After more than a year of laboratory development and testing, radiologists at the Veterans Affairs (VA) Puget Sound Health Care System in Seattle are hopeful that software called RAPTOR designed to help manage medical imaging protocol selection and workflow will be authorized to move into a real-world pilot program.
The Radiology Protocol Tool and Recorder (RAPTOR) software is designed to render the labor-intensive process of protocol assignment and the often paper-based workflow in imaging departments obsolete, according to its developers. It's programmed to search for information from a patient's medical record that is important for protocol decisions and display it in a dashboard synchronized with an electronic protocoling tool.
Based on a radiologist's individualized parameters or a radiology department's requirements, RAPTOR will automatically extract and prioritize orders and relevant information from the VA's VistA electronic medical record (EMR) using Medical Domain Web Services (MDWS). Information required for protocol decisions, such as patient allergies, renal function, clinician contact information, key clinical notes, specific lab values, and radiology reports, is automatically populated into the dashboard and can be easily accessed by authorized users.
"RAPTOR is designed to provide radiologists with seamless, just-in-time patient information, not only to assign protocols but also to track exam acquisition and study interpretation phases of the workflow," explained lead developer Dr. Jonathan Medverd, who is also an assistant professor in the department of radiology at the University of Washington.
"Data moves instantly to the next staff member responsible and is distributed within a multiuser accessible worklist," he said. "Priorities can be assigned on the fly. Everything is date-stamped and electronically signed. Unlike paper systems, nothing gets misplaced."
Protocol assignments
Although protocol assignment critically affects quality and safety within a radiology department, its importance can be overlooked, Medverd said. In hospitals with paper-based records, radiologists may not have access to search for data they need for protocol assignments. And while they may have access to EMRs, this usually means logging into another computer and then searching through electronic data. Patient information is often available, but quick access is rare.
"No matter how well-intentioned radiologists may be to select the best and safest protocol for a patient, they may not have time to be as thorough as they would like to be," he said. "Protocoling is a step that you try to do well, but you try to do it as fast as possible because you have to get on to the business of interpreting images. Because few imaging departments measure the quality of protocol assignment, they do not know how well they are doing. You can't assess performance -- and patient safety -- when it isn't measured. Nor can you assess department efficiency and productivity with respect to protocol assignment."
RAPTOR not only provides information and keeps a detailed record of it and decisions made, it facilitates communication with the ordering physician and other radiologists by secure messaging, Medverd said. It maintains a library of the department's standardized imaging protocols, both for acquisition of imaging and for application of pre- and post-test hydration or medications. In fact, RAPTOR suggests the use of pre- and postexam hydration or medication for patients, when appropriate, and recommends the best standardized protocols.
The software can screen for history of contrast reaction and report it immediately. It will also identify when written informed consent is needed for administration of intravenous contrast agents. It can even automatically recognize unauthorized orders and recommend refusal, according to Medverd.
Eliminating inefficiencies
RAPTOR is designed to eliminate the inefficiencies of paper-based workflow and workflow environments where patient information is contained in siloed health IT systems. It will also provide a comprehensive, time-stamped permanent record of all activities related to protocol assignment -- a record that is seldom acquired and retained by a RIS, he said.
RAPTOR is currently in a process to receive approval to transition from the "laboratory sandbox" to a pilot program at the Seattle VA's radiology department and three other West Coast VA facilities. Its accuracy and performance will be measured against baseline data, such as time expended from an order to protocol assignment.
Funding from the VA Innovation Initiative was used for the project, according to Medverd. He said that the office is facilitating the evaluation and advancement of RAPTOR. If the software works as planned, Medverd anticipates that it will eventually be rolled out for use in every imaging department of the VA healthcare system.
"We have a record of innovation," he concluded in his interview with AuntMinnie.com. "The VA developed one of the earliest and largest EMRs for its medical centers as well as deployed one of the first filmless radiology departments in the world."
Information on RAPTOR was also presented at RSNA 2012 and in an article published online January 4 in the Journal of Digital Imaging.
