Up until about six months ago, the idea of having radiologists work remotely wasn’t on the radar for most organizations. In fact, many were strongly opposed to it.
That, of course, was before Covid-19 turned healthcare on its head, and strategic plans were thrown out the window. Virtual visits spiked dramatically and telecommuting became the norm — even for areas like radiology and pathology that many believed couldn’t be done remotely. At least, not as effectively.
But when the pandemic hit, it was no longer an option. Patients needed to be diagnosed and treated, and images had to be accessible from anywhere, which created “a new set of challenges,” said Eric Rice, senior consultant with Paragon Consulting Partners. During a panel discussion, Rice and Larry Sitka, VP of Enterprise Applications with Canon Medical Informatics, Inc. (formerly Vital Images), discussed the key obstacles in transitioning radiologists to a remote setting, the systemic weaknesses that were exposed by Covid, and how leaders can prepare for what’s happening down the road.
“It’s tough to train our brains to accept this new norm where we’re not sure what’s going to happen next week, especially as policies and guidelines are constantly changing,” noted Rice. “How do we prepare for this?” What he’s finding is that although human workflow and operational readiness are critical, “technology can play a strong role in this.”
A screenshot of healthcare
Across the country, the story was the same: procedure volumes decreased significantly, including ancillary services affiliated with the OR, “which is the moneymaker for most providers,” said Sitka. Patients cancelled screenings for fear of contracting Covid, and when they did show up, the condition was often much more severe. “We’ve convinced the patient population to stay home and that has to change, specifically when it comes to elective procedures.”
The good news is that patients are starting to come back, which can help practices start to recover some of the lost revenue. However, it also means a heavier workload for radiologists, many of whom are still working remotely. That, according to Rice, means leaders must ensure a solid technology platform is in place to “image-enable the home reading room.”
The “never-ending list”
In a typical radiology environment, thin client servers are utilized to stream data to the desktop, noted Sitka. “Everything is rendered in the data center and then shipped through image streaming to the desktop for a physician to view.” And although this method worked well within the four walls – or in a location where users were connected to a workstation with low latency, there was one hiccup. When data was pushed to the workstation, it was exposed on the disk, which increases the risk of a personal health information (PHI) breach. On the other hand, a hybrid thick client pushes images inside of the memory, and when it’s closed out, there is no PHI written on the disk.
Another shift both Rice and Sitka have seen as providers move away from the workplace is the ability to more easily parse a list of studies and identify the right one, which has led to “a dramatic increase” in view counts. It can also decrease “queue fatigue,” which happens when users become overwhelmed by never-ending lists.
“The technologies available to radiologists now are so much smarter,” said Rice. They use “hybrid streaming approaches where it’s doing some work on the server, but you don’t have to go back to the server every time you flip and rotate and zoom.” Using a hybrid approach to rendering is critical, as it can help with latencies, which can have a negative impact. “When all these connections have to be made, every connection gets hit with that latency, and that can really affect the viewer,” said Rice.
In other words, if radiologists — who Sitka noted are often “hyper-scrollers”— flip through images too quickly, the image starts to lag behind. “That’s the latency typically seen in home-based environments without a hybrid approach,” he stated.
If it ain’t broke
Therein lies the problem — or at least one of them. When it comes to digital health, healthcare has lagged far behind. While organizations have invested heavily in implementing EMRs inside the four walls, remote capabilities have been neglected, according to Sitka. “Covid exposed the lack of IT and IT funding,” he said. “Healthcare was already broken; now we’re seeing what was broken.”
Rice, however, argued that the fact radiologists are able to access images from different locations proves that the system isn’t exactly broken. It does, however, need to be tweaked. To that end, he and Sitka offered some best practices for healthcare leaders on how to create a better experience for users.
- Anticipate the surge. Data show that many of the mammography screens scheduled to take place between March and June of 2020 have been rescheduled for the same time block in 2021. Providers, said Rice, need to be ready. “You need to look at how you can get caught up on that volume and how you can spread that one in the coming year. “It’s going to take some time.” Providers need to anticipate influxes of screening requests and scale up quickly in order to manage backlogs.
- All about the patient. As volumes steadily increase, leaders have a golden opportunity to think about how to more effectively meet the needs of patients, noted Rice. “How can we be proactive around scheduling procedures? How can we be smarter about scheduling so that patients don’t have to sit in a crowded waiting room?” Beyond that, how can remote reading rooms be improved? “It’s a good opportunity for everyone to take a step back and think. Providers need to put together a plan and be proactive in their outreach, and patients will have a better future.”
- Think enterprise. When it comes to purchasing applications, healthcare as a whole needs to change its mindset, noted Sitka. “We need to stop thinking service line and start thinking enterprise. If you purchase an application, make sure it replaces and decommissions four or five. We need to stop writing these checks that don’t have to be written anymore.”
- Do something. One of the worst mistakes leaders can make when faced with a serious problem is to do nothing – something healthcare became quite good at, said Sitka. “It broke our revenue stream. It broke our ability to gain revenue, and it’s also breaking the ability for patients to receive services in a safe environment. We need to think much differently.”
Fortunately, there is some low-hanging fruit that can help point organizations in the right direction, noted Sitka, such as reassessing pending acquisitions, rescheduling cancelled visits, and avoiding silo-based purchases. “That’s what got us here,” he noted.
Finally, Sitka advised leaders to focus on modernizing the infrastructure and technology across the enterprise, and consolidating enterprise data “so that we can shift and adjust.” As we’ve seen, “it’s a bit unknown right now as to what it’s going to be like next week; having those capabilities is going to be important. We can’t be stagnant; that’s not going to provide the patient care that we need to provide.”
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