|
Computerized workflow systems--be they coding queues, modality work lists or radiologist reading work lists--exist in virtually all radiology applications out of necessity, if not strategic design. Usually, these work lists are somewhat myopic in scope, having been designed to address a discrete issue with little or no participation in the overall workflow of the radiology department.
 |
| At UWMC, RDW facilitates monitoring of end-to-end throughput in radiology, enabling a flexible, paperless reading room that drives overall workflow efficiency. photo/courtesy Andy Strickland |
It was only a matter of time before someone began developing a systemic view of the radiology department, examining its overall workflow and connecting the dots. A similar evolution in manufacturing, distribution, banking and other industries gave rise to concepts such as manufacturing resource planning (MRP II) and enterprise resource planning (ERP). These universally accepted concepts have helped other industries see their entire operation as a system and have introduced tools and techniques that drive higher levels of efficiency, customer service and profitability. Radiology information system (RIS)-driven workflow (RDW) could do the same for radiology departments. Unlike MRP and ERP, however, the acceptance of RDW as the best way to run a radiology department is far from universal. Many sites compare it to PACS-driven workflow, where the radiologists read exams off a PACS worklist, and feel this approach is more efficient. In our view this isn't a good comparison-or a completely valid conclusion. PACS-driven workflow only addresses the provider's worklist, while the RDW concept engages the entire department. Furthermore, trying to fully implement RDW while maintaining PACS-driven worklists in the reading room would be difficult. Having providers drawing from and sending information to a system that is different from everyone else's is a significant disruption in information flow through the organization and frustrates RDW techniques. Most experts have given RDW the nod as the best way to manage radiology workflow, but the debate continues.
Figure 1 explains RDW and its role in department workflow. The diagram's white boxes represent the main tasks in the life cycle of a radiology exam. The red arrows represent the handoff of tasks, which usually are paper-based in a traditional radiology department. As an example, the presentation of a scheduled exam for protocoling to the provider is a paper protocol sheet (note the arrow between the "Pre-Protocol" and "Protocol" steps). The provider makes handwritten notes on the protocol sheet and returns it to the technologist. The technologist uses this sheet when examining the patient and returns it to the provider when the images are interpreted. RDW automates this portion of the process by providing an electronic protocol work list, which is tied to an electronic protocol form. The technologists can view the protocol information in RIS, and the provider can see the information when he interprets the images, as that information is tied to the exam in RIS, which is associated with the images in PACS.
The advantages of a computer-based workflow management system such as RDW are similar to those of techniques from other industries. In short, paperless workflow hastens the handoff from user to user, reduces errors, allows multiple parties to view information simultaneously and supports electronic auditing. Having implemented RDW at the University of Washington Medical Center (UWMC) in Seattle, we're able to monitor our throughput from end to end, enabling us to find problem areas and bottlenecks, and track performance to standards on an ongoing basis.
|