Why Quality Matters in Diagnostic Imaging
Quality technology, experienced and properly motivated technologists, and a tech-physician relationship built on trust are the cornerstones of a top tier diagnostic imaging practice.
Find out not only how adopting a provider that excels in these three areas can take patient care to the next level, but also the toll a deficit in these areas can take on outcomes and the practices’ bottom line.
The Impact of Diagnostic Errors
The first visual confirmation that a condition exists within a patient’s body usually occurs during a diagnostic imaging session. Whether it’s an ultrasound, x-ray, MRI, or CT scan, diagnostic imaging adds tangibility to what may have just been a “feeling” for the patient prior to that point.
For the medical team, diagnostic imaging sets the foundation for the care plan. Establishing a relationship with an imaging provider can ensure better patient outcomes and compliance, but only if the images are precise and the interpretation is accurate and informative.
Errors in diagnosis can lead to adverse health events and, in some cases, death. In a Harvard Medical Practice Study of more than 30,000 patient records, diagnostic errors were identified in 17% of the adverse health events. Furthermore, of the estimated 850,000 individuals who die in U.S. hospitals each year, approximately 8.4% (71,400 deaths) are tied to a major diagnosis that remained undetected at the time of death.
These errors can also lead to significant financial impacts for the medical practice. Researchers analyzing malpractice claims data found that diagnostic errors were the leading type of paid claims (28.6%) and the highest proportion of total payments made (35.2%). Furthermore, diagnostic errors were almost twice as likely to be associated with patient death as other allegation categories (such as treatment, surgery, medication, or obstetrics claims).
During a 5-year study of over 500 medical malpractice claims from primary care practices, more than 70% of the allegations were related to diagnosis, underscoring the importance of taking all measures necessary for diagnostic accuracy
Errors Vary by Conditions, Diagnostic Tools
The prevalence of diagnostic errors varies based on the complexity of the condition and the inputs to diagnosing that condition. Four of the top five conditions appearing in malpractice cases are ones tightly connected with diagnostic imaging, including cancer, heart disease, vascular disease, and stroke.
In an insurance industry analysis of malpractice claims filed against more than 400 hospitals and 165,000 physicians (including more than 4,500 cases and more than $1 billion total incurred losses), cancer represented almost one-third of all the diagnosis-related medical malpractice claims.
Another study found that potential or probable errors resulted in missed diagnoses for 12.7% of patients admitted to emergency rooms with stroke symptoms. That suggests that up to 165,000 stroke diagnoses are missed in the United States healthcare system each year, with an even higher risk for missed diagnoses among younger, female, and white patients.
Defining Quality in Diagnostic Imaging Providers
Quality matters when performing diagnostic imaging, and it is important that healthcare professionals understand the difference that a quality study can make during a patient’s care.
In the past, it was not uncommon to hear a frustrated healthcare professional say, “why did we bother with the study?” when faced with inconclusive (or worse, inaccurate) diagnostic imaging results. A report with no definitive direction not only causes annoyance for the clinical team; it could cause a delay in treatment, a need for additional tests, and unnecessary psychological strain on the patient.
According to malpractice claims in the ambulatory care category, failure to order appropriate diagnostic tests has been found to account for 55% of missed or delayed diagnoses, making it the second most common factor contributing to a diagnostic error. Forming a complementary partnership with a quality diagnostic imaging provider creates a solid foundation for the patient’s treatment by providing the clinical team with thorough images and informative insights.
When defining what makes a quality imaging provider, there are really three primary areas to consider:
- Technologists – Who is performing the procedure?
- Technology – What equipment/tools are being used?
- Trust – Is there a solid relationship between the techs taking the images and the physicians reading them?
Within each of these areas, it’s important to understand how the provider approaches imaging, and what that approach could mean for the facility’s your care team and patients.
The first area to consider is the technologist performing the procedures. The technologist uses their knowledge and technique to capture images that inform the diagnosis, making them a critical part of defining quality for an imaging provider.
Technologists must be certified for the modality and techniques they are implementing, often specializing in different systems in the body. A Registered Diagnostic Cardiac Sonographer (RDCS) can perform echocardiograms, but they cannot perform a vascular study unless they have also met the requirements to be a Registered Vascular Technologist (RVT).
The gauge of quality in any profession goes beyond meeting the minimum requirements for certification, however. For example, how knowledgeable are the technologists with the machines being utilized? Are they engaging the patient properly and do they understand the condition being observed? It is important that the technologists are supported with ongoing training and access to resources for continued development.
In addition, it’s important to consider how a technologist’s compensation impacts their performance quality. Compensation structures drive activity, so a misalignment between the expectations for proper care, the need for quality images, and the way the technologist is motivated through compensation can work against a practice.
Most companies compensate technologists on an hourly or “per procedure” basis. Hourly rates mean the technologist needs to be in and out of the facility quickly, preventing them from building relationships with the staff or patients. This often leads to breakdowns in communication with practice staff and patients, increasing the likelihood of poor-quality studies and inconclusive results.
Plans that compensate technologists on a per procedure basis are also a risk for patients and providers. Per procedure plans compensate techs for performing as many procedures as possible, often causing them to sacrifice the time it takes to get a quality view of an image or limiting the breadth of images taken.
For example, an echocardiogram procedure is defined by a protocol of hundreds of anatomical images and videos that must be taken by the technologist in order to provide the detail and array of views needed for an interpreting physician to make a thorough and informed diagnosis. These studies should not be rushed or compromised because of improper compensation.
Finally, technologists need procedure protocols to be properly defined and they should receive constructive feedback from the interpreting physicians to help them stay in alignment with the requirements of each patient study. Ongoing communication between technologists and physicians leads to constant improvement to study quality and patient outcomes.
The next area to consider is the technology used by the diagnostic imaging provider. When considering this, it’s important to take into account not only the hardware being used for the imaging procedure, but also the systems supporting that procedure such as the Electronic Medical Record (EMR) and Picture and Communication System (PACS).
When looking at the hardware used in a procedure, it’s key to note whether the hardware is intended for the type of study being performed. Small, hand-held imaging tools are becoming increasingly available and useful in emergency situations, but they lack the sophistication necessary to get the complex images and measurements needed for a thorough diagnosis. Portable tools, such as the GE Vivid series of laptops, have advanced to the point where a trained technologist can provide hospital-quality imaging from the point of care.
But what happens to those images after they are taken? How do they get to the physicians? That is where a Picture and Communication System (PACS) comes into the workflow. A proper PACS should provide the technologist with easy, secure upload of imaging studies, allowing them to be transmitted electronically to the interpreting physician. Imaging providers utilizing a cloud-based PACS solution can provide facilities with increased, secure access to information beyond the physician’s report, including the images themselves.
Technology also supports the imaging provider in areas like scheduling and billing, making sure they have the right information to perform a procedure and ensure the company gets paid for it. Is the technologist focused on the patient or on filling out inefficient worklists during the procedure? Routing technologists efficiently by using technology that streamlines administrative tasks not only leads to job satisfaction for the techs; it also means on-time appointments and lower overhead costs passed to patients.
The final thing to consider when seeking a quality imaging provider is trust. Has the imaging provider built a relationship between the technologist and physicians interpreting the studies, is there an open dialogue that results in improved technique, and does the physician ultimately believe that the images they receive from the technologist provide an accurate representation of the patient’s condition?
All of that adds up to trust between the physician and the technologist, and a failure of trust often results in false or inconclusive results. In their analysis of malpractice claims, CRICO reported that 23% of cases had errors in diagnostic test interpretation, underscoring the importance of a constructive, trusted relationship between the technologist and the interpreting physician.
Imaging practices that focus on establishing trust do so in a variety of ways, from aligning training and imaging protocols with the physician’s needs to actively engaging the physicians and technologists in Quality Assurance meetings. Communication and constructive interactions are critical to maintaining the level of trust necessary to provide informed reports and minimize diagnostic errors.
New Frontier’s Diagnostic Imaging Approach
New Frontier is a new kind of diagnostic imaging company, focusing on providing quality care for our patients where they need it, when they need it.
From the start, New Frontier emphasized that a commitment to delivering quality imaging reports would be at the core of all of our decisions, and we defined the business structure to hire the right techs to use the right technology and work with the right interpreting physicians.
The Right Technologists
New Frontier only hires experienced, certified imaging technologists, and we invest in their long-term well-being. All full-time technologists are provided a salary, eliminating the pressures of hourly or procedure-based compensation. By doing this, New Frontier hopes to improve engagement with the patient and interactions with practice staff.
In addition, New Frontier implements ongoing training for technologists to maintain their certifications, provides a full suite of benefits, and engages the techs in ergonomics lessons to help encourage long-term health.
The Right Technology
New Frontier has also invested in solid technology to support the technologists’ imaging studies. Our techs perform procedures using hospital-grade imaging machines from GE and the latest cloud-based tools for storing imaging results, allowing us to share images securely and quickly with the interpreting physicians.
The Trust of the NFMD/Healient Partnership
Finally, New Frontier built trust into the workflow by fostering a strong relationship with Healient Physician Group, Kansas City’s premier physician practice covering cardiology, radiology, and wound care.
In forming the workflows in the business, New Frontier adopted the Healient protocols for imaging studies, ensuring our technologists deliver the images the physicians need to see to make a diagnosis. Healient physicians provide all of the interpretations for studies recorded by New Frontier technologists, and the teams actively engage in ongoing dialogue, training and quality assurance reviews.
Quality matters when it comes to choosing a partner for diagnostic imaging. To achieve meaningful, timely information about a patient’s condition, practices should seek companies that have integrated multiple layers of quality into the delivery of imaging services.
By hiring and training responsible, committed technologists, investing in high-quality, secure technology, and engaging in a trusted relationship with Healient Physician Group, New Frontier Mobile Diagnostics is redefining what it means to provide quality care to patients when they need it, where they need it.
Contact New Frontier today at (913) 428-9488 or info@NewFrontierMD.com to get started on an in-practice or in-facility diagnostic imaging pilot today.