How One Hospital in Central PA Improved Radiology Workflow in an ICD-10 World


A Large Hospital's Radiology WorkflowWith the ICD-10 migration deadline firmly passed, healthcare organizations are now assessing the initial months of post-migration code management. The sheer number of ICD-10 codes alone (64,000, compared to 14,000 in ICD-9) presents a thorny issue for many hospitals.

However, one large hospital in Central, Pennsylvania responded to the challenge by revamping their radiology workflow with McKesson solutions. Leigh Shuman, M.D. recently spoke to Healthcare Informatics about the process, highlighting the creative steps that the hospital took to make the ICD-10 transition work.

Overcoming the initial challenges
Shuman noted that the hospital’s organizational structure was an initial hurdle, given that he worked as a radiology contractor outside of the hospital itself. As a result, the billing process was repetitive and cumbersome.

“So when we bill for imaging studies, the hospital issues a bill for the technical component and we bill for the professional component separately through our own billing office that we run and operate. We are our own billers,” Shuman said.

Handling these billing issues required a myriad of on-the-spot phone calls or emails, outside of any sophisticated billing system.

“You’d get an email through the hospital’s secure email system saying, ‘Can you please look up so and so? Your report doesn’t contain the information we need or there may be a mistake,’” Shuman said.

“That email system is on a separate computer system than our PACS. So you’d have to actually move your chair to a different set of screens and keyboards to read the email, then go to another one and somehow transfer the information to PACS so you can look up the person, look at the report, and then dictate an addendum as needed.”

This type of billing management process would quickly become overwhelming with the increased code load in ICD-10, so Shuman and the hospital worked with McKesson’s vendor-agnostic Conserus™ product suite to streamline departmental communications.

Establishing a goal of seamless communication
Shuman and the hospital, early adopters of the Conserus suite, looked to develop a secure communication link between the billing office and the radiologists without interrupting work on either end. They ultimately created a unique workflow with few upfront implementation concerns.

“We wanted to be able to get a notice that we had to deal with a particular report while we were sitting at the PACS workstation, so we could solve the problem there instead of going between different computers,” Shuman said.

“So we created a custom workflow that is generated by the billing office when they come across a coding discrepancy.”

This new workflow was able to address their interdepartmental communication concerns while still ensuring the privacy and security of patient data.

“We were able to create a way to maintain a secure server connection between our billing office and the hospital so we didn’t violate anyone’s privacy rules and were still able to interface Conserus with a computer in our billing office so we could make communications more seamless,” Shuman said.

The implementation of this custom workflow resulted in few overall changes to radiologists’ existing workflows, and the pop-up windows from the Conserus suite quickly became part of their daily consultations and peer reviews.

Getting stakeholder buy-in
Shuman noted that aligning the various stakeholders with their proposed workflow changes wasn’t terribly difficult because everyone liked the idea of clearing some of the clutter from their inboxes.

“The billing office liked it because their emails would conveniently get ignored for long periods of time,” Shuman said. “And we radiologists liked it because we hated being interrupted and having to stop what we were doing to go look at those emails.”

Ultimately, the various stakeholders were persuaded that the new workflow would make their processes simpler in an ICD-10 world.

“You didn’t need to rely on a radiologist to trigger the communication, so they were happy about that. The billing office was tickled because they wouldn’t have to chase us down. Everyone has been very happy with it,Shuman said.

If your organization is struggling against the weight of ICD-10, consider updating your workflow to clear the clutter. Learn more about the vendor-agnostic Conserus suite on our website and by subscribing to the Medical Imaging Talk blog.

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