US20090030731A1

US20090030731A1 - Method and apparatus for generating a patient quality assurance

Info

Publication number: US20090030731A1
Application number: US12/213,184
Authority: US
Inventors: Bruce Reiner
Original assignee: Individual
Current assignee: Individual
Priority date: 2006-01-30
Filing date: 2008-06-16
Publication date: 2009-01-29
Also published as: WO2007089686A3; US20070237308A1; US20070232868A1; US8301461B2; US7853476B2; US20070179811A1; US7532942B2; US20070239376A1; US20070239377A1; US20080294507A1; US7831445B2; WO2007089686A2

Abstract

The present invention provides a quality assurance system and method that generates a quality assurance (QA) scorecard for patients that use digital devices in a radiological-based medical imaging study. According to one embodiment, client computers, servers, imaging devices, databases, and/or other components may be coupled to provide a unified data collection system. According to one embodiment, systems and methods are provided that analyze various parameters that are derived from the unified data collection system to calculate a QA score for the patient. The QA score provides a combined subjective and objective feedback system that includes performance evaluations from other users, including clinicians, radiologists, technologists and administrators. According to one embodiment, the feedback may be provided in real-time.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patent application Ser. No. 11/699,349 filed Jan. 30, 2007, which claims priority from U.S. Provisional Patent Application No. 60/762,859, dated Jan. 30, 2006, U.S. Provisional Patent Application No. 60/763,353, dated Jan. 31, 2006, U.S. Provisional Patent Application No. 60/763,357, dated Jan. 31, 2006, U.S. Provisional Patent Application No. 60/771,482, dated Feb. 9, 2006, U.S. Provisional Patent Application No. 60/771,484, dated Feb. 9, 2006, the contents of which are herein incorporated by reference in their entirety.
This application is related to the following concurrently filed commonly owned U.S. patent applications entitled, “Method And Apparatus For Generating A Technologist Quality Assurance Scorecard” (Attorney Docket Nos. 71486.0036 filed Jan. 30, 2007); “Method And Apparatus For Generating An Administrative Quality Assurance Scorecard” (Attorney Docket Nos. 71486.0038 filed Jan. 30, 2007); “Method And Apparatus For Generating A Radiologist Quality Assurance Scorecard” (Attorney Docket Nos. 71486.0039 filed Jan. 30, 2007); and “Method And Apparatus For Generating A Clinician Quality Assurance Scorecard” (Attorney Docket Nos. 71486.0040 filed Jan. 30, 2007), the contents of all of which are herein incorporated by reference in their entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention
The present invention relates to a quality assurance (QA) system and method that quantitatively rates users that perform and/or participate in medical procedures, particularly in the area of radiology. The present invention relates to systems, methods and computer-based software programs that analyze data and generate QA scorecards for clinicians. In the process of doing so, a number of objective data are collected for real-time and future analysis, thereby providing objective feedback to clinicians for continuing quality improvement. In the end, the invention is intended to improve patient safety and overall clinical outcomes.
2. Description of the Related Art
The first and foremost priority for any QA program is to improve quality of service. As QA programs are implemented in the medical field, the ultimate goal is to improve patient care. To accomplish this goal, products and/or services should offer procedures for increasing accountability and improving feedback among users that participate in a medical study. This ultimately will enhance patient diagnosis and/or treatment, which leads to objective improvements in overall health outcomes.
Medical imaging has undergone a transition from film-based imaging technologies to digital imaging technologies. Digital imaging technologies provide digital processing capabilities, such as image capture, image archive, image transfer, and image display that may be shared among users to the medical study. Digital imaging technologies further allow data that is associated with the digital processing operations to be captured and combined with the underlying digital imaging processing operations.
Accordingly, a need exists to leverage digital imaging technologies to increase accountability and improve feedback among users that participate in a medical study.

SUMMARY OF THE INVENTION

The present invention relates to systems, methods and computer-based software programs that provide a QA scorecard for users that participate in a radiology imaging study. The QA scorecard provides the framework for developing a comprehensive medical imaging QA program that defines objective benchmarks. One of ordinary skill in the art will readily recognize that this invention may be applied to other medical disciplines, as well as to non-medical disciplines.
According to one embodiment, the invention is directed to radiological-based medical studies using digital imaging technologies. The medical studies are performed by users that perform discrete tasks in an imaging study workflow sequence. According to one embodiment of the invention, users include clinicians, radiologists, technologists, administrators and patients, among other users. A typical workflow sequence includes imaging exam ordering, imaging exam scheduling, imaging exam acquisition, imaging exam processing, imaging exam archiving, imaging exam distribution, imaging exam display, imaging exam navigation, imaging exam interpretation, imaging exam reporting, communication and billing, among other sequences.
According to one embodiment of the invention, client computers, one or more servers, the imaging devices, one or more databases, and/or other components may be coupled via a wired media, a wireless media, or a combination of the foregoing to provided a unified data collection system.
According to one embodiment of the invention, the client computers may include any number of different types of client terminal devices, such as personal computers, laptops, smart terminals, personal digital assistants (PDAs), cell phones, portable processing devices that combine the functionality of one or more of the foregoing or other client terminal devices.
According to one embodiment, the client computer may include client computer agent modules that gather client computer monitoring data based on user actions that are performed. According to another embodiment of the invention, user action data may include entering information, and/or performing other user actions.
According to one embodiment, the client computer may include client computer agent modules that gather client computer monitoring data based on computer actions that are performed. According to one embodiment of the invention, the client computer agent modules also may gather client computer specification data, such as IP address data, processing speed data, and other client computer specification data. According to one embodiment of the invention, the client monitoring data and/or client computer specification data may be provided in real-time. According to another embodiment of the invention, the client monitoring data and/or client computer specification data may be employed to calculate user QA metrics.
According to one embodiment, the metrics module 232 analyzes data that is associated with a defined list of quality assurance (QA) benchmarks to objectively evaluate patients, quantify a relative success of service participation and provide educational (data-driven) feedback in order to optimize participation, among other benefits. The QA metrics may be tied to economic incentives, such as a pay for performance (P4P) systems, to create financial rewards for those patients that actively participate in the imaging study.
According to one embodiment, a quantifiable list of pre-defined performance parameters may be used by the program 110 to measure overall performance of the patient relating to the QA scorecard include, utilization, such as preventing redundancy; scheduling; data input; compliance, including recommendations for follow-up; documentation of complications; workflow, including subjective feedback; communication; education; availability of EMR; and reporting, including clinical outcomes, adverse outcomes, and economic outcomes; among other predefined parameters. According to one embodiment of the invention, performance metrics may be calculated by the program 110 from various parameters, including completeness of data input, such as clinical history; utilization, including economic outcomes, clinical outcomes, and/or adverse outcomes; communication; timeliness, including time to participate in clinical action; feedback provided to the clinician, technologist and specialists, and/or education, among other predetermined parameters.
According to one embodiment of the invention, performance metrics may be calculated by the program from various parameters, including completeness of data input; utilization; communication; timeliness; feedback provided by the clinician, technologist and/or radiologist; and education; among other parameters.
According to one embodiment of the invention, the imaging devices may include any number of different types of imaging devices, such as magnetic resonance imaging (MRI) devices, computer tomograph (CT) imaging devices, angiograph imaging device, ultrasound imaging devices or other imaging devices.
According to one embodiment of the invention, the imaging devices may include, or be modified to include, imaging device agent modules. The imaging device agent modules may operate to provide data gathering and data exchange functionality. According to one embodiment, the invention may enable monitoring of actions that are performed on the imaging devices.
According to one embodiment of the invention, the imaging device agent modules may associate imaging device identifying information with actions that are performed on the imaging devices. According to one embodiment of the invention, data monitoring features may be employed to generate imaging device audit logs. According to one embodiment of the invention, image device audit logs may be produced to reconstruct actions, such as user actions, imaging device actions, and other actions that are performed on (or by) the imaging devices.
According to one embodiment of the invention, databases or information sources include a Hospital Information System (HIS) 10, a Radiology Information System (RIS) 20, a Picture Archiving and Communication System (PACS) 30, an Electronic Medical Record (EMR), a patient specific imaging datasheet and/or other information sources.
According to one embodiment of the invention, the server may include a merging module that receives data from all devices that are networked to the server, including the client computers, the imaging devices, and/or databases or information sources. According to one embodiment of the invention, the received data may include at least client computer audit log data and/or image device audit log data. According to one embodiment, the merging module merges data that is captured during a medical examination, including user action data, client computer action data, imaging device action data, and other data.
According to one embodiment of the invention, the data that is collected during the imaging study may be analyzed by a metrics module that performs prospective and retrospective trending analysis. The prospective and retrospective trending analysis enables automatic detection of immediate and recurrent problems, as they relate to equipment, personnel, data input, and overall workflow. The result of this automated technical QA analysis is that an automated and normalized analysis may be performed that minimizes subjectivity and human bias, among providing other benefits.
According to one embodiment of the invention, the metrics module may automatically tally and record QA scores. The QA scores may be cross-referenced by the computer program to a number of independent variables including a user identifier, imaging modality, exam type, patient demographics, patient characteristics, patient body habitus, exposure parameters, image processing, exam location, equipment, day/time of exam for trending analysis, radiologist identification, referring clinician, clinical indication, among other variables.
According to one embodiment of the invention, a standard tag may be created by the program within the various informational sources to identify individual QA data parameters. The communication module may extract the parameters from the information sources to calculate metrics and generate a QA score for patients.
According to one embodiment of the invention, the QA metrics module may analyze various parameters to calculate a QA score for the patient. According to one embodiment, the time-stamped data is a component part of objective data analysis. Imaging departments may utilize a program to record individual time-stamped data throughout the course of the imaging cycle, from the time an imaging exam is electronically ordered to the time the imaging report issued and reviewed. This is time-stamped data may be recorded into a QA database for subsequent analysis.
According to one embodiment, in order to optimize safety concerns and record/track cumulative data, the QA scorecard program provides patient safety data at any location where the patient is seeking and/or receiving medical imaging services. By storing the QA Scorecard data within a universal EMR, this data is made accessible to appropriate healthcare providers at any location.
Thus has been outlined, some features consistent with the present invention in order that the detailed description thereof that follows may be better understood, and in order that the present contribution to the art may be better appreciated. There are, of course, additional features consistent with the present invention that will be described below and which will form the subject matter of the claims appended hereto.
In this respect, before explaining at least one embodiment consistent with the present invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of the components set forth in the following description or illustrated in the drawings. Methods and apparatuses consistent with the present invention are capable of other embodiments and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein, as well as the abstract included below, are for the purpose of description and should not be regarded as limiting.
As such, those skilled in the art will appreciate that the conception upon which this disclosure is based may readily be utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the present invention. It is important, therefore, that the claims be regarded as including such equivalent constructions insofar as they do not depart from the spirit and scope of the methods and apparatuses consistent with the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a schematic diagram of a quality assurance scorecard system for radiology, according to one embodiment of the present invention.

FIG. 2 illustrates a schematic diagram of a quality assurance scorecard system for radiology, according to another embodiment of the present invention.

FIG. 3 illustrates a flow chart of a workflow sequence quality assurance program for an image examination from the perspective of a patient, according to one embodiment of the present invention.

DESCRIPTION OF THE INVENTION

The present invention relates to systems, methods, and computer-based software programs for generating quality assurance (QA) metrics, or scorecards, for clinicians that participate in radiological-based medical studies.
Radiological-based medical studies of the present invention are conducted using digital imaging technologies. The medical studies are performed by many users that perform discrete tasks in an imaging study workflow sequence. Typically, the workflow sequence is initiated by a clinician, such as a family practice physician, that examines a patient and orders an imaging examination. The clinician's staff contacts an imaging center and schedules the imaging examination. At the imaging center, a technologist operates one or more imaging devices to acquire patient images. In some cases, the number of patient images taken may total several hundred or several thousand images. During the image acquisition operation, the technologist may process the images, including applying algorithms to the raw imaging data in order to enhance selected image features, reconstructing the raw image data in different ways to optimize imaging views, and/or performing other image processing. Upon completion of the imaging examination, the patient may be discharged from the imaging facility and the images may be locally stored. Generally, imaging administrators periodically obtain the images from the local storage devices and archive the images in a database, such as a Picture Archival Retrieval System (PACS) and/or other imaging databases. The images may be archived and retrieved based on selected criteria, including patient name, patient reference number, patient identifier, physician identifier, and/or other selected criteria.
After the images are archived, the images may be distributed to one or more specialists, such as a radiologist. Alternatively, a message may be communicated to one or more specialists advising the specialists that the images are available and providing instructions for accessing the archived images from the PACS or other imaging databases. The radiologist may access the PACS or other imaging databases and may perform image display and image navigation functions. The radiologist interprets the images and may access decision support tools or other interpretation tools during the image interpretation process. Following the image interpretation, the radiologist may generate a report and/or otherwise communicate the image study results to the referring clinician, among others. Upon completion of the imaging process, the radiologist, an administrator, and/or other service provider may perform billing operations. Additionally, the administrator is tasked with defining the lines of responsibility for the participants of the imaging exam and for developing a comprehensive program that ensures appropriate levels of quality, while balancing economics, service deliverables and productivity. One of ordinary skill in the art will readily appreciate that the imaging study workflow sequence may include other operations.
According to one embodiment of the invention illustrated in FIG. 1, medical (radiological) applications may be implemented using the QA scorecard system 100. The QA scorecard system 100 is designed to interface with existing information systems such as a Hospital Information System (HIS) 10, a Radiology Information System (RIS) 20, a radiographic device 21, and/or other information systems that may access a computed radiography (CR) cassette or direct radiography (DR) system, a CR/DR plate reader 22, a Picture Archiving and Communication System (PACS) 30, and/or other systems. The QA scorecard system 100 may be designed to conform with the relevant standards, such as the Digital Imaging and Communications in Medicine (DICOM) standard, DICOM Structured Reporting (SR) standard, and/or the Radiological Society of North America's Integrating the Healthcare Enterprise (IHE) initiative, among other standards.
According to one embodiment, bi-directional communication between the QA scorecard system 100 of the present invention and the information systems, such as the HIS 10, RIS 20, radiographic device 21, CR/DR plate reader 22, and PACS 30, etc., may be enabled to allow the QA scorecard system 100 to retrieve and/or provide information from/to these systems. According to one embodiment of the invention, bi-directional communication between the QA scorecard system 100 of the present invention and the information systems allows the QA scorecard system 100 to update information that is stored on the information systems. According to one embodiment of the invention, bi-directional communication between the QA scorecard system 100 of the present invention and the information systems allows the QA scorecard system 100 to generate desired reports and/or other information.
The QA scorecard system 100 of the present invention includes a client computer 101, such as a personal computer (PC), which may or may not be interfaced or integrated with the PACS 30. The client computer 101 may include an imaging display device 102 that is capable of providing high resolution digital images in 2-D or 3-D, for example. According to one embodiment of the invention, the client computer 101 may be a mobile terminal if the image resolution is sufficiently high. Mobile terminals may include mobile computing devices, a mobile data organizer (PDA), or other mobile terminals that are operated by the user accessing the program 110 remotely.
According to one embodiment of the invention, an input device 104 or other selection device, may be provided to select hot clickable icons, selection buttons, and/or other selectors that may be displayed in a user interface using a menu, a dialog box, a roll-down window, or other user interface. The user interface may be displayed on the client computer 101. According to one embodiment of the invention, users may input commands to a user interface through a programmable stylus, keyboard, mouse, speech processing device, laser pointer, touch screen, or other input device 104.
According to one embodiment of the invention, the input or other selection device 104 may be implemented by a dedicated piece of hardware or its functions may be executed by code instructions that are executed on the client processor 106. For example, the input or other selection device 104 may be implemented using the imaging display device 102 to display the selection window with a stylus or keyboard for entering a selection.
According to another embodiment of the invention, symbols and/or icons may be entered and/or selected using an input device 104, such as a multi-functional programmable stylus. The multi-functional programmable stylus may be used to draw symbols onto the image and may be used to accomplish other tasks that are intrinsic to the image display, navigation, interpretation, and reporting processes, as described in U.S. patent application Ser. No. 11/512,199 filed on Aug. 30, 2006, the entire contents of which are hereby incorporated by reference. The multi-functional programmable stylus may provide superior functionality compared to traditional computer keyboard or mouse input devices. According to one embodiment of the invention, the multi-functional programmable stylus also may provide superior functionality within the PACS and Electronic Medical Report (EMR).
According to one embodiment of the invention, the client computer 101 may include a processor 106 that provides client data processing. According to one embodiment of the invention, the processor 106 may include a central processing unit (CPU) 107, a parallel processor, an input/output (I/O) interface 108, a memory 109 with a program 110 having a data structure 111, and/or other components. According to one embodiment of the invention, the components all may be connected by a bus 112. Further, the client computer 101 may include the input device 104, the image display device 102, and one or more secondary storage devices 113. According to one embodiment of the invention, the bus 112 may be internal to the client computer 101 and may include an adapter that enables interfacing with a keyboard or other input device 104. Alternatively, the bus 112 may be located external to the client computer 101.
According to one embodiment of the invention, the image display device 102 may be a high resolution touch screen computer monitor. According to one embodiment of the invention, the image display device 102 may clearly, easily and accurately display images, such as x-rays, and/or other images. Alternatively, the image display device 102 may be implemented using other touch sensitive devices including tablet personal computers, pocket personal computers, plasma screens, among other touch sensitive devices. The touch sensitive devices may include a pressure sensitive screen that is responsive to input from the input device 104, such as a stylus, that may be used to write/draw directly onto the image display device 102.
According to another embodiment of the invention, high resolution goggles may be used as a graphical display to provide end users with the ability to review images. According to another embodiment of the invention, the high resolution goggles may provide graphical display without imposing physical constraints of an external computer.
According to another embodiment, the invention may be implemented by an application that resides on the client computer 101, wherein the client application may be written to run on existing computer operating systems. Users may interact with the application through a graphical user interface. The client application may be ported to other personal computer (PC) software, personal digital assistants (PDAs), cell phones, and/or any other digital device that includes a graphical user interface and appropriate storage capability.
According to one embodiment of the invention, the processor 106 may be internal or external to the client computer 101. According to one embodiment of the invention, the processor 106 may execute a program 110 that is configured to perform predetermined operations. According to one embodiment of the invention, the processor 106 may access the memory 109 in which may be stored at least one sequence of code instructions that may include the program 110 and the data structure 111 for performing predetermined operations. The memory 109 and the program 110 may be located within the client computer 101 or external thereto.
While the system of the present invention may be described as performing certain functions, one of ordinary skill in the art will readily understand that the program 110 may perform the function rather than the entity of the system itself.
According to one embodiment of the invention, the program 110 that runs the QA scorecard system 100 may include separate programs 110 having code that performs desired operations. According to one embodiment of the invention, the program 110 that runs the QA scorecard system 100 may include a plurality of modules that perform sub-operations of an operation, or may be part of a single module of a larger program 110 that provides the operation.
According to one embodiment of the invention, the processor 106 may be adapted to access and/or execute a plurality of programs 110 that correspond to a plurality of operations. Operations rendered by the program 110 may include, for example, supporting the user interface, providing communication capabilities, performing data mining functions, performing e-mail operations, and/or performing other operations.
According to one embodiment of the invention, the data structure 111 may include a plurality of entries. According to one embodiment of the invention, each entry may include at least a first storage area, or header, that stores the databases or libraries of the image files, for example.
According to one embodiment of the invention, the storage device 113 may store at least one data file, such as image files, text files, data files, audio files, video files, among other file types. According to one embodiment of the invention, the data storage device 113 may include a database, such as a centralized database and/or a distributed database that are connected via a network. According to one embodiment of the invention, the databases may be computer searchable databases. According to one embodiment of the invention, the databases may be relational databases. The data storage device 113 may be coupled to the server 120 and/or the client computer 101, either directly or indirectly through a communication network, such as a LAN, WAN, and/or other networks. The data storage device 113 may be an internal storage device. According to one embodiment of the invention, QA scorecard system 100 may include an external storage device 114. According to one embodiment of the invention, data may be received via a network and directly processed.
According to one embodiment of the invention, the client computer 101 may be coupled to other client computers 101 or servers 120. According to one embodiment of the invention, the client computer 101 may access administration systems, billing systems and/or other systems, via a communication link 116. According to one embodiment of the invention, the communication link 116 may include a wired and/or wireless communication link, a switched circuit communication link, or may include a network of data processing devices such as a LAN, WAN, the Internet, or combinations thereof. According to one embodiment of the invention, the communication link 116 may couple e-mail systems, fax systems, telephone systems, wireless communications systems such as pagers and cell phones, wireless PDA's and other communication systems.
According to one embodiment of the invention, the communication link 116 may be an adapter unit that is capable of executing various communication protocols in order to establish and maintain communication with the server 120, for example. According to one embodiment of the invention, the communication link 116 may be implemented using a specialized piece of hardware or may be implemented using a general CPU that executes instructions from program 110. According to one embodiment of the invention, the communication link 116 may be at least partially included in the processor 106 that executes instructions from program 110.
According to one embodiment of the invention, if the server 120 is provided in a centralized environment, the server 120 may include a processor 121 having a CPU 122 or parallel processor, which may be a server data processing device and an I/O interface 123. Alternatively, a distributed CPU 122 may be provided that includes a plurality of individual processors 121, which may be located on one or more machines. According to one embodiment of the invention, the processor 121 may be a general data processing unit and may include a data processing unit with large resources (i.e., high processing capabilities and a large memory for storing large amounts of data).
According to one embodiment of the invention, the server 120 also may include a memory 124 having a program 125 that includes a data structure 126, wherein the memory 124 and the associated components all may be connected through bus 127. If the server 120 is implemented by a distributed system, the bus 127 or similar connection line may be implemented using external connections. The server processor 121 may have access to a storage device 128 for storing preferably large numbers of programs 110 for providing various operations to the users.
According to one embodiment of the invention, the data structure 126 may include a plurality of entries, wherein the entries include at least a first storage area that stores image files. Alternatively, the data structure 126 may include entries that are associated with other stored information as one of ordinary skill in the art would appreciate.
According to one embodiment of the invention, the server 120 may include a single unit or may include a distributed system having a plurality of servers 120 or data processing units. The server(s) 120 may be shared by multiple users in direct or indirect connection to each other. The server(s) 120 may be coupled to a communication link 129 that is preferably adapted to communicate with a plurality of client computers 101.
According to one embodiment, the present invention may be implemented using software applications that reside in a client and/or server environment. According to another embodiment, the present invention may be implemented using software applications that reside in a distributed system over a computerized network and across a number of client computer systems. Thus, in the present invention, a particular operation may be performed either at the client computer 101, the server 120, or both.
According to one embodiment of the invention, in a client-server environment, at least one client and at least one server are each coupled to a network 220, such as a Local Area Network (LAN), Wide Area Network (WAN), and/or the Internet, over a communication link 116, 129. Further, even though the systems corresponding to the HIS 10, the RIS 20, the radiographic device 21, the CR/DR reader 22, and the PACS 30 (if separate) are shown as directly coupled to the client computer 101, it is known that these systems may be indirectly coupled to the client over a LAN, WAN, the Internet, and/or other network via communication links. According to one embodiment of the invention, users may access the various information sources through secure and/or non-secure internet connectivity. Thus, operations consistent with the present invention may be carried out at the client computer 101, at the server 120, or both. The server 120, if used, may be accessible by the client computer 101 over the Internet, for example, using a browser application or other interface.
According to one embodiment of the invention, the client computer 101 may enable communications via a wireless service connection. The server 120 may include communications with network/security features, via a wireless server, which connects to, for example, voice recognition. According to one embodiment, user interfaces may be provided that support several interfaces including display screens, voice recognition systems, speakers, microphones, input buttons, and/or other interfaces. According to one embodiment of the invention, select functions may be implemented through the client computer 101 by positioning the input device 104 over selected icons. According to another embodiment of the invention, select functions may be implemented through the client computer 101 using a voice recognition system to enable hands-free operation. One of ordinary skill in the art will recognize that other user interfaces may be provided.
According to another embodiment of the invention, the client computer 101 may be a basic system and the server 120 may include all of the components that are necessary to support the software platform. Further, the present client-server system may be arranged such that the client computer 101 may operate independently of the server 120, but the server 120 may be optionally connected. In the former situation, additional modules may be connected to the client computer 101. In another embodiment consistent with the present invention, the client computer 101 and server 120 may be disposed in one system, rather being separated into two systems.
Although the above physical architecture has been described as client-side or server-side components, one of ordinary skill in the art will appreciate that the components of the physical architecture may be located in either client or server, or in a distributed environment.
Further, although the above-described features and processing operations may be realized by dedicated hardware, or may be realized as programs having code instructions that are executed on data processing units, it is further possible that parts of the above sequence of operations may be carried out in hardware, whereas other of the above processing operations may be carried out using software.
The underlying technology allows for replication to various other sites. Each new site may maintain communication with its neighbors so that in the event of a catastrophic failure, one or more servers 120 may continue to keep the applications running, and allow the system to load-balance the application geographically as required.
Further, although aspects of one implementation of the invention are described as being stored in memory, one of ordinary skill in the art will appreciate that all or part of the invention may be stored on or read from other computer-readable media, such as secondary storage devices, like hard disks, floppy disks, CD-ROM, a carrier wave received from a network such as the Internet, or other forms of ROM or RAM either currently known or later developed. Further, although specific components of the system have been described, one skilled in the art will appreciate that the system suitable for use with the methods and systems of the present invention may contain additional or different components.
FIG. 2 illustrates the QA scorecard system 100 for providing QA assessments of clinicians that access a radiology system, according to one embodiment of the invention. According to one embodiment, the client computers 101 a-101 n (hereinafter client computers 101), one or more servers 120, the imaging devices 210 a-210 n (hereinafter imaging devices 210), one or more databases (HIS 10, RIS 20, PACS 30, etc.), and/or other components may be coupled via a wired media, a wireless media, or a combination of the foregoing. According to one embodiment of the invention, the client computers 101, the server 120, the imaging devices 210, and the databases may reside in one or more networks, such as an internet, an intranet, or a combination thereof.
According to one embodiment of the invention, the client computers 101 may include any number of different types of client terminal devices, such as personal computers, laptops, smart terminals, personal digital assistants (PDAs), cell phones, portable processing devices that combine the functionality of one or more of the foregoing or other client terminal devices,
According to another embodiment of the invention, the client computers 101 may include several components, including processors, RAM, a USB interface, a telephone interface, microphones, speakers, a stylus, a computer mouse, a wide area network interface, local area network interfaces, hard disk drives, wireless communication interfaces, DVD/CD readers/burners, a keyboard, a flat touch-screen display, a computer display, and/or other components. According to yet another embodiment of the invention, client computers 101 may include, or be modified to include, software that may operate to provide data gathering and data exchange functionality.
According to one embodiment of the invention, the client computers 101, the servers 120, and/or the imaging devices 210 may include several modules. The modular construction facilitates adding, deleting, updating and/or amending modules therein and/or features within modules. The client computer 101 may include various modules, including a user interface module 220, an authentication module 222, a communications module 224, an agent module 226, and an alert module 228 and/or other modules. The servers 120 may include various modules, including a server communication module 230, a merging module 231, a metrics module 232, a server authentication module 234, a notification module 236, a report generating module 238, a sorting module 240, a billing module 242, and/or other modules. The imaging devices 210 may include various modules, including a communications module 212, an authentication module 214, an agent module 216 and/or other modules, along with a local storage device 219. It should be readily understood that a greater or lesser number of modules might be used. One skilled in the art will readily appreciate that the invention may be implemented using individual modules, a single module that incorporates the features of two or more separately described modules, individual software programs, and/or a single software program.
According to one embodiment of the invention, the client computer 101 may communicate through a networking application. According to another embodiment, the user interface modules 220 a-220 n (hereinafter user interface modules 220) may support several interfaces including display screens, voice recognition systems, speakers, microphones, input buttons, and/or other interfaces. According to one embodiment of the invention, the user interface modules 220 may display the application on a user interface associated with the client computer 101. According to one embodiment of the invention, select functions may be implemented through the client computer 101 by positioning an indicator over selected icons and manipulating an input device 104, such as a stylus, a mouse, a keyboard, or other input devices.
With regard to user authentication, the authentication modules 222 a-222 n (hereinafter user authentication modules 222) may employ one of several different authentication schemes, as would be appreciated by those skilled in the art. According to one embodiment of the invention, the user authentication modules 222 may prompt users to input alphanumeric code or other identifying information. According to another embodiment of the invention, the user authentication modules 222 may prompt users to provide biometric information (i.e., a thumbprint through a fingerprint scanner) or other suitable identifying information. If the user is not identified, then the user may be invited to resubmit the requested identification information or to take other action.
According to one embodiment of the invention, the client computers 101 may include communication modules 224 a-224 n (hereinafter communication modules 224) for enabling the client computers 101 to communicate with systems, including other client computers, the servers 120, the imaging devices 210, the databases and/or other systems. The client computers 101 may communicate via communications media 201 such as, for example, any wired and/or wireless media. Communications between the client computers 101, the imaging devices 210, the servers 120, and the databases may occur substantially in real-time, when the devices are coupled to the network. According to one embodiment of the invention, the communications module 224 may communicate with the servers 120 to exchange data, wherein the data exchange may occur with or without user awareness of the data exchange.
According to an alternative embodiment of the invention, communications may be delayed for an amount of time if, for example, one or more client computers 101, the server 120, the imaging devices 210, and/or the databases are not coupled to the network. According to one embodiment of the invention, any requests that are submitted while devices are not coupled to the network may be stored and propagated from/to the offline client computer 101, the databases and/or the imaging devices 210 when the target devices are re-coupled to the network. One of ordinary skill in the art will appreciate that communications may be conducted in various ways and among various devices.
According to one embodiment of the invention, user authentication information and/or identification information may be forwarded to the servers 120 to perform various functions. According to another embodiment of the invention, the servers 120 may operate to coordinate communications between the applications that are associated with the client computers 101, the imaging devices 210, and/or the databases.
According to one embodiment of the invention, the client computers 101 may include, or be modified to include, client computer agent modules 226 a-226 n (hereinafter client computer agent modules 226). The client computer agent modules 226 may operate to provide data gathering and data exchange functionality. According to one embodiment, the invention may enable monitoring of actions that are performed on the client computers 101.
According to one embodiment of the invention, the client computer agent modules 226 may associate client computer identifying information with actions that are performed on the corresponding client computers 101. According to one embodiment of the invention, data monitoring features may be employed to generate client computer audit logs. According to one embodiment of the invention, client computer audit logs may be produced to reconstruct actions, such as user actions, computer actions, and/or other actions that are performed on (or by) the client computers 101.
According to one embodiment, the client computer agent modules 226 may gather client computer monitoring data based on user actions performed, such as user login information; data files and databases that are accessed; information that is requested, including patient names/identifiers, exam results; information that is retrieved; client computer access information, including user information, time of access, time of exit, etc.; the application(s) that are used; information that is obtained from the server 120, including time of access, patient identifiers, volume of data retrieved, etc.; information that is obtained from the imaging devices 210, including time of access, patient identifiers, volume of data retrieved, etc.; information that is processed at the client computer 101, including time stamp information; and other user action data. According to another embodiment of the invention, user action data may include accessing digital images, reviewing digital images, manipulating digital images, marking digital images, storing digital images, forwarding digital images, adjusting exposure parameters on digital imaging devices, generating a report, generating a textual report, dictating a report, entering information, conducting continuing medical education (CME) triggered by performing the medical examination, and/or performing other user actions.
According to one embodiment, the client computer agent modules 226 may gather client computer monitoring data based on computer actions performed, such as when data is exchanged; the type of input device used; whether reports are printed; when data is saved; an Internet Protocol (IP) address of devices that are communicated with; a location of data storage/retrieval; etc.; and/or other computer action data. According to one embodiment of the invention, the client computer agent modules 226 also may gather client computer specification data, such as IP address data, processing speed data, and other client computer specification data According to one embodiment of the invention, the client monitoring data and/or client computer specification data may be provided in real-time. According to another embodiment of the invention, the client monitoring data and/or client computer specification data may be employed to calculate user QA metrics.
According to one embodiment of the invention, the server 120 may include a server authentication module 234 that receives authentication information that is entered into a corresponding client computer 101 via the authentication modules 222. The server authentication module 234 may compare the identifying information with existing records and operate as a gatekeeper to the QA scorecard system 100. If the user is determined to be a registered user, the authentication module 234 may attempt to authenticate the registered user by matching the entered authentication information with access information that exists on the servers 120. If the user is not authenticated, then the user may be invited to resubmit the requested identifying information or take other action. If the user is authenticated, then the servers 120 may perform other processing. For example, the client computers 101 may receive information from the servers 120 and/or from another authenticated client computers.
According to one embodiment of the invention, the imaging devices 210 may include any number of different types of imaging devices, such as magnetic resonance imaging (MRI) devices, computer tomograph (CT) imaging devices, angiograph imaging device, ultrasound imaging devices or other imaging devices. According to another embodiment of the invention, the imaging devices 210 may include several components such as processors, databases 219 a-219 n (hereinafter databases 219), RAM, a USB interface, a telephone interface, microphones, speakers, a stylus, a computer mouse, a wide area network interface, local area network interfaces, hard disk drives, wireless communication interfaces, a keyboard, a flat touch-screen display, a computer display, and/or other components.
According to one embodiment of the invention, the imaging devices 210 may include, or be modified to include, imaging device agent modules 216 a-216 n (hereinafter imaging device agent modules 216). The imaging device agent modules 216 may operate to provide data gathering and data exchange functionality. According to one embodiment, the invention may enable monitoring of actions that are performed on the imaging devices 210.
According to one embodiment of the invention, the imaging device agent modules 216 may associate imaging device identifying information with actions that are performed on the imaging devices 210. According to one embodiment of the invention, data monitoring features may be employed to generate imaging device audit logs. According to one embodiment of the invention, image device audit logs may be produced to reconstruct actions, such as user actions, imaging device actions, and other actions that are performed on (or by) the imaging devices 210.
According to one embodiment, the imaging device agent modules 216 may gather image device monitoring data based on user actions performed, such as user login information; imaging modalities; parameters that are selected to perform the imaging modalities, including motion information, positioning information, exposure information, artifact information, collimation information; number of times an imaging exam is performed; data files and databases that are accessed; information that is requested, including patient names/identifiers; information that is retrieved; imaging device access information, including user information, time of access, time of exit, etc.; information that is stored to the server 120, including time of storage, patient identifiers, volume of data stored, etc.; information that was obtained from the imaging devices 210, including time of access, patient identifiers, volume of data stored, etc.; information that was processed at the imaging device 210, including time stamp information; and other user action data.
According to one embodiment, the imaging device agent modules 216 may gather imaging device monitoring data based on imaging device actions performed, such as when data is exchanged; the type of input device used; whether reports are printed; when data was saved; an Internet Protocol (IP) address of devices that were communicated with; a location of data storage/retrieval; imaging device parameter adjustments; and other imaging device data. According to one embodiment of the invention, the imaging device agent modules 216 also may gather imaging device specification data, such as resolution data, IP address data, processing speed data, and other imaging device specification data. According to one embodiment of the invention, the imaging device monitoring data and/or imaging device specification data may be stored in database 219. According to one embodiment of the invention, the imaging device monitoring data and/or imaging device specification data of the program 110 may be provided in real-time. According to another embodiment of the invention, the imaging device monitoring data and/or imaging device specification of the program 110 may be employed to calculate user QA metrics. The inventor has previously submitted an application describing an apparatus for automating QA in medical imaging, as described in U.S. patent application Ser. No. 11/412,884 filed on Apr. 28, 2006, the entire contents of which are hereby incorporated by reference.
According to one embodiment of the invention, the server 120 may include a merging module 231 that receives data from all devices that are networked to the server 120, including the client computers 101, the imaging devices 210, and/or databases. According to one embodiment of the invention, the received data may include at least client computer audit log data and/or image device audit log data. The merging module 231 may locally store the received data in a storage device 260 and/or may store the received data in an external storage device. The merging module 231 merges data that is captured during a medical examination, including user action data, client computer action data, imaging device action data, and other data.
According to one embodiment of the invention, the server 120 may include a sorting module 240 that enables sorting of the data, including the merged data. According to one embodiment of the invention, the sorting module 240 may sort the data based on various sorting criteria, including the chronology of data receipt, the type of device that originated the data, the type of technology used to obtain the data (e.g. CT, MRI, sonogram, etc.), the type of institution in which a data was obtained, the type of professional that obtained the data (i.e., radiologist, technologist, etc.), the user that is associated with the data, the patient that is associated with the data, demographic information, patient population information, the workflow sequence in which the data was captured, the severity of exam results, and/or other sorting criteria. According to one embodiment of the invention, the sorted data may enable tracking, reconstruction, reporting and/or monitoring of actions that are performed during medical examinations. According to one embodiment of the invention, the criteria associated with medical examinations may be used by the program to calculate QA scorecard metrics.
According to one embodiment of the invention, the server 120 may include a communications module 230 that communicates with the client computer 101, imaging devices 210 and/or databases to obtain information regarding the status of the imaging study along a defined workflow sequence. According to one embodiment of the invention, a defined workflow sequence includes various operations, such as image exam ordering, image exam scheduling, image exam acquisition, image processing, image archiving, image navigation, image interpretation, image exam reporting, image exam communication, and/or image exam billing. According to one embodiment of the invention, the communications module 230 provides the status of the imaging study workflow sequence including identifying the current user that is responsible for the image study, a completion percentage of the current stage of the imaging study, and/or other status information. According to one embodiment of the invention, the status of the imaging study workflow may be communicated to users in real-time and/or stored. According to one embodiment of the invention, parameters may be derived from the status of the imaging study workflow sequence by the program 110 to generate a QA scorecard for the various users.
According to one embodiment of the invention, the server 120 may include a report generating module 238 that generates reports based on the occurrence of pre-defined events, including a periodic query of the status of the imaging study, an interpretation that is forwarded by the radiologist, a clinical finding that is submitted by the clinician, and/or the occurrence of other pre-defined events.
According to one embodiment of the invention, the server 120 may include a billing module 242. According to one embodiment, the billing module 242 performs billing functions following completion of the reporting/communication process. The billing module 242 may analyze metrics to assess operational efficiency and accuracy of charges billed and to calculate any additional expenses that occur due to limitations in reporting by users, such as radiologists. According to one embodiment, the additional expenses may take a number of forms and may result from uncertainty and equivocation within the radiology report or radiologist recommendations for additional imaging exams, consultations, and procedures (e.g. biopsy). The billing module 242 may correlate imaging costs with quality of service deliverables, such as diagnostic accuracy and clinical outcomes.
According to one embodiment of the invention, the server 120 may include a scheduling module 244 that enables electronic scheduling, including image exam scheduling. According to one embodiment, the scheduling module 244 may include bi-directional electronic scheduling that provides real-time tracking features to update parties of scheduling changes. The scheduling module 244 may communicate with the communication module 230 and/or notification module 236, among other modules, to communicate the status of an appointment to users in real-time and/or stored.
According to one embodiment of the invention, the server 120 may include a notification module 236 that generates notifications and/or alerts based on the completion of reports, scheduling events, or the occurrence of predefined events. The notifications may be triggered by the release of items, such as status information, completion of an imaging report, changes to appointments and/or other items. The notification module 236 may include monitoring features and/or confirmation features that track and record events, including the date and time that a notification is sent, the date and time that a notification is delivered, the date and time that a notification is opened, such as by return of an acknowledge receipt message, among other events. According to one embodiment, the notification module 236 may generate and forward notifications and/or alerts to client computers 101 and/or mobile devices, using known communication techniques including electronic mail messages, voice messages, telephone messages, text messages, instant messages, facsimile, and/or other communication techniques.
According to one embodiment of the invention, variables that are determined to have a deficiency during the imaging study process and that exceed a pre-determined QA standard threshold may trigger the computer program 110 to produce a notification and/or alert through the notification module 236 that may be instantaneously sent to users, via one or more communications techniques, alerting users as to the specific type of deficiency and requirement for correction.
According to one embodiment of the invention, a minimal amount of the data that is processed at the servers 120 may be stored in storage device 260 by the program 110. In other words, the servers 120 may perform data gathering and/or document generating functions and may thereafter purge all or portions of the retrieved data according to specified criteria. As a result, according to one embodiment, the program 110 may minimize security risks associated with exposing any confidential medical records to unauthorized parties at the servers 120. According to another embodiment of the invention, the retrieved data may be stored at the servers 120 by the program 110 for a predetermined amount of time before being purged. According to yet another embodiment of the invention, public record information, non-confidential retrieved data, and/or tracking information, such as client computer log files and/or image device log files may be stored in storage device 260 by the program 110.
According to one embodiment of the invention, the metrics module 232 may receive objective scores, such as a Likert scale of 1-4, to quantify user performance. For example, a score of 1 may be considered “non-diagnostic”. This means little or no clinically useful (diagnostic) information is contained within the image study. Since the available information obtained during the examination of the patient does not answer the primary clinical question (i.e., indication for the study), then by definition this requires that the imaging exam be repeated for appropriate diagnosis.
A score of 2 may be considered “limited”. This means that the information obtained during the image study is less than expected for a typical examination of this type. However, the information contained within the image study is sufficient to answer the primary clinical question. A requirement that this exam be repeated is not absolute, but is preferred, in order to garner maximal diagnostic value.
A score of 3 may be considered “diagnostic”. This means that the information obtained during the image study is representative of the broad spectrum of comparable images, allowing for the patient's clinical status and compliance. Both the primary clinical question posed, as well as ancillary information, can be garnered from the image for appropriate diagnosis.
A score of 4 may be considered “exemplary”. This means that the information obtained during the image study and overall image quality serves as an example that should be emulated as the “ideal” for that specific imaging study and patient population.
According to one embodiment of the invention, the data that is collected during the imaging study may analyzed by a metrics module 232 for performing prospective and retrospective trending analysis. The prospective and retrospective trending analysis enables automatic detection of immediate and recurrent problems, as they relate to equipment, personnel, data input, and overall workflow. The result of this automated technical QA analysis is that an automated and normalized analysis may be performed that minimizes subjectivity and human bias, among providing other benefits.
According to one embodiment of the invention, the metrics module 232 may automatically tally and record QA scores in a selected database. The QA scores may be cross-referenced by the computer program 110 to a number of independent variables including a technologist identifier, imaging modality, exam type, patient demographics, patient characteristics, patient body habitus, exposure parameters, image processing, exam location, equipment, day/time of exam for trending analysis, radiologist identification, referring clinician, clinical indication, among other variables. According to one embodiment of the invention, the report generating module 238 may access the QA scores to display results from the metrics module 232. The reports may be accesses at any time by users, including the clinician, the radiologist, the technologist, and/or the department/hospital administrator to review individual and collective performance results. The trending analysis provided by this data can in turn be used for educational purposes, performance review, and new technology deployment.
According to one embodiment, the metrics module 232 analyzes data that is associated with a defined list of quality assurance (QA) benchmarks to objectively evaluate patients, quantify a relative success of service participation and provide educational (data-driven) feedback in order to optimize participation, among other benefits. The QA metrics may be tied to economic incentives, such as a pay for performance (P4P) systems, to create financial rewards for those patients that actively participate in the imaging study.
According to one embodiment, a quantifiable list of pre-defined performance parameters may be used by the program 110 to measure overall performance of the patient relating to the QA scorecard include, utilization, such as preventing redundancy; scheduling; data input; compliance, including recommendations for follow-up; documentation of complications; workflow, including subjective feedback; communication; education; availability of EMR; and reporting, including clinical outcomes, adverse outcomes, and economic outcomes; among other predefined parameters. According to one embodiment of the invention, performance metrics may be calculated by the program 110 from various parameters, including completeness of data input, such as clinical history; utilization, including economic outcomes, clinical outcomes, and/or adverse outcomes; communication; timeliness, including time to participate in clinical action; feedback provided to the clinician, technologist and specialists, and/or education, among other predetermined parameters.
According to one embodiment, the QA scorecard program 110 may provide economic incentives to patients to become active participants in their personal medical imaging experience, since steps in the medical imaging process are influenced by the patient. According to one embodiment, patients that are active participants and comply with predefined expectations may be financially rewarded with an overall reduction in imaging costs.
According to one embodiment of the invention, the predefined parameters (see the Table below) may be used to calculate an individual patient QA score. The QA score may be used as a multiplier for image exam cost savings. According to one embodiment of the invention, higher priority variables, such as outcomes, may provide the highest multipliers, when compared with lower priority variables. According to one embodiment of the invention, each variable may be assigned a scoring scale of 1-10.

TABLE

Predefined Parameters	Scale	Source of Data

Utilization	−3 - - - +3	RIS (Appropriateness Criteria)
Scheduling	−1 - - - +1	RIS
Data Input	−2 - - - +2	RIS
Compliance	−3 - - - +3	RIS/EMR
Complications	−2 - - - +2	RIS/PACS
Workflow	−1 - - - +1	Patient Surveys
Communication	−2 - - - +2	PACS/RIS
Education	−1 - - - +1	PACS/Surveys
Accessibility	−5 - - - +5	EMR
Outcomes	−10 - - - +10	EMR

According to one embodiment, the QA scorecard program 110 may increase or decrease a patient's insurance premiums (or individual exam cost) based on a calculated QA score. Alternatively, the QA scorecard program 110 may equally “reward” or “punish” imaging provider and patients by splitting the positive or negative QA percentage score between both parties. According to one embodiment of the invention, the QA score may provide a method to standardize and track technologist QA profiles on local, national, and international levels.
According to one embodiment of the invention, communication and reporting parameters may include, time from order entry to report completion; time from report completion to receipt by clinician; time from receipt by physician to time of contacting patient; time from contacting patient to arrival of patient; time from report receipt to actual review; specific components of the report reviewed by clinician; clinician time reviewing reporting data, such as document report open and report closing; clinician time components for individual report segments; perceived clinician value for report; report structure; report content; report organization; imaging links, including complete imaging file, key images, snapshot; ancillary data, including teaching files, NLM, review articles; communication; method of communication; acknowledgement of receipt of communication; bi-directional consultation; time to initiate treatment; tracking of follow-up recommendations; clinician satisfaction; subjective value; referral patterns; among other parameters.
According to one embodiment of the invention, the communication module 230 may access a number of informational sources, including the electronic medical record (EMR); the computerized physician order entry system (CPOE); the hospital information systems (HIS) 10, the radiology information systems 20 (RIS); the picture archival and communication system (PACS) 30; subjective feedback from the radiologist, patient, and clinician peer group; and/or other informational sources, to obtain clinical performance parameters. According to one embodiment, standard tags may be created within the various informational sources to identify individual QA data parameters.
According to one embodiment of the invention illustrated in FIG. 3, the QA scorecard program 110 presents a welcome screen in operation, or step, 301. In operation 302, the QA scorecard program 110 displays a log-in screen and receives log-in criteria, such as a username and password. According to one embodiment, the user may include the patient, an authorized family member and/or a healthcare providers. In operation 304, the QA scorecard program 110 compares the user log-in criteria against pre-stored log-in criteria for authorized users to determine if the user may gain access to the QA scorecard program 110. if the user log-in criteria is not approved, then the QA scorecard program 110 may notify the user of the registration failure and may return to the main log-in screen.
If the user log-in criteria is approved, then in operation 304, the QA scorecard program 110 may access one or more information sources, including the electronic medical record (EMR), the hospital information system 10 (HIS), the radiology information system 20 (RIS), the PACS 30, among other information sources to obtain information and/or records associated with the selected patient. According to one embodiment, patients, authorized family members, healthcare providers and/or other authorized parties may have access to a confidential master patient record number, an insurance number, a provider number or other confidential information to review the medical imaging studies and reports. Alternatively, patients, authorized family members, healthcare providers and/or other authorized parties may have access to a physical or virtual “smart card” that would keep track of all facilities or healthcare systems in which a patient was treated.
Upon access to the one or more information sources, patients, authorized family members, healthcare providers and/or other authorized parties (hereinafter “users”) may review the patient data. According to one embodiment, the QA scorecard program 110 may enable users to assess redundancy of medical imaging studies, which leads to excessive costs and over-utilization of medical imaging. According to one embodiment, redundancy may result from “doctor shopping”, patient relocation, specialty referrals, or inaccessible/lost medical records.
According to one embodiment, the QA scorecard program 110 may enable users to maintain accurate and reliable medical imaging records, thereby reducing imaging exam redundancy. By reducing redundancy, the QA scorecard program 110 may alert users of subsequent savings in both time and money for diagnosis and treatment. According to one embodiment, the QA scorecard program 110 may access PACS and/or other information sources that support industry-wide standards, such as DICOM, to participate in centralized or distributed medical imaging databases. According to one embodiment, the QA scorecard program 110 may store data in both portable and fixed formats. Thus, even if the QA scorecard program 110 does not have access to a centralized database, an appropriate search engine may be employed using a peer to peer or related strategy, for example, to re-create the patient's imaging data, comprehensive electronic medical record, or other information.
According to one embodiment, universal accessibility of data may be provided using extensible mark-up language (XML). XML further enables communication between disparate information technologies by allowing creation of a standard tag for individual QA data parameters. According to one embodiment, QA metrics may be employed to define XML tags, such as examination time, technologist retake, reject analysis, among other QA metrics. According to one embodiment, XML tags may be communicated among information technologies, such as modalities, information systems, PACS, EMR, CPOE. According to one embodiment, XML tags may be automatically downloaded into a universal QA database.
According to one embodiment, the QA scorecard program 110 may query a comprehensive index/database to access additional imaging studies. According to one embodiment, the QA scorecard program 110 may automatically query the comprehensive index/database using parameters, such as established appropriateness criteria, to confirm that the imaging exam requested is appropriate for the clinical indication and suspected diagnosis.
According to one embodiment, the QA scorecard program 110 may access the comprehensive index/database to enable external peer review of physician actions to measure a number of predefined variables including, image quality; diagnostic accuracy; report content and structure; radiation dose; and timeliness, both in medical imaging and clinical management. By incorporating the electronic medical imaging database into the patient's electronic medical record (EMR), the QA scorecard program 110 may cross-reference medical imaging data with clinical data, thereby allowing for comprehensive clinical outcomes analysis.
In operation 306, the QA scorecard program 110 may enable users to participate in electronic scheduling, including image exam scheduling. According to one embodiment, the QA scorecard program 110 may provide bi-directional electronic scheduling, which allows users to directly participate in scheduling. Electronic scheduling may eliminate many inefficiencies of non-electronic scheduling, including double bookings; patient “no shows”; rescheduling due to incomplete clinical information, lack of third party approval, and lack of adequate patient preparation; among other deficiencies. These inefficiencies result in scheduling backlog and further delays in diagnosis and treatment planning.
According to one embodiment, the QA scorecard program 110 enables the users and the imaging department to establish direct lines of communication in operation 308, through various communication applications, including e-mail, cell phone, pager, facsimile, text messaging, instant messaging, among other communication applications.
According to one embodiment, the QA scorecard program 110 may alert both users and the imaging department of any last minute changes or additional information requirements. According to one embodiment, the QA scorecard program 110 enables specific patient instructions, such as special exam preparation or questions to be directly conveyed and monitored by imaging department staff to ensure exam quality will be optimized. According to one embodiment, the QA scorecard program 110 minimizes exam rescheduling.
According to one embodiment, the QA scorecard program 110 may generate a real-time alert in operation 310 if either party will not keep the scheduled meeting time. According to one embodiment, the QA scorecard program 110 may send the real-time alert to a mobile communication device that is identified in a user's profile. According to one embodiment, the QA scorecard program 110 may adjust appointment times to account for delays. According to one embodiment, the electronic schedule application of the QA scorecard program 110 improves imaging department efficiency and patient satisfaction with the services delivered. According to one embodiment, the QA scorecard program 110 may calculate QA metrics for electronic scheduling in a patient QA scorecard.
According to one embodiment, the QA scorecard program 110 may provide a secure electronic patient health calendar. According to one embodiment, the QA scorecard program 110 may provide the secure electronic patient health calendar as a web service, which could serve as a repository for patient appointments and reminders. According to one embodiment, the QA scorecard program 110 may use an XML application, or similar application, to interface with local hospital or radiology information scheduling packages.
In operation 312, the QA scorecard program 110 provides users, including patients, with instantaneous and direct access to patient records that are stored in information sources, including the electronic medical record (EMR), HIS 10, RIS 20, PACS 30 and/or other information sources. According to one embodiment, information sources provide a gateway for the clinician and radiologist to effectively allocate imaging resources. By providing access to the patient's records that are stored in the information sources, such as the EMR and/or electronic imaging folder, the QA scorecard program 110 provides users with a tool for eliminating the occurrence of redundant exams. According to one embodiment, eliminating redundant imaging exams increases patient safety by subjecting the patient to less radiation exposures and also saves costs by requiring fewer imaging studies. According to one embodiment, the QA scorecard program 110 may calculate QA metrics for eliminating redundancy in a patient QA scorecard.
According to one embodiment, patient exposure to radiation may be reduced by enabling the QA scorecard program 110 to eliminate redundant imaging studies that utilize, for example, ionizing radiation or other radiation sources. According to one embodiment, patient exposure to radiation may be reduced by enabling the QA scorecard program 110 to perform optimizing techniques that includes accessing patient data from the information sources, extracting exposure parameters and corresponding QA scores from all previous imaging studies, and recommending adjustments to radiation levels, among other actions. According to one embodiment, the QA scorecard program 110 may access patient data, including pertinent clinical and laboratory data, such as past discharge summaries, problem lists, consultations, health and physical write-ups; imaging risk factors, such as drug allergies; previous complications and summarized image findings; and key images from historical exams; among other data.
According to one embodiment, the QA scorecard program 110 may store new imaging data from current imaging studies in the information sources. According to one embodiment, the QA scorecard program 110 may incorporate the new imaging data into a summary image folder that is stored in one or more information sources that may be directly accessed by the patient, clinicians, and outside radiologists, among other users. According to one embodiment, the QA scorecard program 110 may provide users with access to the information sources from various locations for second opinions and/or for external peer review purposes, among other purposes.
According to one embodiment, the QA scorecard program 110 may enable the patient to request corrections to data that is stored within the information sources. According to one embodiment, the patient may submit a data correction for the patient data sheet through the QA scorecard program 110 that is reviewed and processed by a clinician or other medical provider. According to one embodiment of the invention, each user may create profiles for the imaging data sheet and may customize the imaging data sheet display to their own individual preferences. For example, the QA scorecard program 110 may display an imaging data sheet that is customized by a user for the patient. According to one embodiment of the invention, the imaging data sheet may provide users with important aspects of the patients medical history. The imaging data sheet may have a standard format and include data, such as past medical and surgical history; prior imaging exams and results, including those performed at outside facilities; current clinical problems; pertinent findings on physical exam; pertinent laboratory and/or pathology data; ancillary data, including procedural findings (e.g. colonoscopy, bronchoscopy), operative or consultation notes, clinical testing (e.g., EEG, EKG); technical information related to the imaging exam performed; technologist observations, including pertinent findings and measurements; technologist notes, including complications, exam limitations; among other data.
According to one embodiment of the invention, new data may be input into the imaging data sheet via the QA scorecard program 110 by clinicians, nurses, radiologist, technologist or other authorized users. According to one embodiment of the invention, new data may be input into the imaging data sheet via the QA scorecard program 110 through computer-derived entry using natural language processing (NLP). According to one embodiment of the invention, the imaging data sheet may have separate tabs for each individual imaging modality, and may store technical data, measurements, and technologist notes specific to each individual exam/modality.
According to one embodiment, the QA scorecard program 110 may enable the patient to enter data corrections that are propagated to one or more information sources. According to one embodiment, data accuracy may affect multiple aspects of the medical imaging process. For example, receiving incorrect and/or insufficient input may cause the QA scorecard program 110 to recommend an incorrect type of imaging exam and/or protocol. According to one embodiment of the invention, each time a new entry or modification is made to an information source, a time-stamp may be included in the record by the program 110, along with the identification of the person inputting (or modifying) the data.
According to one embodiment of the invention, the QA scorecard program 110 enables users to review and maintain accurate data for indications of an imaging study, past medical/surgical history, prior imaging/laboratory evaluation, history of allergic reactions, among other data. According to one embodiment of the invention, the QA scorecard program 110 may access the accurate data and provide optimum decision making for imaging exam and protocols.
According to one embodiment, the QA scorecard program 110 enables users to provide additional demographic information and patient family history that improves the decision-making process. According to one embodiment, the QA scorecard program 110 may receive a signature from authorized users confirming the accuracy of patient information that is provided on the EMR, or other record, before the EMR is stored in an information source. According to one embodiment, the QA scorecard program 110 may document information associated with the user approval of patient data. According to one embodiment, the QA scorecard program 110 may calculate QA metrics for user approval of patient data in a patient QA scorecard.
In operation 314, the QA scorecard program 110 may receive documentation of imaging complications and risk factors from users, including patients. While imaging provides have a primary responsibility to document imaging complications and risk factors, as patients move from one provider to another, complications and risk factors may be overlooked. According to one embodiment, the QA scorecard program 110 may enable tracking of cumulative risk, which may not be documented by imaging departments that focus on the current imaging exam in isolation. For example, a patient that has a disease process (e.g. diabetes) is predisposed to future risk, such as nephrotoxicity. By receiving risk factors, the QA scorecard program 110 may access clinical information, updated laboratory analysis, and prior adverse reactions, such as contrast extravasation or allergic reactions prior to selecting an imaging exam and protocol for the imaging exam. According to one embodiment, if the patient has a longstanding history of diabetes and is prone to develop renal failure, the QA scorecard program 110 may recommend performing a requested CT examination without intravenous contrast or performing ultrasound. According to one embodiment, a specialist may decide to override the QA scorecard program 110 recommendation and add intravenous contrast to improve imaging information, but may elect to order a laboratory study (BUN/creatinine) to assess renal function before deciding the volume and specific type of contrast to be used. According to one embodiment, any documented prior history of allergic reaction would alert a radiologist to replace the requested contrast exam with a non-contrast exam. Alternatively, the radiologist may decide to pre-medicate the patient with corticosteroids. According to one embodiment, the QA scorecard program 110 may calculate QA metrics for documentation of imaging complications and risk factors in a patient QA scorecard.
In operation 316, the QA scorecard program 110 may receive real-time compliance measures. According to one embodiment, compliance parameters may include, being present at the scheduled date and time of an appointment; providing pertinent clinical and imaging data adhering to recommended preparation for an imaging study; providing subjective feedback as it pertains to the quality and timeliness of imaging services; following up on clinical recommendations; among other compliance parameters. According to one embodiment, adhering to compliance measures maximizes clinical outcomes. According to one embodiment, patients that actively participant in clinical and imaging follow-up may improve overall health outcomes, while reducing the cumulative cost of healthcare through, for example, reducing the morbidity and mortality associated with delayed diagnosis and treatment. According to one embodiment, the QA scorecard program 110 may calculate QA metrics for compliance measures in a patient QA scorecard. According to one embodiment, patients provide a contribution to the overall success or failure of medical service delivery. The individual steps of exam ordering, image acquisition, interpretation, communication, and clinical outcomes are to some extent influenced by patient compliance. Each patient provides some degree of impact on the utilization and efficacy of imaging services, with important implications with regard to economics, workflow, and diagnostic accuracy.
In operation 318, the QA scorecard program 110 may enable communication and receive outcome analysis. According to one embodiment, the QA scorecard program 110 may improve the timeliness, reliability, and accuracy of communicating medical finding, especially clinically unexpected and/or emergent imaging findings to patients. According to one embodiment, the QA scorecard program 110 may automate and/or directly communicates pertinent imaging data, with time stamps, to the patient. According to one embodiment, the QA scorecard program 110 may customize the delivery of this content based on the specific preference of each patient. According to one embodiment, the QA scorecard program 110 may create an audit trail that documents receipt of this information.
According to one embodiment, the QA scorecard program 110 may generate an alert that notifies the patient to immediately contact the clinician to directly receive these emergent findings. Whether the communication occurs electronically or verbally, the QA scorecard program 110 documents the communication between the clinician and patient by time stamping and storing the communication for future analysis. Upon receipt of the alert, the patient may immediately contact the clinician to discuss the medial findings. According to one embodiment of the invention, QA scorecard parameters for communication may include criteria such as, report completion by radiologist; acknowledgement of receipt of communication clinician; copy of report to patient, with electronically linked key images; notification of clinically significant findings and follow-up recommendations; links to pertinent educational content; automated scheduling reminder for additional imaging/laboratory studies; capability to perform radiology consultation, such as second opinion; time from report completion to communication with patient; time from communication with patient to follow-up visit with patient; type of communication; time to initiate treatment; time of follow-up recommendations; patient satisfaction; subjective value; among other criteria.
According to one embodiment, the time-stamped data provides objective data analysis. The QA scorecard program 110 records individual time-stamped data points throughout the course of the imaging cycle, from the time an imaging exam is electronically ordered, to the time the imaging report issued and reviewed, to the time the patient is notified of the imaging results. After the patient is contacted, time-stamped data may be tracked by the program 110 within the EMR, which records clinician and patient interactions, in the form of recording progress notes, consultations, and the ordering of clinical tests, imaging studies, and various treatment options (e.g. drug therapy). This is time-stamped data may be recorded into a QA database for subsequent analysis. One such analysis may include an assessment of the time incurred between the imaging exam and initiation of clinical treatment. According to one embodiment, the QA scorecard program 110 enables patients to become more directly involved in the communication process, which may streamline medical care and eliminate patients that are lost to follow-up care. According to one embodiment, the QA scorecard program 110 may provide bi-directional communication pathways between the clinician and the patient. According to one embodiment, the bi-directional communication pathways provided by the QA scorecard program 110 may enable improvement in clinical outcomes, medical economics, and medico-legal ramifications.
Regarding outcome analysis, the QA scorecard program 110 obtains a patient's clinical, imaging, and economic data to derive a comprehensive QA score that relates to how effective imaging services were utilized in diagnosing, practice management, and treatment, relative to the specific clinical diagnosis. According to one embodiment, the QA scorecard program 110 may use natural language processing (NLP) technology, to search the patient's EMR, or other record, for specific CPT codes. According to one embodiment, the QA scorecard program 110 may cross-reference the CPT codes with imaging, pathology, laboratory, and clinical summaries. According to one embodiment, the QA scorecard program 110 may perform statistical analysis to determine the expected imaging cost, complication rate, length of stay, and morbidity associated with each clinical diagnosis. According to one embodiment, the QA scorecard program 110 may provide reduced insurance rates for patients and higher reimbursement rates for providers that enhance safety, economics, and clinical outcomes.
In operation 320, the users may provide feedback via electronic and/or paper surveys. The feedback may include the patient's subjective perceptions as to a number of factors, including conscientiousness, education, responsiveness to questions, communication skills and/or timeliness, among other factors. The feedback may be obtained from the patient before the patient leaves the imaging department or later via electronic or conventional mail. Questions may be posed using a Likert scale to provide a quantitative value. Because answers may be biased (some people grade too harshly, others too easily), the QA scorecard program 110 may extrapolate the scored answers based on individual biases relative to the larger group. Subjective answers may be reviewed by an impartial administrator that may record information into the QA database to identify consistent trends.
In operation 322, the QA scorecard program 110 may recommend materials that are designed to educate patients. According to one embodiment, materials may include educational content that is focused and targeted to the imaging findings and disease diagnosis. Educational content may take a number of forms, including information about the imaging exam to be performed, such as common questions and answers; the disease entity in question; the context-specific imaging findings; among other educational content. Educational content may be provided through a web portal. According to one embodiment, educational programs may be automated and may be customized by the QA scorecard program 110 to specific topics, such as by bookmarking certain on-line education materials to specific medical findings. According to one embodiment, educational content may include interactive content and/or a quiz. According to one embodiment, patients that score well on the quiz may receive a financial reward or gain priority in scheduling. According to one embodiment, a central education program may provide this service for many healthcare providers.
It should be emphasized that the above-described embodiments of the invention are merely possible examples of implementations set forth for a clear understanding of the principles of the invention. Variations and modifications may be made to the above-described embodiments of the invention without departing from the spirit and principles of the invention. All such modifications and variations are intended to be included herein within the scope of the invention and protected by the following claims.

Claims

1. (canceled)

2. A computer implemented method of generating a quality assurance scorecard on a patient, comprising:

receiving a request for an imaging study on the patient;

retrieving information on the patient from at least one database;

retrieving at least one prior imaging study performed on the patient from said at least one database;

analyzing said prior imaging study with said information on the patient, to determine whether said request for said imaging study is clinically indicated; and

confirming whether said imaging study is necessary based on said analysis.

3. The method according to claim 2, further comprising:

analyzing whether said imaging study has been performed previously; and

alerting a user that said imaging study is redundant.

4. The method according to claim 3, wherein said alerting step is accomplished via electronic communication.

5. The method according to claim 2, further comprising:

enabling a user to participate in electronic scheduling, wherein said electronic scheduling is bi-directional.

6. The method according to claim 5, further comprising:

providing at least one direct line of communication between said user and an imaging department, wherein said direct line of communication includes at least one of e-mail, cell phone, pager, facsimile, text messaging, and instant messaging.

7. The method according to claim 6, further comprising:

alerting said users and said imaging department of a change in said scheduling or an additional information requirement, wherein an alert is generated in real-time.

8. The method according to claim 2, further comprising:

storing imaging data from at least one current imaging study in said database.

9. The method according to claim 8, further comprising:

providing a user with access to said database for at least one of a second opinion or an external peer review.

10. The method according to claim 2, further comprising:

enabling said patient to perform corrections to said information that is stored within said database.

11. The method according to claim 2, further comprising:

enabling at least one user to create profiles for an imaging data sheet and customize said imaging data sheet display to said user's own individual preferences.

12. The method according to claim 11, wherein said imaging data sheet provides said user with information on said patient medical history.

13. The method according to claim 12, wherein said information on said patient medical history includes at least one of past medical and surgical history, prior imaging exams and results, current clinical problems, pertinent findings on a physical exam, pertinent laboratory data, pertinent pathology data, ancillary data, technical information related to a prior imaging exam, technologist observations, or technologist notes.

14. The method according to claim 13, further comprising:

communicating emergent findings to a preselected list of users by electronic communication.

15. The method according to claim 13, further comprising:

generating a comprehensive quality assurance score based on prospective and retrospective trending analysis on at least one of data input, workflow, imaging modality, image equipment and exposure parameters, image processing, exam location and results, patient demographics, patient characteristics, or radiologist and clinician identifiers.

16. The method according to claim 14, further comprising:

performing an optimizing technique, comprising the steps of:

accessing said information on said patient from said database;

extracting exposure parameters and corresponding quality assurance scores from all previous imaging studies; and

recommending adjustments to exposure levels.

17. The method according to claim 2, further comprising:

receiving documentation of imaging complications and risk factors for said patient, and

alerting at least one user of said imaging complications and said risk factors.

18. The method according to claim 17, further comprising:

tracking risk factors and determining a cumulative risk to said patient of said imaging study, and instituting an audit trail to track said risk factors and health care decisions made on said patient.

19. The method according to claim 8, further comprising:

receiving an outcome analysis on said current imaging study; and

communicating said outcome analysis to a user.

20. The method according to claim 19, further comprising:

receiving feedback from said user on said outcome analysis, wherein said feedback is received via at least one of an electronic or a paper survey.

21. The method according to claim 20, wherein said feedback includes subjective perceptions of said patient.

22. The method according to claim 16, further comprising:

receiving real-time compliance parameters, wherein said compliance parameters include at least one of being present at a scheduled date and time of an appointment, providing pertinent clinical and imaging data, adhering to recommended preparation for an imaging study; providing subjective feedback as it pertains to a quality and timeliness of imaging services, and following up on clinical recommendations.

23. The method according to claim 22, further comprising:

forwarding at least one educational material to said patient, wherein said material includes at least one of an educational program, educational content that is targeted to imaging findings and disease diagnosis, information about an imaging exam to be performed, common questions and answers, material on a disease entity in question, or context-specific imaging findings.

24. The method according to claim 23, further comprising:

providing said educational material through a web portal.

25. The method according to claim 24, further comprising:

automating and customizing said educational program to specific topics via bookmarking on-line education materials to specific medical findings.

26. The method according to claim 25, wherein said educational content includes at least one of interactive content and a quiz.

27. A computer system for generating a quality assurance scorecard, comprising:

at least one memory containing at least one program comprising the steps of:

receiving a request for an imaging study on the patient;

retrieving information on the patient from at least one database;

analyzing said prior imaging study with said information on the patient, to determine whether said request for said imaging study is clinically indicated;

confirming whether said imaging study is necessary based on said analysis; and

at least one processor for running the program.

28. The system according to claim 27, further comprising:

a biometrics system which authenticates a user prior to authorizing said request for said imaging study.

29. The system according to claim 27, further comprising:

an electronic calendar which is bi-directional between said patient and an imaging department performing said imaging study.

30. The system according to claim 27, further comprising:

a comprehensive quality assurance scorecard based on prospective and retrospective trending analysis on at least one of data input, workflow, imaging modality, image equipment and exposure parameters, image processing, exam location and results, patient demographics, patient characteristics, or radiologist and clinician identifiers.

31. The system according to claim 27, further comprising:

an educational program for said patient, which includes at least one of an educational program, educational content that is targeted to imaging findings and disease diagnosis, information about an imaging exam to be performed, common questions and answers, material on a disease entity in question, or context-specific imaging findings.

32. A computer-readable medium containing instructions for generating a quality assurance scorecard on a patient, comprising:

receiving a request for an imaging study on said patient;

retrieving information on the patient from at least one database;

confirming whether said imaging study is necessary based on said analysis.

33. The computer-readable medium according to claim 32, further comprising:

analyzing whether said imaging study has been performed previously; and

alerting a user that said imaging study is redundant.

34. The computer-readable medium according to claim 32, further comprising:

enabling a user to participate in electronic scheduling.

35. The computer-readable medium according to claim 32, further comprising:

providing at least one direct line of communication between said user and an imaging department.

36. The computer-readable medium according to claim 32, further comprising:

37. The computer-readable medium according to claim 32, further comprising:

38. The computer-readable medium according to claim 32, further comprising:

39. The computer-readable medium according to claim 32, further comprising:

40. The computer-readable medium according to claim 39, further comprising:

performing an optimizing technique, comprising the steps of:

accessing said information on said patient from said database;

recommending adjustments to exposure levels.

41. The computer-readable medium according to claim 32, further comprising:

tracking risk factors and determining a cumulative risk to said patient of said imaging study.

42. The computer-readable medium according to claim 41, further comprising:

instituting an audit trail to track said risk factors and health care decisions made on said patient.

43. The computer-readable medium according to claim 42, further comprising:

receiving an outcome analysis on said current imaging study; and

communicating said outcome analysis to a user.

44. The computer-readable medium according to claim 32, further comprising:

receiving compliance parameters, wherein said compliance parameters include at least one of being present at a scheduled date and time of an appointment, providing pertinent clinical and imaging data, adhering to recommended preparation for an imaging study, providing subjective feedback as it pertains to a quality and timeliness of imaging services, and following up on clinical recommendations.

45. The computer-readable medium according to claim 32, further comprising:

forwarding at least one educational material to said patient, said material including at least one of an educational program, educational content that is targeted to imaging findings and disease diagnosis, information about an imaging exam to be performed, common questions and answers, material on a disease entity in question, or context-specific imaging findings.