Conference coverage from RSNA 2014
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CMS has subjected thousands of general practitioners and hospital systems to meaningful use audits, and healthcare providers may have to pay back up to $33 million in federal EHR incentives after failing audits.
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Radiologists should expect the same scrutiny.
Alberto Goldszal, Ph.D., CIO of New Jersey's University Radiology, one of the biggest private radiology groups in the country and a presenter on meaningful use at the Radiological Society of North America (RSNA) 2014 meeting -- the group's 100th annual gathering -- said about 15 of his radiologists have been audited.
Radiologists should ready for meaningful use audits
They all passed. But others, unless they pay close attention to documenting their attestation to meaningful use measures, may not be as successful, Goldszal warned.
"You don't get money from the government and not expect to be audited," Goldszal told SearchHealthIT. "I don't think the audits are unreasonable. They ask what they should ask."
Goldszal and other meaningful use experts believe the biggest reason for failing the audits is when providers fail to document that they performed a security risk assessment and don't show they are set up to effectively safeguard patients' personal health information.
Security risk assessments are critical
Standard meaningful use measures -- including those involving patient engagement (such as the now fairly widespread patient portals) -- "are pretty straightforward, but when it comes to security, they're tougher," Goldszal said.
Although University Radiology has developed a plan to prepare for meaningful use audits, he said, radiologists should strongly consider hiring a consultant to help them, especially with the security assessment.
Advanced radiology workflow makes strides
Another RSNA presenter, Bradley Erickson, M.D., associate chair for radiology research at the Mayo Clinic in Rochester, Minn., specializes in radiology workflow efficiency and standards, among other radiology subspecialties.
Erickson's efforts with colleagues to establish a standard lexicon for radiology workflow events have already seen results; some 100 of the terms agreed upon have been included in RadLex, RSNA's larger lexicon of 68,000 radiology terms.
Erickson said standardizing workflow event terminology across radiology, and then using those standards to improve image turnaround times, can help meet meaningful use's emphasis on quality in stage 2 and stage 3.
Top 12 standard radiology events
For example, Erickson detailed a dozen basic workflow events that can be easily standardized:
1. Radiology examination ordered
2. Exam scheduled
3. Patient appears at radiology clinic front desk
4. Patient changes into examination clothes
5. Patient waits in waiting room
6. Patients enters imaging room
7. MRI, CT scan or other exam is performed
8. Patient leaves imaging room
9. Images sent to cardiologist or other specialist
10. Physician dictates report
11. Report is sent to EHR
12. Bill sent to patient
Radiology workflow engines coming?
The next step in the advancement of radiology informatics, Erickson maintained, is for EHR vendors to move from simply building databases into their systems to incorporating workflow engines. These would spit out graphical diagrams of the process so radiologists and the doctors they collaborate with can speed up turnaround, among other care improvements.
Erickson said one of his research teams at Mayo built just such a workflow engine out of an open source business process management program called Activiti. Then they designed it to trigger HL7 and DICOM image-sharing health IT pathways.
"We enabled it to speak medicine," he said.
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