Transformation through Collaboration
Ireland’s National Radiology Quality Improvement Programme
Organisation: HSE Quality Improvement Division
- 50 hospitals across Ireland
- Initiative managed by the Royal College of Physicians in Ireland (RCPI).
- First national programme of its kind
- Change Healthcare Workflow Intelligence™
- Improve the timeliness of treatment for patients
- Need to review department’s quality performance against national targets
- Manual processes to measure quality activities
- Inconsistent process for raising alerts related to significant radiological findings
- As of May 2016, 40 Hospitals are live
- Quality metrics defined for entire country of Ireland
- System monitored 24x7
"The software is excellent, its use fitting seamlessly into our workflow. From a patient care perspective, it allows us to document our reviews of each other’s work and discuss differences of radiological opinion that could potentially alter a patient’s management. The ability to issue and track ‘alerts,’ relaying critical results to other Consultants immediately, is a key feature for patient care."
Dr. Anthony Ryan
Consultant Interventional Radiologist, University Hospital Waterford
Introduction to the National Radiology Quality Improvement Programme
Commenced in January 2010, the National Radiology QI Programme is led by the Faculty of Radiologists, Royal College of Surgeons in Ireland (RCSI), in collaboration with the HSE Quality Improvement Division. This key quality improvement initiative is managed by the Royal College of Physicians in Ireland (RCPI).
As the first national programme of its kind, its central aim is to improve quality by enhancing patient care and safety with accurate, complete and timely radiology reports, optimising patient care and facilitating compilation of meaningful national data.
The National Radiology Quality Improvement programme sets out to develop a patient-centred quality framework within each hospital’s radiology department. To achieve this, national quality improvement guidelines were developed to allow the routine review of performance and drive improvement in key quality areas against intelligent targets locally, regionally and nationally.
Programme Objectives include:
- Enable participants to review their department’s quality performance against national aggregate and intelligent targets.
- Support quality improvement at a clinical level by implementing a solution that could be integrated into the radiologist’s workflow.
- Improve the timeliness of treatment for patients who present with critical, urgent or unexpected and significant radiological findings.
The challenge was to find and implement a technology solution in all hospitals in Ireland that could:
- Provide real-time data capture of departmental activities and help radiology departments make relevant departmental information available to clinicians and front line staff.
- Help record quality activities in radiology such as: Peer Review, Radiology Quality Improvement meetings, Multi-Disciplinary Meetings, Radiographer Quality Assurance Meetings, and help manage the alerts process for critical, urgent and unexpected significant radiological findings for an entire country.
- Provide reports and analysis to clinicians that would allow for early identification of potential errors and identify inconsistencies and divergences.
- Support the improvement in accuracy, quality and completeness of diagnoses.
In September 2013, RCPI and the Faculty of Radiologists identified and selected Change Healthcare Workflow Intelligence™ as the Information and Communications Technology (ICT) solution needed to help them achieve the objectives of the National Radiology QI Programme.
Change Healthcare Workflow Intelligence™ is a vendor-neutral, integrated, flexible workflow rules engine that helps bridge the gaps in communication between consultants and general practitioners. It replaces cumbersome manual workflow processes and automates the statistical output of the quality initiatives. It enables users to achieve this by tight integrations, which connect disparate applications while simultaneously helping to eliminate communication barriers. The advanced technology of Change Healthcare Workflow Intelligence™ uses intelligent assignment and re-assignment of tasks, sophisticated prioritisation capabilities, integrated communication tools such as email, SMS and faxing, and escalation pathways to help ensure work is assigned appropriately and tasks are completed as efficiently as possible. The end result is a measurable, integrated closed-loop workflow.
Change Healthcare Workflow Intelligence™ helps healthcare organisations to:
- Provide a comprehensive view of the enterprise quality initiatives
- Automate quality workflows by providing a tightly integrated closed-loop tool set
- Connect disparate applications to help improve communication between isolated healthcare IT systems
- Eliminate interdepartmental communication barriers
- Monitor process performance and provide meaningful analytics which can be used for process improvement
- Alert staff to missed steps and workflow bottlenecks to help ensure that each case that enters the Change Healthcare Workflow Intelligence™ Engine gets closed
The National Quality Improvement Guidelines, developed by the Faculty of Radiologists include the requirement to have a system in place to support:
Prospective Peer Review: To allow radiologists to record real-time consultations from other radiologists across the country in order to aid in difficult diagnosis or to get feedback prior to submitting a final report, hence to help improve the accuracy of radiological diagnosis.
Retrospective Peer Review: Contemporaneous studies are allocated weekly for review or the radiologist may undertake elective retrospective review; comments and results are recorded. Should the peer review activity result in a discrepancy in diagnosis, an opportunity for departmental learning or in a positive example of good reporting, the case is referred to the Radiology Quality Improvement meeting.
Quality Improvement Meeting Manager: To provide support for radiologists when preparing for and presenting at Radiology Quality Improvement and other departmental meetings.
Radiology Alerts: To communicate and record acknowledgement of urgent, critical or unexpected and significant radiology findings to attending consultants and GP’s. Alerts are configured to be sent using email, SMS, and other channels. Escalation pathways and reminder alerts allow departments to meet national turnaround time goals for the acknowledgement of these alerts.
Meeting Management: To support the management of multi-disciplinary team meetings, Departmental meetings and Radiographer Quality Improvement Meetings by creating worklists that collate the information required for presentation at the departmental, hospital and national level.
Change Healthcare worked with the Office of the Chief Information Officer, Health Service Executive (HSE) and the Faculty of Radiology to design and configure the system to meet all of the defined requirements, and to begin a phased rollout that would deliver the solution to all 50 Public Hospitals within a 27-month period.
The first step was to configure the software to fulfil the requirements of the guidelines and support the workflows of the 50 hospitals across the country. This initial build of the software was informed by the requirements that the HSE and Faculty of Radiologists outlined in the tender requirements. This was followed by a series of educational roadshows to introduce Change Healthcare Workflow Intelligence™ to radiology staff, educate the users, receive feedback on the initial build and encourage adoption.
The last steps before implementation were to test all systems and integrations, establish the policies, procedures and methodology, and to develop a full set of documentation. Once the configuration phase was complete, the implementation of the pilot site commenced at University Hospital Waterford. In July 2014, University Hospital Waterford went live with Change Healthcare Workflow Intelligence™.
Prior to commencing the implementation roll out, Change Healthcare and the Faculty of Radiologists reached consensus on a configuration of the Change Healthcare Workflow Intelligence™ solution that could be used in every hospital in the country, in order to limit the level of bespoke configuration that would be required during implementation at each individual site. This approach improved the efficiency of implementation and adoption at each site, and will help to drive standardisation in quality workflows nationally. As a result, the implementation of Change Healthcare Workflow Intelligence™ at new sites happened very quickly. As of May 2016, 40 hospitals are live, and at project completion the solution will be deployed at 50 of Ireland’s hospitals, performing a total of almost 4 million exams annually.
Returning benefits to the Irish Health System
The implementation of Change Healthcare Workflow Intelligence™ as a national ICT system will enable the QI Programme to drive quality improvements in Ireland by capturing data to aid in setting national targets for radiology departments. The system tracks and evaluates consultations and communication between physicians; including the identification and tracking of specific critical, urgent and unexpected significant findings and facilitating the management of the time-sensitive transmission of these reports to defined consultants on a patient’s care team. By converting findings into an electronic format, physicians are able to share results with colleagues in a more effective and timely fashion while mapping statistical trends.
Additionally, the National QI Programme has defined targets for quality metrics on critical, urgent, significant and unexpected results communication.
“The programme aims to help radiologists turn what had largely been a manual and paper-based process into an automated and seamless electronic workflow. By capturing, analysing and acting on the data stored in the radiological images, we can further advance the strides we have made in communication, care delivery, efficiency and patient safety.”
Dr. Jennifer Martin
Quality Improvement Division, Ireland’s Health Service Executive (HSE)
For more info on the National Radiology QI programme: