From the October 2017 issue of HealthCare Business News magazine
By Dr. David Pastel and Dr. Tessa Cook
As radiologists continue to find themselves challenged by an ever-increasing patient census and decreasing reimbursements, we have sought strategies to deliver more efficient, more effective, patient-centered care.
Here are two examples of how imaging informatics can offer solutions to issues that affect both radiologists and our referring physician colleagues at the beginning and end of the imaging ordering process.
Radiology eConsult (Dartmouth-Hitchcock Medical Center)
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Last year, the radiology department at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., launched a new electronic consultation platform that formalizes the traditional “curbside consult.” Radiology eConsults is an electronic consultation service that allows PCPs to ask imaging questions through the hospital’s electronic medical record. The e-consult program enables PCPs to more efficiently and directly communicate with radiology sub-specialists, expediting patient-care decisions while ensuring appropriate image ordering and management of “abnormal findings.”
The eConsult program at Dartmouth-Hitchcock began with a CMMI Health Care Innovation Award. In 2014, Dartmouth-Hitchcock was one of five academic medical centers working with the Association of American Medical Colleges that received a three-year grant to integrate an eConsult program to improve care and contain costs. The grant funded 15 clinical specialties, but did not include radiology. Radiology was added to the service once the hospital recognized radiology eConsult as an important service to improve patient care and manage costs associated with inappropriate imaging requests.
When PCPs have a low acuity imaging question about their patients they simply choose an appropriate subspecialty template and order an eConsult through the EMR. The templates were developed with input from specialists and primary care physicians to ensure that the appropriate data is available for the specialist to give a timely and thoughtful response. All of the radiology templates include the same basic questions with slight variations for the different subspecialties. Once an eConsult is ordered, the completed template lands in the appropriate specialist’s in-basket, who has 72 business hours to respond. Six core subspecialty radiologists handle most of the e-consults at Dartmouth-Hitchcock.
Since the program began in August 2016, the radiology department has received over 60 consultations. Most consultations take less than 20 minutes to complete. A recent survey showed that 86 percent of Dartmouth-Hitchcock PCPs use eConsults and that 95 percent are “very satisfied” with the program underscoring its value. eConsults facilitates engagement of the radiologists in the care of the primary patient and documents daily work done outside of direct image interpretation.
While PCPs and specialists receive RVU credit for generating and responding to eConsults, the service is not yet billable, but is under review by CMS. Until then, the program is more about enhancing radiologists’ value as imagers, not earning RVUs.