endovaginal Ultrasound
• Knee series Ortho bilateral knees
• Standing bilateral knees
• Merchants bilateral knees
• 2 view right knee
• 2 view left knee (add -50 modifier to CPT code)
• Images will be mapped to all of the linked cases

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Dictation goes to all exams
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Report Templates

• Purpose
• Reduce repetitive components
• PA and lateral chest radiographs are compared to
  the exam dated
• Reduce typing/ correction
• Normal phrases remain in the template unless
  replaced- these will not require correction.
• Help organize
• Orderly, consistent reporting
• Guide for residents
• Reminder to review all aspects of the case

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Sample templates
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Final report
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Chest
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CT abdomen with
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Lumbar spine
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Standing right foot
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Dictating reports

• Direct link from VistaRad to the VR software
  reduces errors in uploading the correct exam
• I always choose when to send the dictation
  information to Powerscribe to initiate dictation

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Dictating reports

• Patient name, SSN, the ordering physician, date,
  and history are automatically added into the
  report no need to re-dictate these

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Results reporting

• ACR guidelines
• a. Situations that may require non-routine
• communication include
• i. Findings that suggest a need for immediate
  or urgent intervention
• ii. Findings that are discrepant with a
  preceding interpretation of the same examination
  and where failure to act may adversely affect
  patient health

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ACR guidelines

• iii. Findings that the diagnostic imager
• reasonably believes may be seriously
• unexpected by the treating or referring
• physician
• These cases may not require immediate
• attention but, if not acted upon, may
• worsen over time and possibly result in
• an adverse patient outcome.

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Documentation

• Calling the primary caretaker
• Document to whom the result was called, and exact
  time
• If critical value then add
• time between identification of the abnormality
  and relaying the information
• The finding must be repeated back by the receiver

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View alerts

• At the end of report, option to add a view alert
• Sends an email alert to ordering physician
• Work with CPRS team to make sure they go to the
  right place ED reports also go to primary
  caretaker
• Retain the view alert records in the computer for
  maximum time protects the Radiologist

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Diagnostic codes

• Code 4 Abnormality, attention needed
• Code 5 Major abnormality, physician aware
• Code 7 Unsatisfactory/ Incomplete exam
• Code 9 Malignancy

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Diagnostic codes tracking

• Code 5 Appropriateness of contacting clinicians
  critical results reporting
• Code 9 Tumor registry
• Code 7 QA/QC
• Additional codes for mammography tracking
  Bi-Rads codes associated

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Critical results

• A list of findings which must be called to the
  ordering clinician
• Document time between identifying the abnormality
  and reaching the clinician
• Clinician needs to repeat back the finding
• Code 5 Major abnormality, physician aware
• Keep the list short Free air, intracranial
  hemorrhage, pulmonary embolism, hip fracture

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Summary

• Goals
• Efficient use of Radiologist time
• Read the exams in the appropriate order
• Easy access to clinical information
• Complete, organized reports using voice
  recognition software to its best advantage