Imaging Informatics: Streamlining VA Workflows
By Ricky DeLeon
Radiology Today
Vol. 26 No. 2 P. 26

One of the major challenges the VA faces in streamlining both clinical and administrative workflows for radiology is dealing with paper-based protocols and overbooking issues.

Paper protocols are often misplaced or lost, leading to delays in scheduling. This means medical support assistants (MSAs) may need to contact radiologists directly, wait for protocols to be printed at designated printers, or retrieve them at specific times. These inefficiencies can cause scheduling delays.

In addition, many veterans travel long distances or require transportation assistance, which often results in multiple appointments being scheduled at different clinics on the same day. Overbooking can lead to extended wait times, and in some cases, appointments need to be canceled or rescheduled. This can delay treatment or completion of exams, making it challenging to meet clinically indicated deadlines.

There are, however, new approaches that streamline radiology workflows, helping to enhance overall care access at the VA. For example, it is now possible to leverage electronic protocoling solutions that offer unique filters to help identify which exams require protocols and which have already been protocoled. This provides clear visibility into the status of protocols, allowing MSAs to schedule appointments more efficiently. MSAs can also avoid overbooking appointments for the same date and time, thanks to electronic displays that show all the clinical appointments scheduled for the current day and beyond.

New electronic reporting capabilities capture who completed the protocol, along with the date and time of completion. This allows radiologists to create progress notes for protocols and includes a filter to identify protocols that require such notes. From there, radiologists can back-sign or choose which protocols to sign as needed. Radiologists must also notify ordering providers of critical results so veterans can receive timely treatment. They often reference the time of the notification and use their discretion to prioritize these notifications.

Enhanced Offerings
It is now possible to enhance this process with a real-time view of diagnostic imaging results, using its reports worklist to highlight critical codes, as well as color-coded filters to prioritize results. For example, monitor codes are displayed in yellow to indicate report orders that contain critical information requiring close attention. The exam worklist is designed to simplify the management of radiology exams, offering a centralized place for radiologists and providers to view radiology orders and enter protocol information.

MSAs can also use these kinds of applications to access protocols, schedule exams, complete registrations, and track canceled or missed exams. Ultimately, this ensures compliance with VA directives and streamlines the entire process. Overall, this type of approach helps provide enhanced visibility into veterans’ care and helps to improve overall care outcomes, providing real-time access to radiology results through an easy-to-use interface.

These types of offerings easily integrate with VistA, the legacy EHR system used by the Veterans Health Administration, as well as with the VA’s Computerized Patient Record System. This makes it easier to access and share critical radiology information.

A key priority for the VA is the agency’s journey to become a high reliability organization (HRO). The concept of an HRO is to achieve minimal errors despite highly hazardous and unpredictable conditions, which is common in the aviation and nuclear power industries.

In health care, high reliability is built on principles that foster a culture of safety, where decisions prioritize patient safety above all else. These next generation solutions enable radiologists, techs, and MSAs to communicate effectively, ensuring the best clinical decisions are made for optimal patient outcomes and fit squarely in meeting the VA’s HRO goals. These solutions also track user actions, which allow for the review of errors or near misses and enable the implementation of quality measures to prevent future occurrences.

Of course, the most important thing is putting veterans at the center of care. Thanks to new innovations, it is possible to streamline radiology efforts and workflows to enhance care access while also reducing human errors that can hinder care.