U.S. patent application number 11/699351 was filed with the patent office on 2007-10-11 for method and apparatus for generating a clinician quality assurance scoreboard.
Invention is credited to Bruce Reiner.
Application Number | 20070239377 11/699351 |
Document ID | / |
Family ID | 38327954 |
Filed Date | 2007-10-11 |
United States Patent
Application |
20070239377 |
Kind Code |
A1 |
Reiner; Bruce |
October 11, 2007 |
Method and apparatus for generating a clinician quality assurance
scoreboard
Abstract
The present invention provides a quality assurance system and
method that generates a quality assurance (QA) scorecard for
clinicians that participate in a radiological-based medical imaging
study using digital imaging technologies. According to one
embodiment, client computers, servers, imaging devices, databases,
and/or other components may be coupled to provided a unified data
collection system. According to one embodiment, systems and methods
are provided that analyze various parameters that are derived from
the unified data collection system to calculate a QA score for the
clinician. The QA score provides a combined subjective and
objective feedback system that includes performance evaluations
from other users, including radiologists, technologists and
patients. According to one embodiment, the feedback may be provided
in real-time.
Inventors: |
Reiner; Bruce; (Seaford,
DE) |
Correspondence
Address: |
AKERMAN SENTERFITT
801 PENNSYLVANIA AVENUE N.W., SUITE 600
WASHINGTON
DC
20004
US
|
Family ID: |
38327954 |
Appl. No.: |
11/699351 |
Filed: |
January 30, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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60762859 |
Jan 30, 2006 |
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60763353 |
Jan 31, 2006 |
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60763357 |
Jan 31, 2006 |
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60771482 |
Feb 9, 2006 |
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60771484 |
Feb 9, 2006 |
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Current U.S.
Class: |
702/84 ;
250/252.1; 378/207 |
Current CPC
Class: |
G06Q 10/06398 20130101;
G06Q 10/06395 20130101; G16H 15/00 20180101; G06Q 10/10 20130101;
G06Q 10/00 20130101; G16H 50/20 20180101; G16H 30/20 20180101; G06Q
30/0202 20130101; G16H 40/20 20180101; G16H 80/00 20180101 |
Class at
Publication: |
702/84 ; 378/207;
250/252.1 |
International
Class: |
G06F 19/00 20060101
G06F019/00; G01D 18/00 20060101 G01D018/00; G01N 37/00 20060101
G01N037/00 |
Claims
1. A quality assurance system for radiology, comprising: at least
one client computer; at least one imaging device, comprising: an
agent that captures user action data based on actions that are
performed on the imaging device; a server comprising: a
communications module that communicates with the agent to receive
the user action data and the at least one client computer; and a
notification module that monitors the user action data and forwards
an alert to the client computer based on an occurrence of a
predefined event.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority from U.S. Provisional
Patent Application No. 60/762,859, dated Jan. 30, 2006, U.S.
Provisional Patent Application No. 60/763,353, dated Jan. 31, 2006,
U.S. Provisional Patent Application No. 60/763,357, dated Jan. 31,
2006, U.S. Provisional Patent Application No. 60/771,482, dated
Feb. 9, 2006, U.S. Provisional Patent Application No. 60/771,484,
dated Feb. 9, 2006, the contents of which are herein incorporated
by reference in their entirety.
[0002] This application is related to the following concurrently
filed commonly owned U.S. Patent Applications entitled, "Method And
Apparatus For Generating A Technologist Quality Assurance
Scorecard" (Attorney Docket Nos. 71486.0036 filed Jan. 30, 2007);
"Method And Apparatus For Generating A Patient Quality Assurance
Scorecard" (Attorney Docket Nos. 71486.0037 filed Jan. 30, 2007);
"Method And Apparatus For Generating An Administrative Quality
Assurance Scorecard" (Attorney Docket Nos. 71486.0038 filed Jan.
30, 2007); and "Method And Apparatus For Generating A Radiologist
Quality Assurance Scorecard" (Attorney Docket Nos. 71486.0039 filed
Jan. 30, 2007), the contents of all of which are herein
incorporated by reference in their entirety.
BACKGROUND OF THE INVENTION
[0003] 1. Field of the Invention
[0004] The present invention relates to a quality assurance (QA)
system and method that quantitatively rates users that perform
and/or participate in medical procedures, particularly in the area
of radiology. The present invention relates to systems, methods and
computer-based software programs that analyze data and generate QA
scorecards for clinicians. In the process of doing so, a number of
objective data are collected for real-time and future analysis,
thereby providing objective feedback to clinicians for continuing
quality improvement. In the end, the invention is intended to
improve patient safety and overall clinical outcomes.
[0005] 2. Description of the Related Art
[0006] The first and foremost priority for any QA program is to
improve quality of service. As QA programs are implemented in the
medical field, the ultimate goal is to improve patient care. To
accomplish this goal, products and/or services should offer
procedures for increasing accountability and improving feedback
among users that participate in a medical study. This ultimately
will enhance patient diagnosis and/or treatment, which leads to
objective improvements in overall health outcomes.
[0007] Medical imaging has undergone a transition from film-based
imaging technologies to digital imaging technologies. Digital
imaging technologies provide digital processing capabilities, such
as image capture, image archive, image transfer, and image display
that may be shared among users to the medical study. Digital
imaging technologies further allow data that is associated with the
digital processing operations to be captured and combined with the
underlying digital imaging processing operations.
[0008] Accordingly, a need exists to leverage digital imaging
technologies to increase accountability and improve feedback among
users that participate in a medical study.
SUMMARY OF THE INVENTION
[0009] The present invention relates to systems, methods and
computer-based software programs that provide a QA scorecard for
users that participate in a radiology imaging study. The QA
Scorecard provides the framework for developing a comprehensive
medical imaging QA program that defines objective benchmarks. One
of ordinary skill in the art will readily recognize that this
invention may be applied to other medical disciplines, as well as
to non-medical disciplines.
[0010] According to one embodiment, the invention is directed to
radiological-based medical studies using digital imaging
technologies. The medical studies are performed by users that
perform discrete tasks in an imaging study workflow sequence.
According to one embodiment of the invention, users may include
clinicians, radiologists, technologists, administrators and
patients, among other users. A typical workflow sequence includes
imaging exam ordering, imaging exam scheduling, imaging exam
acquisition, imaging exam processing, imaging exam archiving,
imaging exam distribution, imaging exam display, imaging exam
navigation, imaging exam interpretation, imaging exam reporting,
communication and billing, among other sequences.
[0011] According to one embodiment of the invention, client
computers, one or more servers, the imaging devices, one or more
databases, and/or other components may be coupled via a wired
media, a wireless media, or a combination of the foregoing to
provided a unified data collection system.
[0012] According to one embodiment of the invention, the client
computers may include any number of different types of client
terminal devices, such as personal computers, laptops, smart
terminals, personal digital assistants (PDAs), cell phones,
portable processing devices that combine the functionality of one
or more of the foregoing or other client terminal devices.
[0013] According to one embodiment, the client computer may include
client computer agent modules that gather client computer
monitoring data based on user actions that are performed. According
to another embodiment of the invention, user action data may
include accessing digital images, reviewing digital images,
manipulating digital images, marking digital images, storing
digital images, forwarding digital images, adjusting exposure
parameters on digital imaging devices, generating a report,
generating a textual report, dictating a report, entering
information, conducting continuing medical education (CME)
triggered by performing the medical examination, and/or performing
other user actions.
[0014] According to one embodiment, the client computer may include
client computer agent modules that gather client computer
monitoring data based on computer actions that are performed.
According to one embodiment of the invention, the client computer
agent modules also may gather client computer specification data,
such as IP address data, processing speed data, and other client
computer specification data. According to one embodiment of the
invention, the client monitoring data and/or client computer
specification data may be provided in real-time. According to
another embodiment of the invention, the client monitoring data
and/or client computer specification data may be employed to
calculate user QA metrics.
[0015] According to one embodiment of the invention, the imaging
devices may include any number of different types of imaging
devices, such as magnetic resonance imaging (MRI) devices, computer
tomograph (CT) imaging devices, angiograph imaging device,
ultrasound imaging devices or other imaging devices.
[0016] According to one embodiment of the invention, the imaging
devices may include, or be modified to include, imaging device
agent modules. The imaging device agent modules may operate to
provide data gathering and data exchange functionality. According
to one embodiment, the invention may enable monitoring of actions
that are performed on the imaging devices.
[0017] According to one embodiment of the invention, the imaging
device agent modules may associate imaging device identifying
information with actions that are performed on the imaging devices.
According to one embodiment of the invention, data monitoring
features may be employed to generate imaging device audit logs.
According to one embodiment of the invention, image device audit
logs may be produced to reconstruct actions, such as user actions,
imaging device actions, and other actions that are performed on (or
by) the imaging devices.
[0018] According to one embodiment of the invention, databases or
information sources include a Hospital Information System (HIS) 10,
a Radiology Information System (RIS) 20, a Picture Archiving and
Communication System (PACS) 30, an Electronic Medical Record (EMR),
a patient specific imaging datasheet and/or other information
sources.
[0019] According to one embodiment of the invention, the server may
include a merging module that receives data from all devices that
are networked to the server, including the client computers, the
imaging devices, and/or databases or information sources. According
to one embodiment of the invention, the received data may include
at least client computer audit log data and/or image device audit
log data. According to one embodiment, the merging module merges
data that is captured during a medical examination, including user
action data, client computer action data, imaging device action
data, and other data.
[0020] According to one embodiment, a quantifiable list of
pre-defined clinical performance parameters may be used by the
program to measure overall performance of the clinician, or
practicing physician, such as the utilization and medical imaging
services that are provided in a clinical practice, among other
pre-defined parameters.
[0021] According to one embodiment of the invention, clinical
performance metrics may be calculated by the program based on
predefined parameters, including completeness of data input, such
as clinical history, laboratory data, physical exam findings; exam
appropriateness, such as using defined appropriateness criteria;
utilization patterns, including economic outcomes, clinical
outcomes, and/or medico-legal outcomes; a patient safety profile,
such as requested use of ionizing radiation, contrast, invasive
procedures; communication/reporting, including the availability of
imaging data, the receipt of imaging data, and/or radiologist
consultations; timeliness, including time to initiate clinical
action; feedback provided to the patient and specialists, such as
the radiologist; participation in data collection and analysis,
including outcomes analysis, reporting, and/or diagnostic accuracy;
education and training, including imaging services and new
technologies; peer review, including discretionary assessment of
clinical performance as it relates to imaging services and patient
diagnosis/treatment, among other predefined parameters.
[0022] According to one embodiment of the invention, the data that
is collected during the imaging study may analyzed by a metrics
module that performs prospective and retrospective trending
analysis. The prospective and retrospective trending analysis
enables automatic detection of immediate and recurrent problems, as
they relate to equipment, personnel, data input, and overall
workflow. The result of this automated technical QA analysis is
that an automated and normalized analysis may be performed that
minimizes subjectivity and human bias, among providing other
benefits.
[0023] According to one embodiment of the invention, the metrics
module may automatically tally and record QA scores. The QA scores
may be cross-referenced by the computer program to a number of
independent variables including a technologist identifier, imaging
modality, exam type, patient demographics, patient characteristics,
patient body habitus, exposure parameters, image processing, exam
location, equipment, day/time of exam for trending analysis,
radiologist identification, referring clinician, clinical
indication, among other variables.
[0024] According to one embodiment, the metrics module may analyze
data that is associated with a defined list of quality assurance
(QA) benchmarks to objectively evaluate clinicians, quantify a
relative success of service delivery and provide educational
(data-driven) feedback in order to optimize clinical performance,
among other benefits. The QA metrics may be tied to economic
incentives, such as a pay for performance (P4P) systems, to create
financial rewards for those practitioners that provide high levels
of quality-oriented service deliverables.
[0025] According to one embodiment of the invention, a standard tag
may be created by the program within the various informational
sources to identify individual QA data parameters. The
communication module may extract the parameters from the CPOE
entries to calculate metrics and generate a QA score for the
clinician.
[0026] According to one embodiment of the invention, the QA metrics
module may analyze various parameters to calculate a QA score for
the clinician. According to one embodiment, the time-stamped data
is a part of objective data analysis. Imaging departments may
utilize a program to record individual time-stamped data throughout
the course of the imaging cycle, from the time an imaging exam is
electronically ordered to the time the imaging report issued and
reviewed. After the image report is received, time-stamped data may
be tracked by the program within the EMR, which records clinician
actions, in the form of recording progress notes, consultations,
and the ordering of clinical tests, imaging studies, and various
treatment options (e.g. drug therapy). In either case, the QA
scorecard program enables the clinician to enter data
electronically into the EMR. This is time-stamped data may be
recorded into a QA database for subsequent analysis. One such
analysis may include an assessment of the time incurred between the
imaging exam and initiation of clinical treatment.
[0027] According to one embodiment, in order to optimize safety
concerns and record/track cumulative data, the QA scorecard program
provides patient safety data at any location where the patient is
seeking and/or receiving medical imaging services. By storing the
QA Scorecard data within a universal EMR, this data is made
accessible to appropriate healthcare providers at any location.
[0028] According to one embodiment, the QA scorecard program may
track, record and analyze longitudinal patient-specific safety data
and clinician-specific safety data, both an individual patient and
group basis. This provides insight as to whether individual
clinicians are over-utilizing certain types of "higher risk"
imaging studies and provides educational feedback to specific
clinicians. Additionally, mandatory educational resources may be
forwarded to targeted clinicians for completion before imaging
privileges are re-instated. This "clinician safety profile" data
and trending analyses may be correlated by the program with local,
regional, and national norms, with data available to third party
payers and insurers to assist with economic incentive programs
(P4P) to encourage improved performance and continuing medical
education, as it relates to medical imaging safety factors.
[0029] According to one embodiment, a combined subjective and
objective feedback system, method and computer program are provided
that supply data to clinicians as to how their performance is
perceived by imaging service providers, such as radiologists, and
customers, such as patients. According to one embodiment, the
feedback may be provided in real-time.
[0030] Thus has been outlined, some features consistent with the
present invention in order that the detailed description thereof
that follows may be better understood, and in order that the
present contribution to the art may be better appreciated. There
are, of course, additional features consistent with the present
invention that will be described below and which will form the
subject matter of the claims appended hereto.
[0031] In this respect, before explaining at least one embodiment
consistent with the present invention in detail, it is to be
understood that the invention is both limited in its application to
the details of construction and to the arrangements of the
components set forth in the following description or illustrated in
the drawings. Methods and apparatuses consistent with the present
invention are capable of other embodiments and of being practiced
and carried out in various ways. Also, it is to be understood that
the phraseology and terminology employed herein, as well as the
abstract included below, are for the purpose of description and
should not be regarded as limiting.
[0032] As such, those skilled in the art will appreciate that the
conception upon which this disclosure is based may readily be
utilized as a basis for the designing of other structures, methods
and systems for carrying out the several purposes of the present
invention. It is important, therefore, that the claims be regarded
as including such equivalent constructions insofar as they do not
depart from the spirit and scope of the methods and apparatuses
consistent with the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0033] FIG. 1 illustrates a schematic diagram of a quality
assurance scorecard system for radiology, according to one
embodiment of the present invention.
[0034] FIG. 2 illustrates a schematic diagram of a quality
assurance scorecard system for radiology, according to another
embodiment of the present invention.
[0035] FIGS. 3A and 3B illustrate a flow chart of a workflow
sequence quality assurance program for image ordering from the
perspective of a clinician, according to one embodiment of the
present invention.
[0036] FIG. 4 illustrates a flow chart of a workflow sequence
quality assurance program for communication and reporting from the
perspective of a clinician, according to one embodiment consistent
with the present invention.
DESCRIPTION OF THE INVENTION
[0037] The present invention relates to systems, methods, and
computer-based software programs for generating quality assurance
(QA) metrics, or scorecards, for clinicians that participate in
radiological-based medical studies.
[0038] Radiological-based medical studies of the present invention
are conducted using digital imaging technologies. The medical
studies are performed by many users that perform discrete tasks in
an imaging study workflow sequence. Typically, the workflow
sequence is initiated by a clinician, such as a family practice
physician, that examines a patient and orders an imaging
examination. The clinician's staff contacts an imaging center and
schedules the imaging examination. At the imaging center, a
technologist operates one or more imaging devices to acquire
patient images. In some cases, the number of patient images taken
may total several hundred or several thousand images. During the
image acquisition operation, the technologist may process the
images, including applying algorithms to the raw imaging data in
order to enhance selected image features, reconstructing the raw
image data in different ways to optimize imaging views, and/or
performing other image processing. Upon completion of the imaging
examination, the patient may be discharged from the imaging
facility and the images may be locally stored. Generally, imaging
administrators periodically obtain the images from the local
storage devices and archive the images in a database, such as a
Picture Archival Retrieval System (PACS) and/or other imaging
databases. The images may be archived and retrieved based on
selected criteria, including patient name, patient reference
number, patient identifier, physician identifier, and/or other
selected criteria.
[0039] After the images are archived, the images may be distributed
to one or more specialists, such as a radiologist. Alternatively, a
message may be communicated to one or more specialists advising the
specialists that the images are available and providing
instructions for accessing the archived images from the PACS or
other imaging databases. The radiologist may access the PACS or
other imaging databases and may perform image display and image
navigation functions. The radiologist interprets the images and may
access decision support tools or other interpretation tools during
the image interpretation process. Following the image
interpretation, the radiologist may generate a report and/or
otherwise communicate the image study results to the referring
clinician, among others. Upon completion of the imaging process,
the radiologist, an administrator, and/or other service provider
may perform billing operations. Additionally, an administrator may
be tasked with defining the lines of responsibility for the
participants of the imaging exam and for developing a comprehensive
program that ensures appropriate levels of quality, while balancing
economics, service deliverables and productivity. One of ordinary
skill in the art will readily appreciate that the imaging study
workflow sequence may include other operations.
[0040] According to one embodiment of the invention illustrated in
FIG. 1, medical (radiological) applications may be implemented
using the QA scorecard system 100. The QA scorecard system 100 is
designed to interface with existing information systems such as a
Hospital Information System (HIS) 10, a Radiology Information
System (RIS) 20, a radiographic device 21, and/or other information
systems that may access a computed radiography (CR) cassette or
direct radiography (DR) system, a CR/DR plate reader 22, a Picture
Archiving and Communication System (PACS) 30, and/or other systems.
The QA scorecard system 100 may be designed to conform with the
relevant standards, such as the Digital Imaging and Communications
in Medicine (DICOM) standard, DICOM Structured Reporting (SR)
standard, and/or the Radiological Society of North America's
Integrating the Healthcare Enterprise (IHE) initiative, among other
standards.
[0041] According to one embodiment, bi-directional communication
between the QA scorecard system 100 of the present invention and
the information systems, such as the HIS 10, RIS 20, radiographic
device 21, CR/DR plate reader 22, and PACS 30, etc., may be enabled
to allow the QA scorecard system 100 to retrieve and/or provide
information from/to these systems. According to one embodiment of
the invention, bi-directional communication between the QA
scorecard system 100 of the present invention and the information
systems allows the QA scorecard system 100 to update information
that is stored on the information systems. According to one
embodiment of the invention, bi-directional communication between
the QA scorecard system 100 of the present invention and the
information systems allows the QA scorecard system 100 to generate
desired reports and/or other information.
[0042] The QA scorecard system 100 of the present invention
includes a client computer 101, such as a personal computer (PC),
which may or may not be interfaced or integrated with the PACS 30.
The client computer 101 may include an imaging display device 102
that is capable of providing high resolution digital images in 2-D
or 3-D, for example. According to one embodiment of the invention,
the client computer 101 may be a mobile terminal if the image
resolution is sufficiently high. Mobile terminals may include
mobile computing devices, a mobile data organizer (PDA), or other
mobile terminals that are operated by the user accessing the
program 110 remotely.
[0043] According to one embodiment of the invention, an input
device 104 or other selection device, may be provided to select hot
clickable icons, selection buttons, and/or other selectors that may
be displayed in a user interface using a menu, a dialog box, a
roll-down window, or other user interface. The user interface may
be displayed on the client computer 101. According to one
embodiment of the invention, users may input commands to a user
interface through a programmable stylus, keyboard, mouse, speech
processing device, laser pointer, touch screen, or other input
device 104.
[0044] According to one embodiment of the invention, the input or
other selection device 104 may be implemented by a dedicated piece
of hardware or its functions may be executed by code instructions
that are executed on the client processor 106. For example, the
input or other selection device 104 may be implemented using the
imaging display device 102 to display the selection window with a
stylus or keyboard for entering a selection.
[0045] According to another embodiment of the invention, symbols
and/or icons may be entered and/or selected using an input device
104, such as a multi-functional programmable stylus. The
multi-functional programmable stylus may be used to draw symbols
onto the image and may be used to accomplish other tasks that are
intrinsic to the image display, navigation, interpretation, and
reporting processes, as described in U.S. patent application Ser.
No. 11/512,199 filed on Aug. 30, 2006, the entire contents of which
are hereby incorporated by reference. The multi-functional
programmable stylus may provide superior functionality compared to
traditional computer keyboard or mouse input devices. According to
one embodiment of the invention, the multi-functional programmable
stylus also may provide superior functionality within the PACS and
Electronic Medical Report (EMR).
[0046] According to one embodiment of the invention, the client
computer 101 may include a processor 106 that provides client data
processing. According to one embodiment of the invention, the
processor 106 may include a central processing unit (CPU) 107, a
parallel processor, an input/output (I/O) interface 108, a memory
109 with a program 110 having a data structure 111, and/or other
components. According to one embodiment of the invention, the
components all may be connected by a bus 112. Further, the client
computer 101 may include the input device 104, the image display
device 102, and one or more secondary storage devices 113.
According to one embodiment of the invention, the bus 112 may be
internal to the client computer 101 and may include an adapter that
enables interfacing with a keyboard or other input device 104.
Alternatively, the bus 112 may be located external to the client
computer 101.
[0047] According to one embodiment of the invention, the image
display device 102 may be a high resolution touch screen computer
monitor. According to one embodiment of the invention, the image
display device 102 may clearly, easily and accurately display
images, such as x-rays, and/or other images. Alternatively, the
image display device 102 may be implemented using other touch
sensitive devices including tablet personal computers, pocket
personal computers, plasma screens, among other touch sensitive
devices. The touch sensitive devices may include a pressure
sensitive screen that is responsive to input from the input device
104, such as a stylus, that may be used to write/draw directly onto
the image display device 102.
[0048] According to another embodiment of the invention, high
resolution goggles may be used as a graphical display to provide
end users with the ability to review images. According to another
embodiment of the invention, the high resolution goggles may
provide graphical display without imposing physical constraints of
an external computer.
[0049] According to another embodiment, the invention may be
implemented by an application that resides on the client computer
101, wherein the client application may be written to run on
existing computer operating systems. Users may interact with the
application through a graphical user interface. The client
application may be ported to other personal computer (PC) software,
personal digital assistants (PDAs), cell phones, and/or any other
digital device that includes a graphical user interface and
appropriate storage capability.
[0050] According to one embodiment of the invention, the processor
106 may be internal or external to the client computer 101.
According to one embodiment of the invention, the processor 106 may
execute a program 110 that is configured to perform predetermined
operations. According to one embodiment of the invention, the
processor 106 may access the memory 109 in which may be stored at
least one sequence of code instructions that may include the
program 110 and the data structure 111 for performing predetermined
operations. The memory 109 and the program 110 may be located
within the client computer 101 or external thereto.
[0051] While the system of the present invention may be described
as performing certain functions, one of ordinary skill in the art
will readily understand that the program 110 may perform the
function rather than the entity of the system itself.
[0052] According to one embodiment of the invention, the program
110 that runs the QA scorecard system 100 may include separate
programs 110 having code that performs desired operations.
According to one embodiment of the invention, the program 110 that
runs the QA scorecard system 100 may include a plurality of modules
that perform sub-operations of an operation, or may be part of a
single module of a larger program 110 that provides the
operation.
[0053] According to one embodiment of the invention, the processor
106 may be adapted to access and/or execute a plurality of programs
110 that correspond to a plurality of operations. Operations
rendered by the program 110 may include, for example, supporting
the user interface, providing communication capabilities,
performing data mining functions, performing e-mail operations,
and/or performing other operations.
[0054] According to one embodiment of the invention, the data
structure 111 may include a plurality of entries. According to one
embodiment of the invention, each entry may include at least a
first storage area, or header, that stores the databases or
libraries of the image files, for example.
[0055] According to one embodiment of the invention, the storage
device 113 may store at least one data file, such as image files,
text files, data files, audio files, video files, among other file
types. According to one embodiment of the invention, the data
storage device 113 may include a database, such as a centralized
database and/or a distributed database that are connected via a
network. According to one embodiment of the invention, the
databases may be computer searchable databases. According to one
embodiment of the invention, the databases may be relational
databases. The data storage device 113 may be coupled to the server
120 and/or the client computer 101, either directly or indirectly
through a communication network, such as a LAN, WAN, and/or other
networks. The data storage device 113 may be an internal storage
device. According to one embodiment of the invention, QA scorecard
system 100 may include an external storage device 114. According to
one embodiment of the invention, data may be received via a network
and directly processed.
[0056] According to one embodiment of the invention, the client
computer 101 may be coupled to other client computers 101 or
servers 120. According to one embodiment of the invention, the
client computer 101 may access administration systems, billing
systems and/or other systems, via a communication link 116.
According to one embodiment of the invention, the communication
link 116 may include a wired and/or wireless communication link, a
switched circuit communication link, or may include a network of
data processing devices such as a LAN, WAN, the Internet, or
combinations thereof. According to one embodiment of the invention,
the communication link 116 may couple e-mail systems, fax systems,
telephone systems, wireless communications systems such as pagers
and cell phones, wireless PDA's and other communication
systems.
[0057] According to one embodiment of the invention, the
communication link 116 may be an adapter unit that is capable of
executing various communication protocols in order to establish and
maintain communication with the server 120, for example. According
to one embodiment of the invention, the communication link 116 may
be implemented using a specialized piece of hardware or may be
implemented using a general CPU that executes instructions from
program 110. According to one embodiment of the invention, the
communication link 116 may be at least partially included in the
processor 106 that executes instructions from program 110.
[0058] According to one embodiment of the invention, if the server
120 is provided in a centralized environment, the server 120 may
include a processor 121 having a CPU 122 or parallel processor,
which may be a server data processing device and an I/O interface
123. Alternatively, a distributed CPU 122 may be provided that
includes a plurality of individual processors 121, which may be
located on one or more machines. According to one embodiment of the
invention, the processor 121 may be a general data processing unit
and may include a data processing unit with large resources (i.e.,
high processing capabilities and a large memory for storing large
amounts of data).
[0059] According to one embodiment of the invention, the server 120
also may include a memory 124 having a program 125 that includes a
data structure 126, wherein the memory 124 and the associated
components all may be connected through bus 127. If the server 120
is implemented by a distributed system, the bus 127 or similar
connection line may be implemented using external connections. The
server processor 121 may have access to a storage device 128 for
storing preferably large numbers of programs 110 for providing
various operations to the users.
[0060] According to one embodiment of the invention, the data
structure 126 may include a plurality of entries, wherein the
entries include at least a first storage area that stores image
files. Alternatively, the data structure 126 may include entries
that are associated with other stored information as one of
ordinary skill in the art would appreciate.
[0061] According to one embodiment of the invention, the server 120
may include a single unit or may include a distributed system
having a plurality of servers 120 or data processing units. The
server(s) 120 may be shared by multiple users in direct or indirect
connection to each other. The server(s) 120 may be coupled to a
communication link 129 that is preferably adapted to communicate
with a plurality of client computers 101.
[0062] According to one embodiment, the present invention may be
implemented using software applications that reside in a client
and/or server environment. According to another embodiment, the
present invention may be implemented using software applications
that reside in a distributed system over a computerized network and
across a number of client computer systems. Thus, in the present
invention, a particular operation may be performed either at the
client computer 101, the server 120, or both.
[0063] According to one embodiment of the invention, in a
client-server environment, at least one client and at least one
server are each coupled to a network 220, such as a Local Area
Network (LAN), Wide Area Network (WAN), and/or the Internet, over a
communication link 116, 129. Further, even though the systems
corresponding to the HIS 10, the RIS 20, the radiographic device
21, the CR/DR reader 22, and the PACS 30 (if separate) are shown as
directly coupled to the client computer 101, it is known that these
systems may be indirectly coupled to the client over a LAN, WAN,
the Internet, and/or other network via communication links.
According to one embodiment of the invention, users may access the
various information sources through secure and/or non-secure
internet connectivity. Thus, operations consistent with the present
invention may be carried out at the client computer 101, at the
server 120, or both. The server 120, if used, may be accessible by
the client computer 101 over the Internet, for example, using a
browser application or other interface.
[0064] According to one embodiment of the invention, the client
computer 101 may enable communications via a wireless service
connection. The server 120 may include communications with
network/security features, via a wireless server, which connects
to, for example, voice recognition. According to one embodiment,
user interfaces may be provided that support several interfaces
including display screens, voice recognition systems, speakers,
microphones, input buttons, and/or other interfaces. According to
one embodiment of the invention, select functions may be
implemented through the client computer 101 by positioning the
input device 104 over selected icons. According to another
embodiment of the invention, select functions may be implemented
through the client computer 101 using a voice recognition system to
enable hands-free operation. One of ordinary skill in the art will
recognize that other user interfaces may be provided.
[0065] According to another embodiment of the invention, the client
computer 101 may be a basic system and the server 120 may include
all of the components that are necessary to support the software
platform. Further, the present client-server system may be arranged
such that the client computer 101 may operate independently of the
server 120, but the server 120 may be optionally connected. In the
former situation, additional modules may be connected to the client
computer 101. In another embodiment consistent with the present
invention, the client computer 101 and server 120 may be disposed
in one system, rather being separated into two systems.
[0066] Although the above physical architecture has been described
as client-side or server-side components, one of ordinary skill in
the art will appreciate that the components of the physical
architecture may be located in either client or server, or in a
distributed environment.
[0067] Further, although the above-described features and
processing operations may be realized by dedicated hardware, or may
be realized as programs having code instructions that are executed
on data processing units, it is further possible that parts of the
above sequence of operations may be carried out in hardware,
whereas other of the above processing operations may be carried out
using software.
[0068] The underlying technology allows for replication to various
other sites. Each new site may maintain communication with its
neighbors so that in the event of a catastrophic failure, one or
more servers 120 may continue to keep the applications running, and
allow the system to load-balance the application geographically as
required.
[0069] Further, although aspects of one implementation of the
invention are described as being stored in memory, one of ordinary
skill in the art will appreciate that all or part of the invention
may be stored on or read from other computer-readable media, such
as secondary storage devices, like hard disks, floppy disks,
CD-ROM, a carrier wave received from a network such as the
Internet, or other forms of ROM or RAM either currently known or
later developed. Further, although specific components of the
system have been described, one skilled in the art will appreciate
that the system suitable for use with the methods and systems of
the present invention may contain additional or different
components.
[0070] FIG. 2 illustrates the QA scorecard system 100 for providing
QA assessments of clinicians that access a radiology system,
according to one embodiment of the invention. According to one
embodiment, the client computers 101a-101n (hereinafter client
computers 101), one or more servers 120, the imaging devices
210a-210n (hereinafter imaging devices 210), one or more databases
(HIS 10, RIS 20, PACS 30, etc.), and/or other components may be
coupled via a wired media, a wireless media, or a combination of
the foregoing. According to one embodiment of the invention, the
client computers 101, the server 120, the imaging devices 210, and
the databases may reside in one or more networks, such as an
internet, an intranet, or a combination thereof.
[0071] According to one embodiment of the invention, the client
computers 101 may include any number of different types of client
terminal devices, such as personal computers, laptops, smart
terminals, personal digital assistants (PDAs), cell phones,
portable processing devices that combine the functionality of one
or more of the foregoing or other client terminal devices.
[0072] According to another embodiment of the invention, the client
computers 101 may include several components, including processors,
RAM, a USB interface, a telephone interface, microphones, speakers,
a stylus, a computer mouse, a wide area network interface, local
area network interfaces, hard disk drives, wireless communication
interfaces, DVD/CD readers/burners, a keyboard, a flat touch-screen
display, a computer display, and/or other components. According to
yet another embodiment of the invention, client computers 101 may
include, or be modified to include, software that may operate to
provide data gathering and data exchange functionality.
[0073] According to one embodiment of the invention, the client
computers 101, the servers 120, and/or the imaging devices 210 may
include several modules. The modular construction facilitates
adding, deleting, updating and/or amending modules therein and/or
features within modules. The client computer 101 may include
various modules, including a user interface module 220, an
authentication module 222, a communications module 224, an agent
module 226, and/or other modules. The servers 120 may include
various modules, including a server communication module 230, a
merging module 231, a metrics module 232, a server authentication
module 234, a notification module 236, a scheduling module 244 a
report generating module 238, a sorting module 240, a billing
module 242, and/or other modules. The imaging devices 210 may
include various modules, including a communications module 212, an
authentication module 214, an agent module 216 and/or other
modules, along with a local storage device 219. It should be
readily understood that a greater or lesser number of modules might
be used. One skilled in the art will readily appreciate that the
invention may be implemented using individual modules, a single
module that incorporates the features of two or more separately
described modules, individual software programs, and/or a single
software program.
[0074] According to one embodiment of the invention, the client
computer 101 may communicate through a networking application.
According to another embodiment, the user interface modules
220a-220n (hereinafter user interface modules 220) may support
several interfaces including display screens, voice recognition
systems, speakers, microphones, input buttons, and/or other
interfaces. According to one embodiment of the invention, the user
interface modules 220 may display the application on a user
interface associated with the client computer 101. According to one
embodiment of the invention, select functions may be implemented
through the client computer 101 by positioning an indicator over
selected icons and manipulating an input device 104, such as a
stylus, a mouse, a keyboard, or other input devices.
[0075] With regard to user authentication, the authentication
modules 222a-222n (hereinafter user authentication modules 222) may
employ one of several different authentication schemes, as would be
appreciated by those skilled in the art. According to one
embodiment of the invention, the user authentication modules 222
may prompt users to input alphanumeric code or other identifying
information. According to another embodiment of the invention, the
user authentication modules 222 may prompt users to provide
biometric information (i.e., a thumbprint through a fingerprint
scanner) or other suitable identifying information. If the user is
not identified, then the user may be invited to resubmit the
requested identification information or to take other action.
[0076] According to one embodiment of the invention, the client
computers 101 may include communication modules 224a-224n
(hereinafter communication modules 224) for enabling the client
computers 101 to communicate with systems, including other client
computers, the servers 120, the imaging devices 210, the databases
and/or other systems. The client computers 101 may communicate via
communications media 201 such as, for example, any wired and/or
wireless media. Communications between the client computers 101,
the imaging devices 210, the servers 120, and the databases may
occur substantially in real-time, when the devices are coupled to
the network. According to one embodiment of the invention, the
communications module 224 may communicate with the servers 120 to
exchange data, wherein the data exchange may occur with or without
user awareness of the data exchange.
[0077] According to an alternative embodiment of the invention,
communications may be delayed for an amount of time if, for
example, one or more client computers 101, the server 120, the
imaging devices 210, and/or the databases are not coupled to the
network. According to one embodiment of the invention, any requests
that are submitted while devices are not coupled to the network may
be stored and propagated from/to the offline client computer 101,
the databases and/or the imaging devices 210 when the target
devices are re-coupled to the network. One of ordinary skill in the
art will appreciate that communications may be conducted in various
ways and among various devices.
[0078] According to one embodiment of the invention, user
authentication information and/or identification information may be
forwarded to the servers 120 to perform various functions.
According to another embodiment of the invention, the servers 120
may operate to coordinate communications between the applications
that are associated with the client computers 101, the imaging
devices 210, and/or the databases.
[0079] According to one embodiment of the invention, the client
computers 101 may include, or be modified to include, client
computer agent modules 226a-22bn (hereinafter client computer agent
modules 226). The client computer agent modules 226 may operate to
provide data gathering and data exchange functionality. According
to one embodiment, the invention may enable monitoring of actions
that are performed on the client computers 101.
[0080] According to one embodiment of the invention, the client
computer agent modules 226 may associate client computer
identifying information with actions that are performed on the
corresponding client computers 101. According to one embodiment of
the invention, data monitoring features may be employed to generate
client computer audit logs. According to one embodiment of the
invention, client computer audit logs may be produced to
reconstruct actions, such as user actions, computer actions, and/or
other actions that are performed on (or by) the client- computers
101.
[0081] According to one embodiment, the client computer agent
modules 226 may gather client computer monitoring data based on
user actions performed, such as user login information; data files
and databases that are accessed; information that is requested,
including patient names/identifiers, exam results; information that
is retrieved; client computer access information, including user
information, time of access, time of exit, etc.; the application(s)
that are used; information that is obtained from the server 120,
including time of access, patient identifiers, volume of data
retrieved, etc.; information that is obtained from the imaging
devices 210, including time of access, patient identifiers, volume
of data retrieved, etc.; information that is processed at the
client computer 101, including time stamp information; and other
user action data. According to another embodiment of the invention,
user action data may include accessing digital images, reviewing
digital images, manipulating digital images, marking digital
images, storing digital images, forwarding digital images,
adjusting exposure parameters on digital imaging devices,
generating a report, generating a textual report, dictating a
report, entering information, conducting continuing medical
education (CME) triggered by performing the medical examination,
and/or performing other user actions.
[0082] According to one embodiment, the client computer agent
modules 226 may gather client computer monitoring data based on
computer actions performed, such as when data is exchanged; the
type of input device used; whether reports are printed; when data
is saved; an Internet Protocol (IP) address of devices that are
communicated with; a location of data storage/retrieval; etc.;
and/or other computer action data. According to one embodiment of
the invention, the client computer agent modules 226 also may
gather client computer specification data, such as IP address data,
processing speed data, and other client computer specification
data. According to one embodiment of the invention, the client
monitoring data and/or client computer specification data may be
provided in real-time. According to another embodiment of the
invention, the client monitoring data and/or client computer
specification data may be employed to calculate user QA
metrics.
[0083] According to one embodiment of the invention, the server 120
may include a server authentication module 234 that receives
authentication information that is entered into a corresponding
client computer 101 via the authentication modules 222. The server
authentication module 234 may compare the identifying information
with existing records and operate as a gatekeeper to the QA
scorecard system 100. If the user is determined to be a registered
user, the authentication module 234 may attempt to authenticate the
registered user by matching the entered authentication information
with access information that exists on the servers 120. If the user
is not authenticated, then the user may be invited to resubmit the
requested identifying information or take other action. If the user
is authenticated, then the servers 120 may perform other
processing. For example, the client computers 101 may receive
information from the servers 120 and/or from another authenticated
client computers.
[0084] According to one embodiment of the invention, the imaging
devices 210 may include any number of different types of imaging
devices, such as magnetic resonance imaging (MRI) devices, computer
tomograph (CT) imaging devices, angiograph imaging device,
ultrasound imaging devices or other imaging devices. According to
another embodiment of the invention, the imaging devices 210 may
include several components such as processors, databases 219a-219n
(hereinafter databases 219), RAM, a USB interface, a telephone
interface, microphones, speakers, a stylus, a computer mouse, a
wide area network interface, local area network interfaces, hard
disk drives, wireless communication interfaces, a keyboard, a flat
touch-screen display, a computer display, and/or other
components.
[0085] According to one embodiment of the invention, the imaging
devices 210 may include, or be modified to include, imaging device
agent modules 216a-216n (hereinafter imaging device agent modules
216). The imaging device agent modules 216 may operate to provide
data gathering and data exchange functionality. According to one
embodiment, the invention may enable monitoring of actions that are
performed on the imaging devices 210.
[0086] According to one embodiment of the invention, the imaging
device agent modules 216 may associate imaging device identifying
information with actions that are performed on the imaging devices
210. According to one embodiment of the invention, data monitoring
features may be employed to generate imaging device audit logs.
According to one embodiment of the invention, image device audit
logs may be produced to reconstruct actions, such as user actions,
imaging device actions, and other actions that are performed on (or
by) the imaging devices 210.
[0087] According to one embodiment, the imaging device agent
modules 216 may gather image device monitoring data based on user
actions performed, such as user login information; imaging
modalities; parameters that are selected to perform the imaging
modalities, including motion information, positioning information,
exposure information, artifact information, collimation
information; number of times an imaging exam is performed; data
files and databases that are accessed; information that is
requested, including patient names/identifiers; information that is
retrieved; imaging device access information, including user
information, time of access, time of exit, etc.; information that
is stored to the server 120, including time of storage, patient
identifiers, volume of data stored, etc.; information that was
obtained from the imaging devices 210, including time of access,
patient identifiers, volume of data stored, etc.; information that
was processed at the imaging device 210, including time stamp
information; and other user action data.
[0088] According to one embodiment, the imaging device agent
modules 216 may gather imaging device monitoring data based on
imaging device actions performed, such as when data is exchanged;
the type of input device used; whether reports are printed; when
data was saved; an Internet Protocol (IP) address of devices that
were communicated with; a location of data storage/retrieval;
imaging device parameter adjustments; and other imaging device
data. According to one embodiment of the invention, the imaging
device agent modules 216 also may gather imaging device
specification data, such as resolution data, IP address data,
processing speed data, and other imaging device specification data.
According to one embodiment of the invention, the imaging device
monitoring data and/or imaging device specification data may be
stored in database 219. According to one embodiment of the
invention, the imaging device monitoring data and/or imaging device
specification data of the program 110 may be provided in real-time.
According to another embodiment of the invention, the imaging
device monitoring data and/or imaging device specification of the
program 110 may be employed to calculate user QA metrics. The
inventor has previously submitted an application describing an
apparatus for automating QA in medical imaging, as described in
U.S. patent application Ser. No. 11/412,884 filed on Apr. 28, 2006,
the entire contents of which are hereby incorporated by
reference.
[0089] According to one embodiment of the invention, the server 120
may include a merging module 231 that receives data from all
devices that are networked to the server 120, including the client
computers 101, the imaging devices 210, and/or databases. According
to one embodiment of the invention, the received data may include
at least client computer audit log data and/or image device audit
log data. The merging module 231 may locally store the received
data in a storage device 260 and/or may store the received data in
an external storage device. The merging module 231 merges data that
is captured during a medical examination, including user action
data, client computer action data, imaging device action data, and
other data.
[0090] According to one embodiment of the invention, the server 120
may include a sorting module 240 that enables sorting of the data,
including the merged data. According to one embodiment of the
invention, the sorting module 240 may sort the data based on
various sorting criteria, including the chronology of data receipt,
the type of device that originated the data, the type of technology
used to obtain the data (e.g. CT, MRI, sonogram, etc.), the type of
institution in which a data was obtained, the type of professional
that obtained the data (i.e., radiologist, technologist, etc.), the
user that is associated with the data, the patient that is
associated with the data, demographic information, patient
population information, the workflow sequence in which the data was
captured, the severity of exam results, and/or other sorting
criteria. According to one embodiment of the invention, the sorted
data may enable tracking, reconstruction, reporting and/or
monitoring of actions that are performed during medical
examinations. According to one embodiment of the invention, the
criteria associated with medical examinations may be used by the
program to calculate QA scorecard metrics.
[0091] According to one embodiment of the invention, the server 120
may include a communications module 230 that communicates with the
client computer 101, imaging devices 210 and/or databases to obtain
information regarding the status of the imaging study along a
defined workflow sequence. According to one embodiment of the
invention, a defined workflow sequence includes various operations,
such as image exam ordering, image exam scheduling, image exam
acquisition, image processing, image archiving, image navigation,
image interpretation, image exam reporting, image exam
communication, and/or image exam billing. According to one
embodiment of the invention, the communications module 230 provides
the status of the imaging study workflow sequence including
identifying the current user that is responsible for the image
study, a completion percentage of the current stage of the imaging
study, and/or other status information. According to one embodiment
of the invention, the status of the imaging study workflow may be
communicated to users in real-time and/or stored. According to one
embodiment of the invention, parameters may be derived from the
status of the imaging study workflow sequence by the program to
generate a QA scorecard for the various users.
[0092] According to one embodiment of the invention, the server 120
may include a report generating module 238 that generates reports
based on the occurrence of pre-defined events, including a periodic
query of the status of the imaging study, an interpretation that is
forwarded by the radiologist, a clinical finding that is submitted
by the clinician, and/or the occurrence of other pre-defined
events.
[0093] According to one embodiment of the invention, the server 120
may include a billing module 242. According to one embodiment, the
billing module 242 performs billing functions following completion
of the reporting/communication process. The billing module 242 may
analyze metrics to assess operational efficiency and accuracy of
charges billed and to calculate any additional expenses that occur
due to limitations in reporting by users, such as radiologists.
According to one embodiment, the additional expenses may take a
number of forms and may result from uncertainty and equivocation
within the radiology report or radiologist recommendations for
additional imaging exams, consultations, and procedures (e.g.
biopsy). The billing module 242 may correlate imaging costs with
quality of service deliverables, such as diagnostic accuracy and
clinical outcomes.
[0094] According to one embodiment of the invention, the server 120
may include a scheduling module 244 that enables electronic
scheduling, including image exam scheduling. According to one
embodiment, the scheduling module 244 may include bi-directional
electronic scheduling that provides real-time tracking features to
update parties of scheduling changes. The scheduling module 244 may
communicate with the communication module 230 and/or the
notification module 236, among other modules, to communicate the
status of an appointment to users in real-time and/or stored.
[0095] According to one embodiment of the invention, the server 120
may include a notification module 236 that generates notifications
and/or alerts based on the completion of reports, scheduling or the
occurrence of predefined events. The notifications may be triggered
by the release of items, such as status information, completion of
an imaging report, changes to appointments, and/or other items. The
notification module 236 may include monitoring features and/or
confirmation features that track and record events, including the
date and time that a notification is sent, the date and time that a
notification is delivered, the date and time that a notification is
opened, such as by return of an acknowledge receipt message, among
other events. According to one embodiment, the notification module
236 may generate and forward notifications and/or alerts to client
computers 101 and/or mobile devices, using known communication
techniques including electronic mail messages, voice messages,
telephone messages, text messages, instant messages, facsimile,
and/or other communication techniques.
[0096] According to one embodiment of the invention, variables that
are determined to have a deficiency during the imaging study
process and that exceed a pre-determined QA standard threshold may
trigger the computer program 110 to produce a notification and/or
alert through the notification module 236 that may be
instantaneously sent to users, via one or more communications
techniques, alerting users as to the specific type of deficiency
and requirement for correction.
[0097] According to one embodiment of the invention, a minimal
amount of the data that is processed at the servers 120 may be
stored in storage device 260 by the program 110. In other words,
the servers 120 may perform data gathering and/or document
generating functions and may thereafter purge all or portions of
the retrieved data according to specified criteria. As a result,
according to one embodiment, the program 110 may minimize security
risks associated with exposing any confidential medical records to
unauthorized parties at the servers 120. According to another
embodiment of the invention, the retrieved data may be stored at
the servers 120 by the program 110 for a predetermined amount of
time before being purged. According to yet another embodiment of
the invention, public record information, non-confidential
retrieved data, and/or tracking information, such as client
computer log files and/or image device log files may be stored in
storage device 260 by the program 110.
[0098] According to one embodiment of the invention, the metrics
module 232 may receive objective scores, such as a Likert scale of
1-4, to quantify user performance. For example, a score of 1 may be
considered "non-diagnostic". This means little or no clinically
useful (diagnostic) information is contained within the image
study. Since the available information obtained during the
examination of the patient does not answer the primary clinical
question (i.e., indication for the study), then by definition this
requires that the imaging exam be repeated for appropriate
diagnosis.
[0099] A score of 2 may be considered "limited". This means that
the information obtained during the image study is less than
expected for a typical examination of this type. However, the
information contained within the image study is sufficient to
answer the primary clinical question. A requirement that this exam
be repeated is not absolute, but is preferred, in order to garner
maximal diagnostic value.
[0100] A score of 3 may be considered "diagnostic". This means that
the information obtained during the image study is representative
of the broad spectrum of comparable images, allowing for the
patient's clinical status and compliance. Both the primary clinical
question posed, as well as ancillary information, can be garnered
from the image for appropriate diagnosis.
[0101] A score of 4 may be considered "exemplary". This means that
the information obtained during the image study and overall image
quality serves as an example that should be emulated as the "ideal"
for that specific imaging study and patient population.
[0102] According to one embodiment of the invention, the data that
is collected during the imaging study may analyzed by a metrics
module 232 for performing prospective and retrospective trending
analysis. The prospective and retrospective trending analysis
enables automatic detection of immediate and recurrent problems, as
they relate to equipment, personnel, data input, and overall
workflow. The result of this automated technical QA analysis is
that an automated and normalized analysis may be performed that
minimizes subjectivity and human bias, among providing other
benefits.
[0103] According to one embodiment of the invention, the metrics
module 232 may automatically tally and record QA scores in a
selected database. The QA scores may be cross-referenced by the
computer program 110 to a number of independent variables including
a technologist identifier, imaging modality, exam type, patient
demographics, patient characteristics, patient body habitus,
exposure parameters, image processing, exam location, equipment,
day/time of exam for trending analysis, radiologist identification,
referring clinician, clinical indication, among other variables.
According to one embodiment of the invention, the report generating
module 238 may access the QA scores to display results from the
metrics module 232. The reports may be accesses at any time by
users, including the clinician, the radiologist, the technologist,
and/or the department/hospital administrator to review individual
and collective performance results. The trending analysis provided
by this data can in turn be used for educational purposes,
performance review, and new technology deployment.
[0104] According to one embodiment, the metrics module 232 analyzes
data that is associated with a defined list of quality assurance
(QA) benchmarks to objectively evaluate clinicians, quantify a
relative success of service delivery and provide educational
(data-driven) feedback in order to optimize clinical performance,
among other benefits. The QA metrics may be tied to economic
incentives, such as a pay for performance (P4P) systems, to create
financial rewards for those practitioners that provide high levels
of quality-oriented service deliverables.
[0105] According to one embodiment, a quantifiable list of
pre-defined clinical performance parameters may be used by the
program 110 to measure overall performance of the clinician, or
practicing physician, such as the utilization and medical imaging
services that are provided in a clinical practice, among other
pre-defined parameters. According to one embodiment of the
invention, clinical performance metrics may be calculated by the
program 110 from various parameters, including completeness of data
input, such as clinical history, laboratory data, physical exam
findings; exam appropriateness, such as using defined
appropriateness criteria; utilization patterns, including economic
outcomes, clinical outcomes, and/or medico-legal outcomes; a
patient safety profile, such as requested use of ionizing
radiation, contrast, invasive procedures; communication/reporting,
including the availability of imaging data, the receipt of imaging
data, and/or radiologist consultations; timeliness, including time
to initiate clinical action; feedback provided to the patient and
specialists, such as the radiologist; participation in data
collection and analysis, including outcomes analysis, reporting,
and/or diagnostic accuracy; education and training, including
imaging services and new technologies; peer review, including
discretionary assessment of clinical performance as it relates to
imaging services and patient diagnosis/treatment, among other
predetermined parameters.
[0106] According to one embodiment of the invention, communication
and reporting parameters may include, time from order entry to
report completion; time from report completion to receipt by
clinician; time from report receipt to actual review; specific
components of the report reviewed by clinician; clinician time
reviewing reporting data, such as document report open and report
closing; clinician time components for individual report segments;
perceived clinician value for report; report structure; report
content; report organization; imaging links, including complete
imaging file, key images, snapshot; ancillary data, including
teaching files, NLM, review articles; communication; method of
communication; acknowledgement of receipt of communication;
bi-directional consultation; time to initiate treatment; tracking
of follow-up recommendations; clinician satisfaction; subjective
value; referral patterns; among other parameters.
[0107] According to one embodiment of the invention, the
communication module 230 may access a number of informational
sources, including the electronic medical record (EMR); the
computerized physician order entry system (CPOE); the hospital
information systems (HIS) 10, the radiology information systems 20
(RIS); the picture archival and communication system (PACS) 30;
subjective feedback from the radiologist, patient, and clinician
peer group; and/or other informational sources, to obtain clinical
performance parameters. According to one embodiment, standard tags
may be created within the various informational sources to identify
individual QA data parameters.
[0108] According to one embodiment of the invention illustrated in
FIG. 3, the QA scorecard program 110 presents a welcome screen in
operation, or step, 301. In operation 302, the QA scorecard program
110 displays a log-in screen and receives log-in criteria, such as
a username and password. In operation 304, the QA scorecard program
110 compares the user log-in criteria against pre-stored log-in
criteria for authorized users to determine if the user may gain
access to the system. If the user log-in criteria is not approved,
then the QA scorecard program 110 may notify the user of the
registration failure and may return to the main log-in screen. If
the user log-in criteria is approved, then in operation 306, the QA
scorecard program 110 may determine whether or not the user is
assigned full privileges to perform actions within the QA scorecard
program 110. If the user has full privileges, then the QA scorecard
program 110 requests patient information or a patient
identification number in operation 314.
[0109] According to one embodiment of the invention, a reduction of
privileges may be prescribed for various predefined reasons,
including failure to follow a predefined protocol, frequently
misdiagnosing an ailment, failure to follow a cost effective
treatment plan, and/or failure to complete continuing medical
education (CME) credits, among other predefined reasons.
[0110] According to one embodiment of the invention, if the user
does not have full privileges, then in operation 309, the QA
scorecard program 110 displays a warning message on the user
interface advising the user that less than full privileges are
associated with the log-in criteria. In operation 310 the QA
scorecard program 110 may identify and recommend re-credentialing
programs, including approved CME courses, computer training, or
other re-credentialing programs. The QA scorecard program 110 will
enable the user to immediately access the recommended
re-credentialing programs through the QA scorecard program 110.
According to one embodiment, the user may defer starting the
recommended re-credentialing programs until a future date. After
users successfully complete the re-credentialing program, the QA
scorecard program 110 may restore full privileges to the user.
[0111] According to one embodiment of the invention, policies
governing removal and re-institution of imaging privileges may be
under the jurisdiction of a multi-disciplinary QA team including
radiologists, administrators, and chief technologists, who would
all have input into the overall process of reviewing data from the
CPOE system.
[0112] According to one embodiment of the invention, the warning
message displayed in operation 309 also may identify a grace period
that is granted for regaining full privileges before all the
privileges are revoked. According to one embodiment of the
invention, the grace period may be defined by a threshold, such as
a number of log-ins, a number of days, or other threshold that may
not be exceeded before all privileges are revoked.
[0113] According to one embodiment of the invention, the grace
period threshold may be determined by the program 110 based on
predetermined factors, such as the frequency of occurrence of one
of predefined triggers, the severity of a clinician error, the
amount of time required to complete a re-credentialing program,
and/or other factors. In operation 312, the QA scorecard program
110 determines if the user has exceeded the allowed number of grace
period log-ins. If the number of allowed grace period log-ins are
exceeded, then the QA scorecard program 110 may revoke all
privileges and the user may be presented with an alert that all
privileges are revoked. The QA scorecard program 110 may prevent
the user from proceeding further in the QA scorecard program 110
and the QA scorecard program 110 may return to the welcome screen.
The QA scorecard program 110 may provide the user with contact
information for re-establishing privileges.
[0114] If the grace period threshold has not been exceeded, then
the QA scorecard program 110 prompts the user for patient
information or a patient identification number in operation
314.
[0115] In operation 316, the QA scorecard program 110 accesses one
or more information sources, including the electronic medical
record (EMR), the hospital information system 10 (HIS), the
radiology information system 20 (RIS), the PACS 30, among other
information sources to obtain information and/or records associated
with the selected patient.
[0116] In operation 318, the QA scorecard program 110 displays the
information and/or records that are associated with the selected
patient. For example, the QA scorecard program 110 may display an
imaging data sheet that is customized by a user for the patient.
According to one embodiment of the invention, the imaging data
sheet provides users with important aspects of the patients medical
history. The imaging data sheet may have a standard format and
include data, such as past medical and surgical history; prior
imaging exams and results, including those performed at outside
facilities; current clinical problems; pertinent findings on
physical exam; pertinent laboratory and/or pathology data;
ancillary data, including procedural findings (e.g. colonoscopy,
bronchoscopy), operative or consultation notes, clinical testing
(e.g., EEG, EKG); technical information related to the imaging exam
performed; technologist observations, including pertinent findings
and measurements; technologist notes, including complications, exam
limitations; among other data. The QA scorecard program I 1O
facilitates creation of a universal, patient-specific imaging
datasheet for digital images that could be stored in the EMR, RIS,
and/or PACS, among other information systems.
[0117] According to one embodiment of the invention, each time a
new entry or modification is made to the imaging data sheet, a
time-stamp may be included in the record by the program 110, along
with the identification of the person inputting (or modifying) the
data. According to one embodiment of the invention, each user may
create profiles for the imaging data sheet and may customize the
imaging data sheet display to their own individual preferences.
According to one embodiment of the invention, the customized
imaging data sheet may be linked by the program 110 to users via a
log-in criteria.
[0118] According to one embodiment of the invention, new data may
be input into the imaging data sheet via the QA scorecard program I
0 by clinicians, nurses, radiologist, technologist or other
authorized users. According to one embodiment of the invention, new
data may be input into the imaging data sheet via the QA scorecard
program 110 through computer-derived entry using natural language
processing (NLP). According to one embodiment of the invention, the
imaging data sheet may have separate tabs for each individual
imaging modality, and may store technical data, measurements, and
technologist notes specific to each individual exam/modality.
[0119] In operation 320, the QA scorecard program 110 presents the
clinician with a computerized physician order entry (CPOE)
application to initiate an exam order. In operation 322, the QA
scorecard program 110 receives data that includes all pertinent
clinical data elements that are related to the diagnosis being
evaluated. According to one embodiment of the invention, the data
elements include past medical and surgical history; allergies, with
particular emphasis directed to contrast media used in medical
imaging; risk factors, including family history and tumor markers;
non-imaging data, including laboratory, clinical testing,
pathology; clinical indication and presumptive diagnosis, which
prompted the ordered imaging exam; findings on physical
examination; historical imaging data, including outside imaging
exams and findings; and/or other data elements.
[0120] According to one embodiment of the invention, a standard tag
may be created by the program 110 within the various informational
sources to identify individual QA data parameters. The
communication module 230 may extract the parameters from the CPOE
entries to calculate metrics and generate a QA score for the
clinician. For example, the metric module 232 may reduce a QA score
if data elements are "missing," such as if key information fields
are not filled in or are incomplete. In this case of missing
elements, the QA scorecard program 110 may not process the
request.
[0121] According to one embodiment of the invention, the
radiologist and/or technologist may review the data elements that
are entered into the CPOE system before the requested imaging exam
is performed. The availability of the data elements provides an
opportunity for the technologist and/or radiologist to clarify any
discrepancies or clinical questions. The QA scorecard program 110
enables the technologist and/or radiologist to make adjustment to
the exam protocol and/or to optimize the image exam prior to
performing the image exam. According to one embodiment of the
invention, discrepancies are defined to include data that is
inconsistent with other information that is included in the record.
For example, the clinician may input data indicating that no prior
history of cancer exists. However, a prior imaging report may show
past medical history of cancer.
[0122] In operation 324, the QA scorecard program 110 determines
whether or not the clinician's image exam order is appropriate in
view of clinical imaging variables. Exam order appropriateness is a
quantitative analysis that evaluates the clinical efficacy of the
image exam ordered, based on an evaluation of the data elements
associated with the examination request. According to one
embodiment of the invention, the QA scorecard program 110 may
objectively track the exam order appropriateness using pre-defined
appropriateness criteria, such as linking clinical and historical
data with different types of imaging exams. For example, if a
clinician orders a chest CT to evaluate for lung cancer without
first ordering a chest radiograph, the CPOE system may require the
less expensive screening study (radiograph) to be performed before
performing a more expensive CT. If, for example, the patient is
being evaluated for kidney stones (urolithiasis) and has a past
history of allergic reaction to intravenous contrast dye, the CPOE
system will recommend a non-contrast CT or ultrasound (US) in lieu
of an intravenous pyelogram (IVP), which requires contrast.
[0123] If the exam order is determined to be inappropriate, then
the QA scorecard program 110 may display recommendations in
operation 325 for modifying the imaging exam order. According to
one embodiment of the invention, the QA scorecard program 110 may
use algorithms to generate mandatory and optional recommendations
for the clinician. For example, if the patient has a past history
of allergic reaction to contrast, then an IVP is contraindicated
and cannot be performed. If, on the other hand, both a CT and US
will provide comparable data, the program 110 may recommend the US
over the CT, at least due to the fact that US does not have
ionizing radiation, while CT does. In the end, the QA scorecard
program 110 defers to the discretion of the ordering clinician.
According to one embodiment of the invention, the willingness and
availability of the requesting clinician to receive and modify the
exam request may be included by the program 110 in the exam
appropriateness analysis.
[0124] According to one embodiment of the invention, availability
may defined as the ability to communicate in a timely fashion (i.e.
accessibility). For example, availability may be a combined measure
of the time requirements to document receipt of data and confirm a
response. Electronic communication pathways may be created by the
program 110 to automate the communication process as defined
through each clinician user profile. For example, clinicians may
prefer text messaging, e-mail alerts, cell phone, faxing, and/or
other communication methods.
[0125] According to one embodiment of the invention, willingness
may be defined as a degree with which an individual modified the
imaging requisitions in accordance with appropriateness criteria
data and recommendations of departmental staff. While there are
situations where the clinician may insist on following a prescribed
order, trending analysis may be performed by the program 110 to
demonstrate outliers, in terms of those clinicians that
consistently over-ride standard guidelines.
[0126] The appropriateness criteria are designed to take into
account a multitude of clinical and imaging variables and provide
objective feedback data by the program 110 to the ordering
clinician in order to maximize patient safety, cost, and diagnostic
accuracy. According to one embodiment of the invention, the metrics
module 232 may generate a QA score for the clinician based on an
evaluation of the appropriateness data.
[0127] According to one embodiment, the QA scorecard program 110
may request the clinician to provide additional data in operation
325 for further evaluating the image exam order. According to one
embodiment of the invention, the QA scorecard program 110 may
electronically track, store, and analyze recommendations reading
exam appropriateness to create physician profiles on ordering
habits, completeness of input data, and compliance with
appropriateness standards, among other elements. This profile data
may in turn be used for clinician education and training.
[0128] According to one embodiment of the invention, another
component of exam appropriateness may be the routine ordering of
preventative screening imaging exams (e.g. screening mammography),
in accordance with community standards and patient/family risk
factors. As genetic markers become an integral part of the patient
clinical profile, these preventative screening studies will take on
greater importance in disease prevention and will also become an
important component in the assessment of exam appropriateness.
[0129] Upon completion of operation 325, the QA scorecard program
110 returns to operation 322 in order to allow modification of the
pertinent clinical data elements. In operation 324, the QA
scorecard program 110 again evaluates the modified CPOE to
determine whether or not the clinician's exam order is appropriate
in view of clinical imaging variables. If the exam order again
determined to be inappropriate, then the QA scorecard program 110
proceeds to operation 325.
[0130] On the other hand, if the exam order is determined to be
appropriate, then the QA scorecard program 110 proceeds to
operation 326, where the data derived from this appropriateness
analysis may be stored in a database, such as RIS 20, among other
databases. In operation 328, the QA scorecard program 110 may
analyze the patients data obtained from the HIS 10, RIS 20, EMR or
other information source against a patient's clinician profile. In
operation 330, the QA scorecard program 110 may present an
automated list of preventative screening imaging exams for the
selected patient based on surveillance guidelines.
[0131] In operation 332, the QA scorecard program 110 may present
additional preventative screening imaging exams that may be added
to the image order exam. In operation 334, the QA scorecard program
110 may forward the imaging exam to the clinician's staff for
scheduling.
[0132] According to one embodiment of the invention, the QA
scorecard program 110 may evaluate the utilization patterns of
ordering clinicians during the appropriateness evaluation. In
operation 334, the QA scorecard program 110 may retrieve, store,
and analyze the utilization data from the HIS 10 and/or RIS 20 and
may correlate the utilization data with each individual patient's
clinical profile. According to one embodiment, the correlation may
be defined by disease-specific current procedural terminology (CPT)
codes. These codes are contained within the HIS 10 for inpatient
hospitalizations and the EMR, among other databases.
[0133] According to one embodiment of the invention, the QA
scorecard program 110 may periodically track and analyze this data
in order to provide insight as to specific clinical indications and
diagnoses requiring remedial education on the part of the
clinician. The frequency of analysis may be established by each
individual site and may be performed monthly or quarterly basis,
for example. The QA scorecard program 110 may analyze variables,
such as patient safety, cost, redundancy, and clinical efficacy,
among other variables. According to one embodiment of the
invention, patient safety may include elements such as contrast
administration, radiation exposure, and invasive procedures (e.g.
biopsies). According to one embodiment of the invention, cost may
include an analysis that takes into account whether less expensive
imaging studies are being utilized in lieu of more expensive,
technology intensive exams. For example, if a patient presents with
headaches, CT is a less expensive exam that provides comparable
diagnostic information to a more expensive MRI. According to one
embodiment of the invention, redundancy is the duplication of
imaging exams to provide similar imaging data. One of the problems
with over-utilization is that physicians often order multiple
imaging exams that individually answer the same clinical questions.
If, for example, a patient is being evaluated for elevated liver
enzymes there is little yield in ordering both an abdominal US and
CT, yet it occurs quite frequently. Invasive procedures are fraught
with potential morbidity and mortality. As a result, they should
only be performed after all non-invasive diagnostic work-ups have
been exhausted.
[0134] Adverse effects of over-utilization of medical imaging
services may be determined from these variables. Adverse effects of
over-utilization of medical imaging services may include economic
factors, such as increased costs for overall healthcare delivery;
timeliness, such as potential delay in diagnosis and treatment
planning; decreased accessibility, such as diminished capacity and
increased exam backlog; diffusion of responsibility, such as
increased number of consultants and tests with diminished clinical
focus on primary care provider; increased reliance on technology,
such as depersonalization of medical practice; patient safety, such
as increased risk of adverse actions associated with contrast and
ionizing radiation; diminished R & D, such as potential to
decrease innovation and new product development due to medico-legal
risk; among other factors.
[0135] In operation 336, the QA scorecard program 10 may perform
trend analysis of clinician medical imaging utilization. The trend
analysis may be evaluated on an individual patient and patient
group basis, with patient groups classified according to
demographics, medical histories, and clinical profiles. According
to one embodiment of the invention, the QA scorecard program 11O
may perform trend analysis to identify specific trends in imaging
utilization patterns. Since patient, institution, and clinical
indication are unique, they should be taken in the overall context
of multiple data points. For example, if a physician
inappropriately orders the wrong study on a single patient than it
is recorded and taken into context. If, on the other hand, that
same physician repeatedly orders the wrong imaging study on
multiple patients, then the overall trend is one which identified a
need for intervention, such as in the form of education.
[0136] In operation 338, the QA scorecard program 10 may correlate
utilization data trends with local, regional, and national norms.
The QA scorecard program 110 may provide data-driven feedback to
each clinician relative to their peer group for educational
purposes. The QA scorecard program 11O may separate utilization
patterns into categories including, preventative medicine,
diagnosis, treatment, and disease surveillance, among other
categories. In operation 340, the QA scorecard program 110 may
present feedback to the clinician regarding the utilization
data.
[0137] In operation 342, the QA scorecard program 10 may derive
apply the utilization data to create best practice guidelines and
assist in technology allocation, development of new imaging
services, and improved appropriation of healthcare funding.
[0138] Best practice guidelines refer to what are shown to be the
most effective imaging studies for specific clinical indications,
based on a large number of data from multiple institutions. For
example, in the evaluation of osteomyelitis for the diabetic foot,
it may be demonstrated through scientific study, that contrast
enhanced MRI is the best imaging study (analyzing cost, safety, and
clinical efficacy), as opposed to alternative imaging exams (CT,
radionuclide bone scan or white blood cell scan).
[0139] Regarding technology allocation, if the QA scorecard program
110 generates cumulative data from the utilization analysis showing
a need for a second MRI scanner, than this evidence may be provided
to support a request for a second MRI during the next capital
equipment cycle. In this regard, some states require certificates
of need (CON) for certain types of advanced technologies (e.g. PET
scanner) and this data provides an objective means to justify (or
refute) requests for CON.
[0140] Regarding education, the QA scorecard program 110 may
distinguish between intra-departmental or on-line educational
courses that are designed to educate clinicians as to new imaging
technologies and applications. The QA scorecard program 110 may
also direct users to information regarding the best utilization of
these services. If for example, a clinician continues to
inappropriately order the same type of imaging exam for a specific
clinical indication/diagnosis, then they may be made aware of
existing recommendations. These educational programs may be
automated and customized to a specific problem by the program 110,
such as by bookmarking certain on-line education materials to
specific imaging data. For example, maybe a website has an overview
on new MRI applications for neuro-imaging. If a clinician is
inappropriately ordering brain MRI exams, the program 110 may
identify the error and direct the clinician to the on-line
educational program that best fits the area of concern. Once the
educational program has been completed, as documented by CME
credits, for example, the QA scorecard program 110 may restore any
temporarily removed privileges.
[0141] FIG. 4 illustrates a communication and reporting process
that may be presented to a clinician after a radiologist has
interpreted the imaging study, according to one embodiment of the
invention. Communication and reporting procedures of the program
110 ensure that the information contained within the medical
imaging report is received in a timely fashion and appropriately
utilized for clinical management. The QA scorecard program 110 may
alert the clinician after the radiologist has interpreted the
images.
[0142] In operation 400, the QA scorecard program 110 presents
imaging results to the clinician from information sources, such as
HIS 10, RIS 20, PACS 30, among other information sources. In
operation 402, the QA scorecard program 110 receives an assessment
regarding whether or not the imaging study contains unexpected
results or emergent findings.
[0143] If the imaging study does not include unexpected results or
emergent findings, then the clinician is presented with the results
by the program 110 pursuant to standard protocol. If the imaging
study includes unexpected results or emergent findings, then the
clinician is presented with the results by the program 110 pursuant
to special protocol. When the QA scorecard program 110 receives
information of clinically unexpected or emergent findings by the
radiologist during the course of imaging exam interpretation, the
QA scorecard program 110 generates an alert that notifies the
ordering clinician to immediately contact the radiologist to
directly receive these emergent findings.
[0144] When the imaging study includes unexpected results or
emergent findings, the QA scorecard program 110 sends an alert to
the clinician in operation 404 with instructions for contacting the
radiologist. Whether the communication occurs electronically or
verbally, the QA scorecard program 110 documents the communication
by time stamping and storing the communication for future analysis.
Upon receipt of the alert, the clinician may immediately contact
the imaging department staff (i.e. radiologists, technologists,
administrators) to discuss the clinical concerns. In operation 406,
the clinician may contact the patient to advise of the results. The
QA scorecard program 110 documents the communication between the
clinician and patient by time stamping and storing the
communication for future analysis. According to one embodiment of
the invention, QA scorecard parameters for reporting and
communication may include criteria such as, time from order entry
to report completion; time from report completion to receipt by
clinician; time from report receipt to actual review; specific
components of the report reviewed by clinician; clinician time
reviewing reporting data, such as document report open and report
closing; clinician time components for individual report segments;
perceived clinician value for report; report structure; report
content; report organization; imaging links, including complete
imaging file, key images, snapshot; ancillary data, including
teaching files, NLM, review articles; communication; method of
communication; acknowledgement of receipt of communication;
bi-directional consultation; time to initiate treatment; tracking
of follow-up recommendations; clinician satisfaction; subjective
value; referral patterns; among other criteria.
[0145] According to one embodiment, the time-stamped data is a
component part of objective data analysis. Imaging departments are
able to utilize program 110 to record individual time-stamped data
throughout the course of the imaging cycle, from the time an
imaging exam is electronically ordered to the time the imaging
report issued and reviewed. After the image report is received,
time-stamped data may be tracked by the program 110 within the EMR,
which records clinician actions, in the form of recording progress
notes, consultations, and the ordering of clinical tests, imaging
studies, and various treatment options (e.g. drug therapy). In
either case, the QA scorecard program 110 enables the clinician to
enter data electronically into the EMR. This is time-stamped data
may be recorded into a QA database for subsequent analysis. One
such analysis may include an assessment of the time incurred
between the imaging exam and initiation of clinical treatment.
[0146] According to one embodiment, a clinician may order a chest
CT angiography (CTA) in the assessment of suspected pulmonary
embolism. Due to the emergent nature of the clinical indication,
the QA scorecard program 110 may be accessed to order the imaging
exam (within the CPOE system) as "stat". The exam order time is
recorded by the QA scorecard program 110, for example at 18:08
hours. The patient arrival time to the imaging department may also
be recorded by the QA scorecard program 110, for example at 18:32
hours. The individual components of the examination performance
time also may be recorded within the RIS by the QA scorecard
program 110, including the exam begin time, for example at 18:40
hours and exam completion time, for example at 18:45 hours. The
image exam may be transferred and saved to the PACS upon completion
by the QA scorecard program 110. Once the exam is saved to the
PACS, the QA scorecard program 110 may make the exam available to
the radiologist and the radiologist may be alerted accordingly. The
time that the image exam is recorded within the PACS, along with
the time the imaging exam was displayed and the time dictation was
completed may be recorded by the QA scorecard program 110, for
example at 19:01 hours. If, in this example, the radiologist used
speech recognition software to transcribe the dictated report, the
report completion time may be identical to the time dictation was
completed, for example at 19:01 hours.
[0147] Due to the emergent nature of the imaging exam (ordered
stat), the QA scorecard program 110 may immediately send the
imaging report to the referring clinician, such as via a Critical
Results Reporting program within the PACS. Receipt by the clinician
may be acknowledged and confirmed electronically by the QA
scorecard program 110, via the clinician's PDA, for example at
19:10 hours. Based on the positive findings of pulmonary embolism
(on the CTA report), the clinician in turn may access the QA
scorecard program 110 to immediately order initiation of
anti-coagulation therapy, with the time-stamped order recorded in
the EMR, for example at 19:14 hours.
[0148] Since all these events are recorded electronically within
the various information systems, they are available to be recorded
into the QA database, along with any corresponding analysis. The QA
scorecard program 110 may calculate metrics from various
parameters, including the exam completion time, such as the time
from order entry to exam completion: 37 minutes; reporting time,
such as the time from exam reviewed by radiologist to time report
received by clinician: 25 minutes; the time to initiate clinical
action, such as the time from report receipt to order entry into
EMR: 4 minutes; and the total exam to treatment cycle time, such as
time from exam order to treatment order: 66 minutes; among other
parameters.
[0149] According to one embodiment, the QA database and
time-stamped data elements within the QA database enable the
various time requirements to be quantified by the program 110 for
various components within the overall imaging/treatment cycle. By
doing so, an objective methodology is provided by the program 110
to assess clinician availability and responsiveness with regard to
imaging examination data. This time-stamped data becomes a valuable
tool for users, such as administrators and clinicians, to assess
overall workflow and identify bottlenecks and limitations within
the system. The QA database also provides valuable data to the
community at large as to the time efficiency of imaging service and
clinical providers.
[0150] When the imaging study does not include unexpected results
or emergent findings, the process proceeds to operation 408, where
the QA scorecard program 110 presents the imaging results to the
clinician. In operation 410, the QA scorecard program 110 may
present the clinician with support tools and facilitate a
consultation with the radiologist, as needed. The QA scorecard
program 110 may present decision support tools, including
computer-aided detection (CAD), specialized image processing,
electronic teaching files and other on-line educational resources
for patient management, such as the National Library of Medicine
(NLM) for literature searches.
[0151] In operation 412, the QA scorecard program 110 presents the
imaging study data including exposure levels and other parameters
of the imaging study. The imaging study data may be provided by the
program 110 from multiple sources, including the imaging modality,
such as acquisition parameters used to calculate radiation dose;
contrast injector technology, such as contrast-related data; EMR,
such as patient historical data; and radiology personnel
(radiologist, technologist, nurse). In operation 414, the QA
scorecard program 110 may store the imaging study data in a storage
device associated with RIS 20, among other storage devices. The
imaging study data may be associated by the program 110 with
clinical feedback information.
[0152] In operation 416, the QA scorecard program 110 calculates an
amount of patient radiation exposure. For example, the QA scorecard
program 110 may calculate the ionizing radiation that is associated
with each individual medical imaging exam, based on acquisition and
exposure parameters. The calculation may be performed prospectively
by the program 110 and may be stored to track longitudinal
radiation dose and carcinogenesis risk. In operation 418, HIS 10
and RIS 20, and/or other information sources, may be updated by the
program 110 to include the calculated safety factors.
[0153] According to one embodiment, in order to optimize safety
concerns and record/track cumulative data, the QA scorecard program
110 provides patient safety data at any location where the patient
is seeking and/or receiving medical imaging services. In the event
that the patient had a previous allergic reaction to contrast at
another medical imaging facility and the patient now presents with
altered mental status and cannot provide accurate historical data,
the QA scorecard program 110 provides access to the pre-existing
safety data before any imaging exam is performed. By storing the QA
Scorecard data within a universal EMR, this data is made accessible
by the program 110 to appropriate healthcare providers at any
location.
[0154] One method of providing universal accessibility for the data
is to use extensible mark-up language (XML). XML further enables
communication between disparate information technologies by
allowing creation of a standard tag for individual QA data
parameters. According to one embodiment, QA metrics may be employed
to define XML tags, such as examination time, technologist retake,
reject analysis, among other QA metrics. According to one
embodiment, XML tags may be communicated among information
technologies, such as modalities, information systems, PACS, EMR,
CPOE. According to one embodiment, XML tags may be automatically
downloaded into a universal QA database.
[0155] According to one embodiment, the QA scorecard program 110
may track, record and analyze longitudinal patient-specific safety
data and clinician-specific safety data, both an individual patient
and group basis. This provides insight as to whether individual
clinicians are over-utilizing certain types of "higher risk"
imaging studies and provides educational feedback to specific
clinicians. Additionally, mandatory educational resources may be
forwarded to targeted clinicians for completion before imaging
privileges are re-instated. This "clinician safety profile" data
and trending analyses may be correlated by the program 110 with
local, regional, and national norms, with data available to third
party payers and insurers to assist with economic incentive
programs (P4P) to encourage improved performance and continuing
medical education, as it relates to medical imaging safety
factors.
[0156] In operation 420, the QA scorecard program 10 may determine
whether or not patient safety factors are exceeded. If patient
safety factors are exceeded, then the QA scorecard program 110 may
refer the radiologist and technologist to a QA committee in
operation 422.
[0157] If patient safety factors are not exceeded, then the QA
scorecard program 110 may proceed to present the clinician with
external peer review results in operation 424. External peer review
serves as a mechanism for each clinician to be evaluated both
prospectively and retrospectively by their medical peers. According
to one embodiment, prospective evaluation may be provided by
radiologists that serve as imaging consultants and provide feedback
as to the efficacy of imaging exam utilization. According to one
embodiment, clinician peers may provide both prospective and
retrospective feedback as to the efficacy of clinical management,
following completion of the initial imaging exam. According to one
embodiment, utilization of consultants, laboratory and clinical
tests, and invasive procedures (e.g. surgical biopsy) play an
important role in diagnosis, while medical, surgical, and radiation
therapy all play a role in disease treatment. By random electronic
auditing of the CPOE and EMR, peer review can be directly
incorporated into patient management and provide an important
subjective tool for providing feedback to the clinician on imaging
service and clinical management. The data derived from this peer
review would be entered into a comprehensive QA database and
provided to the clinician on a periodic basis for educational
purposes, with trending analyses documenting "best practice"
guidelines relative to local, regional, and national peer
groups.
[0158] According to one embodiment, combined subjective and
objective feedback provides data to clinicians as to how their
performance is perceived by imaging service providers, such as
radiologists, and customers, such as patients. Radiologist may
provide feedback regarding availability and accessibility for
reporting, consultations, and queries related to the patient and
exam ordered. In addition, radiologists may provide data as to the
frequency and reliability of clinical feedback provided to them by
the clinicians. For example, if a radiologist reported a
nonspecific lung nodule on a chest CT exam and recommended PET scan
correlation, it is instructive for that radiologist to receive
follow-up information, in the event that the recommended PET scan
was performed at an outside institution. According to one
embodiment of the invention, feedback may be provided in an
automated fashion by the program 110 with the introduction of
pop-up menus and electronic auditing tools that track clinician
review of the imaging report and record their preferences. The
bi-directional nature of this feedback is ultimately aimed at
improving clinical outcomes and is equally important to both the
radiologist and the clinician. Clinician feedback is critical in
the overall evaluation of medical imaging services, including
report accuracy, recommended follow-up, and timeliness in
diagnosis.
[0159] According to one embodiment of the invention, the clinician
may also obtain feedback from the patient via electronic and/or
paper surveys. The feedback may include the patient's subjective
perceptions as to a number of factors, including conscientiousness,
education, responsiveness to questions, communication skills and/or
timeliness, among other factors. The feedback may be obtained from
the patient before the patient leaves the imaging department or
later via electronic or conventional mail. Questions may be posed
using a Likert scale to provide a quantitative value. Because
answers tend to be biased (some people grade too harshly, others
too easily), the scored answers may be extrapolated by the program
110 based on individual biases relative to the larger group.
Subjective answers may be reviewed by an impartial administrator
who records information into the QA database to identify consistent
trends.
[0160] Active participation in prospective data collection and
analysis is a component of the QA Scorecard and pay for performance
system. The data that is collected and analyzed by the program 110
provides the foundation for evaluating reports, diagnostic
accuracy, and clinical outcomes analysis.
[0161] It should be emphasized that the above-described embodiments
of the invention are merely possible examples of implementations
set forth for a clear understanding of the principles of the
invention. Variations and modifications may be made to the
above-described embodiments of the invention without departing from
the spirit and principles of the invention. All such modifications
and variations are intended to be included herein within the scope
of the invention and protected by the following claims.
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