#ACR2015 Designing A Better Radiology Order

Over the last few days I have been following #ACR2015

There have been a lot of interesting conversations occurring, information being shared, and topics trending.

One of the comments made recently by Kristina Hoque (@KristinaHoque) was the following:

Screen Shot 2015-05-18 at 2.18.39 PM

At the same time Colin (@colinsegovis) made this comment:

Screen Shot 2015-05-18 at 2.19.12 PM

I reiterated that radiologists need to do more to connect with stakeholders. Referring physicians, patients, administration, payers, community, and so on and so forth.

As I was traveling today I continued to think about the above comments and my response. I started to think about the design of the radiology ordering process.

Simplified it is as follows:

Patient sees a physician that is a non-radiologist–>history and physical documented, along with signs and symptoms, and any other medical history–> physician writes an order for an imaging exam–>patient is scheduled–>patient may or may not need lab work for contrast–>patient shows up for imaging exam–> exam performed–>exam read–>exam documented and report generated–>entered into EHR/EMR–>patient goes home. End of story.

In the imperfect world of healthcare that is not the reality.

Why is the system designed this way? (I know it is due to how the government sets the rules for reimbursement)

However, why?

Why is our system designed to have a non-imaging expert (referring physicians) order an imaging exam to be performed by the radiologist and the radiology staff?

Would a surgeon allow a primary care physician to order the type of surgery they are going to perform on a patient? I doubt.

When did radiologists become a cog in the industrial machine of healthcare?

I order, you do.

Wouldn’t it make far more sense to design a system that allows “ordering” physicians to define the problem they need help in solving? A system designed that allows radiologists to choose the best tool to solve the patient and the physicians problem? To obtain the best possible answer to enable a diagnosis and treatment?

If a system was designed to compensate and reward based on the problem defined, the best possible manner to answer the problem, and allow experts to connect with one another, would it organically lead to improved quality, improved efficiency, and better cost controls?

We can wait for the government. We can wait for administrators. We can wait for other physicians. We can wait for the invite.

I challenge that we don’t wait for the invite and design a new process.

If the order comes in and it doesn’t make sense, call, make a connection with the referring physician, and recommend the best option.

If the order comes in and it lacks the information you need, call, make a connection, and educate why you need more information to help the referring physicians in their work.

Don’t wait for the invite, it is not in the mail.

Choose yourself, send out the invites, and design a better radiology world.

The one that allows you an abundance to connect.

As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek



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