The impact of hospital consolidation on management of IR quality assurance
As hospitals and health systems consolidate, management of clinical departments often shifts to align with the structure of the new organization. In many cases, this means that an IR division that once operated independently with little or no oversight at the hospital corporate level now must report up to radiology and quality management within the health system. For IR division chiefs who find themselves responsible for not just their own IR department but also those of IR departments across the health system, managing quality and outcomes becomes a bigger challenge but can also offer greater opportunities for standardization of care and quality improvement.
In this article, three IR division leaders of large health systems shared their perspective on strategic and practical techniques for managing IR across multiple facilities.
Please tell us a little about your career path leading up to today.
James B. Spies, MD, MPH, FSIR: I am an interventional radiologist who came late to academics. I was in private practice for nearly 8 years before coming to Georgetown. Over the years, I was asked to take on different roles in the department, finally leading to my appointment as department chair in 2005.
David J. Spinosa, MD: I have a diverse background in medicine including 3 years as a surgical resident and 1 year as an emergency room physician before radiology residency and fellowship. I initially began my radiology career in private practice performing general and interventional radiology services, before working in an academic hospital system for about 9 years as an interventional radiologist with interests in research and teaching. I have spent the last 15 years in private practice as section chief for interventional radiology at a 950-bed hospital in Northern Virginia. During that time I became medical director of vascular operations for endovascular services for five hospitals within our hospital system. I am now president of a large radiology practice in Northern Virginia.
Greg Pilat, MBA: My early days as a technologist started in the early 1970s, where I held positions as a radiologic technologist, interventional technologist, clinical instructor, supervisor and then chief tech manager. In the early 1980s I moved into management where, in addition to the traditional responsibilities of imaging management, I also did stints of managing cardiology, cardiodiagnostics, GI lab, physical medicine and ambulatory care. About 18 years ago, I moved out of the acute care environment into a corporate position with oversight and planning responsibility for imaging services.
How do you define quality?
JS: It is therapeutic outcome, patient experience, safety and efficiency. You can’t have quality without all these.
DS: Quality is the adherence to a mutually agreed upon single standard of care across our system regardless of physician, specialty or hospital.
GP: At an institutional level and in its simplest terms, quality is how consistently individual inputs of work interact together to create the desired output, product or service.
How well is your electronic medical record (EMR) helping you meet the challenges you face when measuring quality in IR across an enterprise?
JS: It is not. EMRs are a sea of words without much meaning. It can’t provide easy answers to simple questions—complication rates, patient satisfaction, therapeutic benefit. One needs a more specialized program like HI-IQ to begin to answer these questions. It does not answer every question, but it provides more of the answers that I need than another program.
DS: For us, HI-IQ is critical in providing our practices a standardized method of collecting IR data and presenting that data in easy-to-understand reports that we can use to share with our physicians and administrators. HI-IQ is designed to target both IRs and other endovascular specialists in a way our hospital EMR is not. Because we are a five-hospital system, the new web-based enterprise HI-IQ product allows us to collect, tabulate, report and share this data and these reports from one location saving time, manpower and money and increasing transparency.
GP: I suspect the more contemporary EMRs have more robust data analytics capability than we generally take advantage of. Consistency in how you format and record your data is a basic prerequisite to data mining and data analytics. In my view, you are already at a disadvantage if you need a bunch of reference tables or cross-maps to normalize and compare your data from across different sites. This is especially common in enterprise environment where different EMRs or software versions are being used. In general, I always read the footnotes, asterisks and other notes when comparing data generated from disparate systems.
How do you use HI-IQ? Can you give a specific example of an improvement area you identified via the system and describe what steps you took to make improvements?
JS: It is our primary tool for managing our practice day to day, making sure we are efficient and that the work flows smoothly. In this, it is excellent. It also is our primary record of outcomes, particularly safety outcomes, and it is the only means that we have to summarize adverse events efficiently.
DS: We use HI-IQ to collect data for both IR and endovascular procedures across our five-hospital system. Physicians outside of IR also participate. The new web-based HI-IQ product allows us to collect data, produce standardized reports, and share this data with our physicians to monitor quality and productivity. The transparency in this process allows for input by both our physicians and administrators to set our yearly goals for service and continually monitor and improve our performance.
GP: I moved the enterprise IR services to HI-IQ primarily for three reasons:
- To ensure the data was being entered consistently, that we were all sharing the same operating definitions for the data being collected and that the data was being consistently captured. I wanted our clinicians and quality improvement teams to have a relatively easy-to-use single data repository, to record and analyze our site and system level IR data.
- To better understand and interpret the data before identifying best practices or opportunities for improvement. I wanted the data to be used as a tool for our IR clinicians and others to identify areas of best practices and opportunities that would result in improvements in patient care and clinical outcomes/results.
- So our clinicians could compare their results with other external performance benchmarks (like the ACR/SIR).
Do you think consolidation in health care is improving or reducing quality? How have you seen this play out in your organization?
JS: It depends on the physicians and others who are involved in the consolidation. Many systems that are consolidating, such as my own, are doing it with the goal of providing higher quality and more seamless care. We now can treat patients at any number of our centers and can escalate care easily as needed. When quality is the goal, consolidation can provide the resources and collaboration to make real improvements. This may not be the goal in all systems that are consolidating but, when it is, real progress can be made.
DS: To me there are four parts to a successful quality program for our system:
- Deciding to collect and report quality data in a standardized fashion. This decision is made by physicians in conjunction with hospital administrators.
- Determining the method (hardware/software) to collect and report data, then purchasing it. This requires physician leaders to decide on the best program for their hospital/system and hospital/system administrators to commit resources including people and money.
- Tabulating and reporting the data in a fair, unbiased way. This requires physician cooperation and team work, and hospital commitment to resources.
- Taking corrective action based on the results from the data collected. This requires a team approach to make meaningful changes to programs and people that the data directs to improve quality and care.
The first three parts require time and money, and the forth requires “will.” In my experience, larger systems have more resources, but less "will."
GP: With or without consolidation of the health care industry, I think there is no question that quality and clinical outcomes improve when clinicians are given the opportunity to share their experiences and best practices and compare their own data to that of their peers and others. The opportunity to share and learn is amplified when health care organizations come together and part of their stated goal is to standardize and develop best practices where possible.
Disclaimer: Please note that SIR is not responsible for any products or services offered by ConexSys, including HI-IQ. Nor is SIR responsible for any guarantees offered by ConexSys. Any concerns or questions about HI-IQ should be directed to ConexSys at (866) 604-4447.
About those interviewed for this article:
- James Spies [JS] is the Chairman, Chief of Service, and a Professor of the Department of Radiology at Medstar Georgetown University Hospital. He also serves on Medstar’s Interventional Clinical Practice Committee, where he owns responsibility for IR Quality Improvement across the nine (9) Medstar hospitals providing interventional radiology services.
- David Spinosa [DS] is Medical Director of Inova’s Vascular Center of Excellence, where he oversees endovascular services for Inova’s five hospitals. He was section chief of IR services at Inova Fairfax Hospital for 15 years and now is president of Fairfax Radiological Consultants, the largest private radiology practice in the mid Atlantic Region.
- Greg Pilat [GP] is the Radiology Systems Director for Advocate Healthcare, a network comprised of twelve (12) hospitals, which recently merged with Aurora Healthcare. Greg oversees the functionality and integration of all radiology systems throughout the Advocate hospitals.