What Does Patient-Centered Radiology Look Like? Several U.S. Health Systems Are Leading the Way

In the ongoing transition from fee-for-service to value-based care delivery and payment models, there is an imperative to focus more on the patient, and that holds true for radiology as well.

According to Miriam Sznycer-Taub, a consultant with The Advisory Board Company (Washington, D.C.) who works in the firm’s imaging performance partnership, while the healthcare environment is evolving its focus from volume to cost and outcomes, many imaging leaders continue to have an unchanged perspective and remain focused on efficiency and growth. “We’ve been doing research about imaging leaders as it relates to measuring quality and our results indicated that imaging leaders largely are tracking turnaround time and volumes,” Sznycer-Taub says. “Those metrics are fine for a fee-for-service environment, but we need to think about how the world is changing and change our perspective along with it.”

Sznycer-Taub shared The Advisory Board’s imaging research during a webinar in December with a focus on how health systems can transition radiology services to a more patient-centered model of care. The webinar was sponsored by The Advisory Board and Ambra Health, an imaging technology company.

“Radiology needs to prove its value as an essential component of comprehensive patient care, as refocusing care delivery on the patient can both improve patient outcomes and financial margins,” she said.

Imaging can play into a health system’s broader population health initiative, she noted.  “If you think about the role imaging plays in the care pathway, patients face a lot of roadblocks on the path to care that may prevent them from following through with imaging referral and downstream care. And that means they are not receiving the care that they need and that can cost health systems money down the line.”

She continued, “Imaging has a unique role to play here. Imaging can play a critical role in patient outcomes, not just diagnostic information, but being sure we’re transitioning to the next step in the care pathway. And, imaging can really be thought of a stepping stone before the actual care pathway. We need to think of imaging as the true entry into the health care system for patients and think about it in that lens that imaging plays this role in patient outcomes as we’re moving from disease-based care to patient-centered care.”

Some healthcare organizations are leveraging imaging technology to improve the patient experience. During the webinar, several healthcare organizations were highlighted:

• At St. Luke’s University Health Network, a seven-hospital network serving parts of New Jersey and Pennsylvania, imaging leaders have transitioned away from using imaging CDs/DVDs, which often took at least an hour to burn, and implemented a technology platform that uploads imaging and sends patients a secure link to download the imaging themselves with upload times taking less than three minutes.
• The Houston-based Memorial Hermann Health System, a 13-hospital system, has implemented a cloud-based imaging platform and now has 100 external sending sites connected to its main campus through gateways for receiving trauma and general referrals from external PACS systems in real-time.

Many health systems are taking innovative steps to transition their radiology departments to be more patient-centered. Drilling down on the initiatives, Sznycer-Taub outlined three imperatives that health systems should focus on to achieve patient-centered radiology—patient education, results delivery and patient handoff.

As studies show that patient education improves adherence to care, radiology departments should implement pre-appointment calls to educate and engage patients by assuring patients about the privacy and safety of the procedure and providing information about the procedure and sharing information about the training and background of patients’ assigned technologists, she said.

At Houston Methodist Willowbrook Hospital, a 250-bed hospital in Houston, radiology department staff are trained to call patients before appointments and use careful scripting to ensure patient comprehension of exams and proper preparation. The implementation of the calls significantly increased patient satisfactions and decreased prep time during appointments, she said.

At Cone Health, a six-hospital health system in Greensboro, North Carolina, technologists are held accountable for patient engagement and are required to explain the exam to patients, answer any outstanding questions and, before the scan begins, technologists must document that patient education was completed in the radiology information system.

The second imperative, according to Sznycer-Taub, is to tailor results delivery and keep patients activated beyond the scan. While there are three options for results delivery—the radiology department, the referring physicians and via a patient portal—research has shown that there is a strong patient preference for radiologist delivery of the imaging exam results, she said. A study published in the Journal of the American College of Radiology found that 99 percent of patients agree that radiologist delivery was beneficial and 90 percent said the option for radiologist delivery would make them more likely to return.

She noted that there are drawbacks and challenges with radiologist-led results delivery, such as higher costs, potential liability and more time required by radiologists. Additionally, referring physicians often want to retain full ownership of patient care and radiologists often have no prior relationship with patients.

Sznycer-Taub also said research shows that offering patient portals that include delivery of imaging-related content can provide more rapid delivery of exam results to patients. Health systems can build in a time delay on portal access in order to enable referring physicians to connect with patients first and can provide a brief explanation of the results in lay language in the radiology report.

“These approaches are not mutually exclusive and the radiologist, referring physician and the patient portal can play complementary roles,” she said. “Whether results are delivered by the referrer, a radiologist and/or a patient portal, institutions should consider the needs and wishes of all stakeholders involved.”

The third imperative is to ensure a successful patient handoff. Research indicates that 15 percent of electronic exam notifications are not ready by the referring physicians, Sznycer-Taub said, and she recommends radiology departments develop ways to confirm that referring physicians have received the results to be a safety net that helps to bridge the referrer-patient gap. “To be integrated into patient-centered care, imaging needs to close the loop as patients move to the next step of the process,” she said.

At the La Crosse, Wis.-based Gundersen Health System, which operates three hospitals, imaging leaders have implemented an incidental findings tracking initiative to ensure patient follow-up. As part of this initiative, the radiology department activated a query box in voice recognition software so radiologists can indicate the need for follow-up care on the report. Staff members run weekly reports, compile cases that need follow-up and send messages via Epic to referring physicians to confirm the report has been received. In that message, referring physicians are requested to indicate a follow-up plan and the radiology department documents the response to maintain a record of physician communication.

Additionally, if the referrer doesn’t respond after two weeks, the case passes is passed to a quality assurance radiologist to contact the referrer, and, as a last step, the QA radiologist alerts the department chairmen.

Additionally, at Gundersen, the radiology department matches emergency department patients who do not have a referring physician with internal medicine residents for follow-up care.

“There’s this gap between radiology and the referrer and someone needs to bridge the gap and radiology is best positioned to fill that void,” she said.

Essentially, Sznycer-Taub contends that imaging programs should take responsibility for follow-up care by confirming that referrers have acted upon radiology results. “In this way, radiology confirms that its product has been utilized as intended and adds value as a patient care coordinator,” she said.