By Teri Yates
Teri Yates, Founder and Principal Consultant, Accountable Radiology Advisors
Ron Hosenfeld asserts that if you want to increase the value of radiology services, you have to start by talking to radiologists. In his role as Chief Information Officer for Riverside Radiology & Interventional Associates (RRIA), which is the largest independent radiology practice in Ohio, Hosenfeld has talked with his physicians a lot about peer review. For the most part, the feedback hasn’t been good. “When I would ask our doctors about peer review I heard over and over that it isn’t a value added activity for anyone in the process,” said Hosenfeld. He and the radiologists at RRIA hope to change that dynamic by using new software to fundamentally modify their peer review workflow.
Radiology peer review is typically a retrospective activity, with previously interpreted studies selected for evaluation weeks, months or even years after the initial interpretation was performed. Until early 2015, RRIA also employed that kind of system, relying on a third party software solution to leverage comparison of relevant prior studies as a peer review event.
Evaluation of relevant prior studies is the predominant form of radiology peer review in the United States, in large part because groups believe it is most cost-effective and efficient to make use of an evaluation that is already occurring within the normal workflow. There are several important drawbacks to this method, however, including that it does not yield a representative sample of cases for peer review because some examination types are less likely than others to be repeated.
Another major flaw of the approach is that it inevitably leads to the discovery of clinically significant errors when it is too late to help the patient. To solve this problem, RRIA has developed new software that enables them to perform peer review almost in real-time. The group believes this change will help eliminate awkward disclosure of old errors to ordering providers, and more importantly, reduce patient harm from misdiagnosis. Hosenfeld explains the change. “We need to perform the peer review in the clinically relevant window, so in our new system cases become available for evaluation almost immediately after dictation.”
The group’s quality committee sets a monthly peer review quota for each radiologist, who then selects cases on-demand to meet that quota from their available pool of peer review cases. Radiologists are only exposed to cases appropriate for review based on their subspecialty, and the system ages cases out of the pool after just a few hours to ensure that any review completed is done on a very current study.
Hosenfeld calls this approach “contemporaneous peer review”, and says the change will have a significant positive impact on patient care by revealing diagnostic errors in time to quickly course-correct treatment decisions. He asserts that “by doing peer review contemporaneously, you enhance the value of the process for the group, the ordering provider and the patient.” RRIA’s work represents an important shift in the purpose of peer review, expanding beyond its educational benefit to also actively manage malpractice risk and prevent patient harm.
New Peer Review Workflow at Riverside Radiology & Interventional Associates
A common challenge in implementing a radiology peer review program: attaining consistent radiologist participation. Hosenfeld believes the new software they’ve developed solves this problem too. He indicates that their group’s goal is for each radiologist to complete three evaluations per day, and under the new system doctors have a clear line of sight into how much peer review they have already completed. “We display a peer review progress bar near the radiologist’s worklist so they can see at any time if they are on track to complete their monthly quota,” said Hosenfeld. “We tell them it isn’t hard to get it done if they just do one case before morning coffee, one before lunch and one before leaving for the day.”
The new software offers other functionality to support the RRIA peer review program too, like the ability to conduct ad hoc reviews and assign cases for focused review. Hosenfeld notes that the system also includes robust reporting capabilities, allowing the group to visualize and analyze its peer review data. RRIA has been beta testing the system with a selected group of its radiologists for several months, and plans to implement the system practice-wide before this summer.
The group’s quality director, Geoffrey Wiot, MD, is confident that the new system will have a meaningful impact on the value of their services. “Applying technology innovation to the peer review process is a natural evolution for us and will ultimately enhance the clinical quality and safety for our hospital partners, referring physicians, and patients who put their trust in us,” said Wiot. RRIA’s decision to design its own peer review software is a typical approach for the practice, which has opted before to build their own solutions when third party products just did not deliver what they needed. “Our group has always understood the value of technology and invested in building an IT innovation division more than a decade ago,” said Doug Reader, MD, RRIA’s president. “This commitment has paid off on multiple levels and has been integral in our ability to grow and effectively service our clients across the state of Ohio.”
Hosenfeld is optimistic that other groups will want to buy the system on a standalone basis for their own practices and RRIA plans to market it through its Lucid Workflow Solutions software company in the future. To enable this, RRIA’s developers designed the cloud-based solution to work on any platform; Hosenfeld thinks successful expansion of it to a network of radiology practices will further enhance its clinical benefits. As an example, he envisions that separate radiology groups could use the system to evaluate each other’s work. “With this software, practices across the country can collaborate on peer review. Having physicians in separate groups evaluate each other’s work could really improve the objectivity of the process.”
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Teri Yates is the Founder and Principal Consultant for Accountable Radiology Advisors, a consulting practice that helps radiologists and hospitals deliver services of higher value. For more information, visit www.accountableradiologyadvisors.com
