RSNA News - March 2005

Paperless Environment Improves Radiologist Efficiency

I believe the real benefits go well beyond the radiologist and include very real improvements in efficiency, patient throughput, accuracy and patient safety throughout the department.
—Paul Chang,  M.D.

The transition from a film-based to a paperless environment is responsible for a significant improvement in a radiologist's efficiency, but many radiology departments still use paper to alert radiologists to completed studies.

In addition, upgrades for picture archiving and communication systems (PACS), such as integrated dictation and integrated clinical information, may be as important as PACS itself in improving the workflow of the reading room.

Jonathan L. Mates, M.D.

University of Pittsburgh Medical Center

Jonathan L. Mates, M.D., formerly of Henry Ford Hospital in Detroit, now with the University of Pittsburgh Medical Center (UPMC), presented the findings of a new study during a scientific paper session at RSNA 2004.

Dr. Mates and his UPMC colleagues conducted a workflow analysis that involved videotaping three radiologists dictating during their normal workload. Two of the radiologists were from Henry Ford Hospital; one was from UPMC.

UPMC has both a paperless and a seldom used paper-driven system, while Henry Ford Hospital has a partially integrated dictation system using a voice recognition application (Powerscribe) as well as an older, completely unintegrated dictation system using RTAS.

The researchers said they watched the videotapes and then categorized and classified the various dictation tasks. The four categories for dictation were:

• Session-level steps


• Patient or study ID steps


• Preparatory steps


• Dictation/interpretation steps

"We identified those steps which were most affected by the change to a paperless environment and measured the mean case dictation time and compared them between the various methods," Dr. Mates explained.

The researchers found that radiologists at the two institutions spent a similar amount of time interpreting images, but associated tasks took significantly less time in the more integrated environments. "There is less time spent on items like typing in patient information or dictating patient data. And that's just on the radiologist's side—we didn't even begin to discuss the improvements for the technologists," said co-author Barton Branstetter, M.D.

"We found that efficiency was improved when the integration between the dictation system and PACS was leveraged to automatically communicate information that was previously the responsibility of the radiologist," Dr. Mates said. "In other words, in the unintegrated, paper-driven systems, the radiologist had to barcode or type the study number into the dictation system and PACS separately. With an integrated, paperless system, the dictation system 'knows' from the PACS all the important study information."

As an example, Dr. Mates said that changing from a barcode and type system to a paperless system could save 19 seconds per case. A radiologist who reads 200 cases a day could be finished an hour earlier each day. At UPMC, they use their paperless system to read over 600,000 cases per year, theoretically saving enough time to account for nearly two full-time radiologists.

"With this type of robust, reliable integration, radiologists no longer have to act as a bridge between the two systems, and they can spend their time on the most important part of the workflow—interpreting the images," Dr. Mates said.

Co-author Paul Chang, M.D., said the impact of the paperless environment could be much broader, "I believe the real benefits go well beyond the radiologist and include very real improvements in efficiency, patient throughput, accuracy and patient safety throughout the department."

Dr. Mates cautioned that going paperless all by itself is not enough. The way in which it is done determines whether a department solves problems or creates new ones. "Worklist creation, for example, can make or break you," he said. "Worklist creation in the paper-driven environment consists of someone in the back room organizing a stack of papers. In the paperless workflow, this task has been given to the radiologist when he or she chooses studies from the worklist."

A poorly designed worklist could force a radiologist to spend an inordinate amount of time hunting through all the studies he or she is supposed to read. "This can lead to problems with efficiency, because of longer dictation times; morale, because of frustrated radiologists; and patient care, because of unread, overlooked studies," Dr. Mates concluded.

This story was adapted from an article that appeared in the RSNA 2004 Daily Bulletin.