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So this is a nice application that can sit on top of such system, where its easy to use interface allows for powerful searching capability across multiple different databases. Going a step further, radiology reports are a unique type of medical document. There are numerous nuances around the ways that radiologists dictate and write their reports, so we’ve created a tool that accounts for that. For example, let’s say that you’re searching for a report that discusses pneumothorax, which simply is a hole in the lung, causing presence of air between the lung and the chest wall. Now, many radiologists dictate absence of pneumothorax in chest radiography reports routinely. However, if you are doing a search for “pneumothorax”, you are likely looking for positive cases of pneumothorax and want to exclude all those reports that say, “there is no pneumothorax.”
Well, you can perform “negation searches” to remove all such cases so that you are left with only positive cases of pneuomothorax. Understanding such unique elements in any medical specialty are very important; this is why it is crucial to have domain expertise when creating search and data mining tools in medicine. That is also what makes Montage unique; it’s developed by physicians for physicians. We have also created various dashboards and analytics with quality assurance capabilities like error-checking within radiology reports to improve report quality and patient safety.
What lessons have you and your colleagues learned so far?
One thing is, when you give end-user physicians the ability to data mine and search their own reports, the ideas they come up with are absolutely fantastic—in particular, some really neat quality improvement projects have come out as a result. And you engage the younger guys; and by doing so you also promote academic research and quality improvement. So they’ll come up with things like, how many malpositioned catheterizations have there been in the past year? Or, how many times is the endotracheal tube being placed in too deeply? Or how many times a feeding tube is put into the airway instead of the esophagus? I’m sure the hospital has its own procedure and incident report database, but how often are radiologists identifying malpositioning?
How about how many times has a radiologist made a mistake and identified the wrong side of the body in his reports, such as a fracture of the left hand instead of the right hand? People really come up with creative ideas and solutions. Having this ability to search and data mine really empowers end-users. Speaking of the left and right issue, I have created a whole dashboard just on laterality errors—and when I first created this, the error rates were higher than I’d expected. But when I started sending out these error reports to physicians and when the physicians found out this was being monitored, the error rate dropped by almost 50 percent; purely the awareness that someone was watching dropped dictation error rates by more than half. Such behavior modification has been well documented so it’s no surprise, but it is nice to see such tools can be used to improve quality and patient safety.
And radiology is one of the specialties where a lot of people haven’t yet thought about quality improvement, right?
They have, but not enough. And this is just one specialty in medicine. But if you give this ability to do search, in a HIPAA-compliant fashion, the kind of information you can get is absolutely fantastic and mind-blowing.
What thoughts would you like to share with CIOs and other IT leaders?
People like to say in healthcare IT world we’re many years behind everyone else [outside healthcare] in terms of IT, such as financial/banking services. Now if you were a product in WalMart, WalMart knows exactly where you are and have been at all times. Yet how many times a day do we lose lab test results or have studies that go unread in healthcare? So if you look outside healthcare for potential paths forward, that will help. Take for example the whole concept of dashboards and business analytics; those tools have been used for decades outside healthcare. That’s why I like to look outside healthcare for ideas and implementation strategies. So the simple comment I would make to CIOs and CMIOs is, what do you do every day when you go online? Half of the time, you are searching for something. And imagine what you can do if you could do that inside your own hospital. And right now, if I took Google away from you, you’d feel pretty limited. We are living with just such limitations but don’t know just how much. The fact is that we don’t have Google-like search capabilities when it comes to patient care right now. But imagine what could happen if we really did have that ability.
