Aalpen Patel, chairman of the radiology department at Geisinger, explains how point-of-care ultrasonography (POCUS) technology is revolutionizing imaging operations and improving both business and clinical outcomes.
Healthcare organizations are moving away from the bulky ultrasound machines of years past and embracing digital health platforms that make imaging more mobile and integrate directly with the EHR to improve care management and workflows.
One of those health systems is Geisinger, which today announced a partnership with medical imaging and software company Exo to streamline the mobile ultrasound process. The Pennsylvania health system is using point-of-care ultrasonography (POCUS) in its women's health, emergency, and sports medicine departments and plans to expand to more than a dozen other locations in the future.
The streamlining of inpatient services is on every executive's to-do list as healthcare organizations seek to reduce workflow stress on staff and clinicians, reduce hefty medical costs, and boost clinical outcomes through better data access and analysis. Medical imaging costs are a significant burden on a hospital's bottom line and an area ripe for innovation.
"POCUS is perhaps the single most revolutionary technological advancement in medicine in the last 30 years," says Aalpen Patel, MD, MBA, FSIR, chairman of the Geisinger's radiology department, in an e-mail conversation with HealthLeaders. "Its scope spans almost every specialty and exponentially extends the clinician's ability to make rapid diagnoses and guide many procedures safely."
"Historically, ultrasound was performed in radiology or cardiology, where in-depth, time-consuming studies performed by techs were then interpreted by a physician (not at the bedside). This often required the patient to be transported to another area of the hospital, which is problematic, especially if the patient is unstable. POCUS has significantly extended the bedside clinician's ability to rapidly answer important clinical questions about the patient and narrow their differential."
Aside from improving workflows and care coordination, the technology also impacts clinical outcomes.
"POCUS allows clinicians to rapidly diagnose or exclude life-threatening conditions at the bedside," Patel says. "It is also used for procedural guidance, making procedures significantly safer for patients. Having the ability to archive images and generate reports in a streamlined workflow allows other members of the healthcare team to view this data and make clinical decisions."
According to Patel, hospitals are turning to this technology for several reasons.
"First and foremost, using an enterprise POCUS workflow can improve the quality of care for patients," he says "It allows the ability to perform quality assurance on images. This data can be used for assessing clinician competency, helping with credentialing and privileging, and providing quality feedback for continuous POCUS skill improvement and education."
"It also allows health systems to collect previously uncaptured revenue for POCUS studies," Patel adds. "Creating a POCUS workflow and archive also provides a database for quality review and helps mitigate medicolegal risk. And it can improve ED and hospital throughput, decreasing procedural complications and high-end radiology utilization such as CT, MRI or Interventional Radiology."
On the other side of the ledger, there are challenges to adopting this technology. And in this turbulent economy the biggest barrier may be the cost. Imaging systems aren't cheap, and it's up to the CIO or radiology department head to connect the dots for the CEO and CFO between expenses and ROI.
"Sometimes it can be difficult to convince leadership that a standardized POCUS workflow is needed to ensure that POCUS is performed properly and safely," Patel says. "However, demonstrating the quality and safety benefits along with the positive ROI from both soft and hard revenues gained by investing in an enterprise POCUS workflow solution can help overcome this barrier."
Ther's also the challenge of integrating new technology into the workflow.
"Clinicians are extremely busy, and every extra click they are asked to make takes them away from direct, patient-facing care.," Patel says. "Ensuring that the POCUS workflow is streamlined and seamlessly integrated in the EMR can help overcome this barrier. These exams allow the clinician more time at the patient's bedside, and [the technology] has been shown to improve patient satisfaction and experience scores."
"Another challenge is the ability to standardize a POCUS workflow across multiple departments," he adds. "Different specialties have different needs and expectations from a POCUS workflow. Providing a flexible workflow with customizable reports can help overcome this challenge."
And finally, Patel says, it's important to have resources on hand to educate staff about how to use the technology.
"Some specialties have POCUS education embedded in their residency and fellowship training curriculum, but others do not," he says. "Providing attending clinicians with educational and training resources including internal courses, didactics, image review sessions, and hands-on training sessions and simulation can help overcome this challenge. Fortunately, POCUS is being incorporated into not only residency and fellowship training but in many medical school curriculums."
A lot of the potential around this technology lies in its mobility. As health systems look to move more services outside the hospital and closer to the patient—be it in the home, a community health center, a remote clinic or doctor's office or even an accident scene—mobile ultrasound platforms are showing their value for providing on-demand care.
"POCUS technology and workflow is evolving at light speed," Patel says. "In the last 10 years these machines have transformed from large, clunky, cart-based machines with suboptimal image quality to compact and handheld units that can be taken to almost any environment inside or outside the hospital. Many newer machines are equipped with Wi-Fi capabilities, wireless technology, significantly improved imaging quality, and various Doppler technologies. Many of the newer devices have built in AI/machine learning [capabilities] that allow for auto-labeling and auto-calculations, and they can direct novice learners to the correct scanning plane and beam angle. And POCUS workflow reporting from various vendors allows mobile reports to be generated on iPhones, iPads, and android devices with a few swipes of the finger."
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
Imaging accounts for a significant amount of hospital spending and impacts almost every clinical department.
Advances in digital health and mobile technology are making these platforms easier to use and easier to integrate with the EHR.
Health systems adopting this technology need to map out both short- and long-term ROI, while making sure those who will use it know how to use it and where they'll see the benefits.