Dr. Christopher (“Cree”) Gaskin is Professor of Radiology and Medical Imaging, Orthopedic Surgery; Director of Musculoskeletal Imaging and Intervention; Department Vice-Chair of Informatics; and Medical Center Associate Chief Medical Information Officer at the University of Virginia Medical Center (UVA) in Charlottesville, Virginia.
What should drive the workflow?
Dr. Gaskin has long been a proponent of providing full patient information to the radiologists interpreting a study. To accomplish this information sharing, there are three options: an EHR-driven workflow, which Dr. Gaskin prefers; a PACS-driven workflow, where the worklist is in the PACS and the health record is enslaved behind it to stay in synchronized context. Or a third party application can pull the EHR data and share it with the radiologist during image interpretation.
Integration is the key.
Dr. Gaskin called on his IT team to work with Carestream to integrate the PACS with their EHR. “With an EHR-driven workflow, the radiologist interacts with the health record to drive study interpretations while centralizing the other tasks and increasing awareness of patient information,” Dr. Gaskin stated.
It’s all available from a central log-in.
Available at UVA upon login on a UVA radiology workstation are Protocoling, Reading Studies, Chart Review/Search, Report Creation, Administrative Reports, and much more. When issuing protocols for studies, relevant data can include information for prioritization, safety flags, lab values, previous protocols, prior studies, and full chart access.
A typical radiology setup at UVA includes two PACS monitors and a large admin monitor with room for EHR data and Speech Recognition (SR) Software.
UVA built automatic prioritization of studies into the reading worklist.
Dr. Gaskin and colleagues developed a nine-point scale for reading priority beyond the conventional order priority, which has improved turnaround time for high priority studies.
Key learnings from UVA’s integrated approach to an EHR-driven workflow.
When the EHR drives radiology workflow, data flows to the radiologist, leading to more informed reading and substantial increases in efficiency, according to Dr. Gaskin. He also believes that clinical collaboration requires full access to patient records including images, lab results, and relevant reports. Another benefit of this approach for UVA has been qualifying for incentives available under the Meaningful Use program in the U.S. And finally, the EHR-driven workflow at UVA has increased clinical collaboration across the enterprise.
NB: Additional information on the UVA Epic/Carestream integration is available in our CIO eBook, From Trust to Use and Beyond: The Road to Clinical Decision Support, Chapter 5, Clinical Workflow in an Era of Interoperability.