Cross-organizational workflow in radiology: an empirical study of the quality of shared metadata elements in Region Västra Götaland, Sweden.

BACKGROUND: Challenges related to the cross-organizational access of accurate and timely information about a patient's condition has become a critical issue in healthcare. Interoperability of different local sources is necessary. PURPOSE: To identify and present missing and semantically incorrect data elements of metadata in the radiology enterprise service that supports cross-organizational sharing of dynamic information about patients' visits, in the Region Västra Götaland, Sweden. MATERIAL AND METHODS: Quantitative data elements of metadata were collected yearly from the first Wednesday in March from 2006 to 2011 from the 24 in-house radiology departments in Region Västra Götaland. These radiology departments were organized into four hospital groups and three stand-alone hospitals. Included data elements of metadata were the patient name, patient ID, institutional department name, referring physician's name, and examination description. RESULTS: The majority of missing data elements of metadata was related to the institutional department name for Hospital 2, from 87% in 2007 to 25% in 2011. All data elements of metadata except the patient ID contained semantic errors. For example, for the data element "patient name", only three names out of 3537 were semantically correct. CONCLUSION: This study shows that the semantics of metadata elements are poorly structured and inconsistently used. Although a cross-organizational solution may technically be fully functional, semantic errors may prevent it from serving as an information infrastructure for collaboration between all departments and hospitals in the region. For interoperability, it is important that the agreed semantic models are implemented in vendor systems using the information infrastructure.

Simulation of radiology workflow and throughput.

Emerging electronic health technologies create an unending transformation process. This calls for new ways to plan and prepare the radiology department for these changes. There is a lack of literature addressing ways to predict the effects of implementing and using new technologies in healthcare. Innovative services by means of simulation is a technique that could predict effects of changes beforehand. The aim of this study was to validate the use of discrete event simulation to plan future examination throughput changes in the radiology department of Alingsås Hospital in Sweden after both the investment in a new MRI suite and the closing down of two old rooms. The simulation scenario presented here was based on real life local examination throughput in combination with the total examination throughput from other radiology departments in the region already having MRI suites in use.

The use of simulation in radiology.

The aim of this study is to analyze how simulation has been used in healthcare (radiology, in particular) to predict the outcome of work practice changes. This is a literature study concerning different simulation models as a planning tool prior to changes in work practice. The radiology organization is in a transformation process. There is a lack of existing literature addressing ways to predict or imagine new technology in the context of its use in radiology work practice. Yet, studies also illustrate that data collection and mining is an excellent investment in understanding complex systems and how simulation models can be applied for change in radiology. If changes in work practices are a result of changing ourselves and the way we think about our work, simulation could be a technique to help the individual understand changes in the healthcare process.

My care pathways - creating open innovation in healthcare.

In this paper we describe initial results from the Swedish innovation project "My Care Pathways" which envisions enabling citizens to track their own health by providing them with online access to their historical, current and prospective future events. We describe an information infrastructure and its base services as well as the use of this solution as an open source platform for open innovation in healthcare. This will facilitate the development of end-user e-services for citizens. We have technically enabled the information infrastructure in close collaboration with decision makers in three Swedish health care regions, and system vendors as well as with National eHealth projects. Close collaboration between heterogeneous actors made implementation in real practice possible. However, a number of challenges, mainly related to legal and business issues, persist when implementing our results. Future work should therefore target the development of business models for sustainable provision of end-user e-services in a public health care system such as the Swedish one. Also, a legal analysis of the development of third party provider (nonhealthcare based) personal health data e-services should be done.

The effect of PACS on the practice of orthopaedic surgeons.

When new information and communication technologies are implemented there are organizational effects. Picture Archiving and Communication Systems (PACS) have been implemented not only within radiology but also within the orthopaedic context. We studied the impact of PACS on the work practice and professional role of orthopaedic surgeons in relation to radiologists. Qualitative interviews were performed with 15 surgeons at two hospitals. The interviews were transcribed, analysed and then coded using grounded theory. Three main categories were defined: professional role, diagnostic practice and technology used. There was a shift in orthopaedics from a single to a mixed profession, and from a relatively static practice in interpreting images to a more flexible practice, where every orthopaedic surgeon could view and access images from anywhere at any time, including three-dimensional imaging. It was easier for surgeons to see and interpret the images, and their diagnostic skills became accessible to everyone. The use of PACS also improved the dialogue with patients, according to the respondents. This was necessary in order to explain the treatment options for the patient or the details of the disease. PACS therefore acts as an information and communications technology and users required new knowledge and skills.

The impact of PACS on radiologists' work practice.

This paper identifies and analyzes how the implementation and use of picture archiving and communication system impacts radiologists' work practice. The study is longitudinal from 1999 to 2005 and have a qualitative perspective were data were collected by structured interviews in a total of 46. The interviews were transcribed, analyzed, and coded using grounded theory as an organizing principle. In radiologists' work practice, three main categories were defined: professional role, diagnostic practice, and technology in use. The changing trends within the professional role indicated that radiologists moved from a more individual professional expertise to become more of an actor in a network. The diagnostic practice changed, as reading x-ray films was seen as an art form in 1999, requiring years of training. Once everyone could view digital images, including 3-dimensional technology, it was easier for other clinicians to see and interpret the images and the skills become accessible to everyone. The change in technology in use as a result of the shift to digital images led to an increased specialization of the radiologist.