The value of the CIIP: Part 3 -- Radiologist support

Unmet departmental needs and increased costs can occur if subject matter experts aren't available to help clinicians. In this article, I'll show how an organization's decision to utilize certified imaging informatics professionals (CIIPs) can yield a more efficient and cost-effective imaging practice.

Parts 1 and 2 of my series focused on the value CIIPs bring to their imaging practices by ensuring data integrity and optimizing workflow. This article will focus on the CIIP's ability to support radiologists and the improved outcomes that can be achieved as a result.

The right skill set

Ensuring radiologists have the support they need to operate at maximum efficiency is one of the most important roles within the imaging practice. However, many practices struggle to find professionals with the correct set of skills that are truly needed to excel in this position. Most general IT professionals lack the clinical understanding and imaging informatics-specific knowledge needed to relate to the needs of the radiologists. Conversely, clinical resources such as lead technologists or radiology supervisors don't have the technical abilities to meet their needs.

Thankfully, one certification -- the CIIP -- can assure any imaging practice that the credentialed professional has at least a baseline level of the clinical and technical skills needed to support radiologists. CIIPs are tested within numerous domains, such as clinical engineering, medical imaging informatics, image management, IT, training and education, communication, and many more areas that relate to the skills needed to properly support radiologists.

Deploying the proper radiologist support resources can mean the difference between an imaging practice that runs smoothly and one that struggles to survive. If you don't believe me, let's take a look at the two paths that our fictitious imaging practice Adventure Health goes down as we present two very different models of supporting radiologists.

Option 1: CIIP

Supporting radiologists is one of Adventure Health's top priorities. It engages CIIP resources to develop and maintain a radiologist support structure built on best practices. The CIIP resources begin by creating a support framework that will allow them to use their skills and abilities to the fullest while they support radiologists.

Luke Bideaux, founder of Vega Imaging Informatics.

Since the CIIPs understand the value of radiologists' time, they develop a direct phone line that any radiologist can call, which will simultaneously ring the phones of all CIIPs on duty. The team also develops an email support system that allows radiologists to email a specific distribution group that will be quickly reviewed by a CIIP resource.

Finally, the CIIP resources collaborate with Adventure Health's primary IT help desk to develop the necessary assignment groups and internal processes to ensure that issues coming in through other channels are assigned to the proper resources and that all support activity can be tracked in accordance with organizational policies.

The radiologists at Adventure Health feel appreciated and empowered. Having direct access to skilled CIIP resources enables them to focus more time on patient care and spend less time struggling with application or workflow issues. Most radiologist support calls are resolved in a matter of minutes due to the expertise of the professionals on the other end of the phone. Radiologists find it extremely refreshing to be able to communicate their issues without having to translate them into a language the support representatives can understand.

Adventure Health also notices improved radiologist reading volumes and decreased turnaround times following the addition of this enhanced level of support. Radiologists attribute the improvements to some of the system fixes and system optimizations that the support resources were able to perform within their PACS viewer and reporting system.

Also, radiologists say that they are able to spend less time on the phone reporting issues and more time reading studies. Overall, Adventure Health realizes a 7% increase in reading volumes, generating $53,000 in additional annual revenue. It also reports a 12% decrease in overall turnaround times, resulting in improved patient and referring physician satisfaction.

Option 2: No CIIP

Adventure Health implements a strategy to centralize its technical support resources and standardize its support processes across the enterprise using an enterprise ticketing system. All staff members are instructed to call or email the main IT help desk for any technical issues that they are experiencing or to submit tickets using the enterprise ticketing system.

Elaborate Visio diagrams and process documents are designed for support teams to utilize as they cycle support issues through the troubleshooting process. Adventure Health implements a tiered support resource model, where entry-level support representatives answer most incoming calls, emails, and tickets. Issues are then assigned to the appropriate support team and escalated as needed.

Radiologists at Adventure Health are frustrated, to say the least. Whenever radiologists call the IT help desk to report an issue, they are typically greeted by a support representative who has difficulty interpreting the issue and generating an accurate support ticket. Since most of the support representatives at Adventure Health do not understand the necessary imaging informatics concepts needed to resolve radiologist issues, an enormous amount of time is wasted when attempts are made. Troubleshooting efforts often go astray.

As a result, many radiologists have had outbursts over the phone or have had their days completely derailed due to time spent on a fruitless attempt to resolve an issue. Radiologists estimate that they collectively spend roughly 1.5 hours per day reporting/troubleshooting issues with their IT help desk.

Due to the lack of internal support, radiologists have been leaning on vendor support more and more. Unfortunately, their vendors are not equipped to serve as PACS administrators or IT help desk representatives. Issues that fall outside of software bugs, performance issues, or enhancement requests are categorized as "professional service requests," requiring purchase of professional service hours before any action can be taken. As the issues continue to pile up, the lines begin to blur between those that result from a lack of proper support and those that result from issues with the software itself.

Then the inevitable happens. Radiology leaders begin reporting to the C-suite at Adventure Health about the trouble they continue to have with their system and the lack of support they receive. Adventure Health executive and clinical leaders begin evaluating new PACS and reporting systems in order to resolve these issues. Radiologists and executive leaders are taken on site visits; they are amazed at how efficiently the show sites operate and how satisfied the clinical staff seems to be with its systems. The board approves a budget of $250,000 for a new PACS and reporting system, and leadership makes the vendor selections.

As Adventure Health attempts to implement the new solutions, it quickly realizes that it doesn't have any in-house experts to lead the project. Again, it relies heavily on vendor resources to implement the system, which results in a default configuration and design that works well for the vendor but is not tailored to Adventure Health's specific needs.

Once the implementation concludes, the vendor representatives move on to their next project and Adventure Health is transitioned to vendor support. New issues emerge, and radiologists are caught between an internal IT help desk that can't relate to them and a vendor help desk that is not equipped to become their internal support team. The radiologists cringe as they see history repeat itself and begin picturing the struggle that the future will most certainly bring.

What did Adventure Health lose in one year by failing to engage the necessary CIIP resources for its practice?

• Increase in volume of exam reads (opportunity cost): $53,000
• Radiologist labor costs: $29,127
• Procurement of new PACS and reporting system: $250,000

Total: $332,127

Running total including one-year costs from part 1 and part 2 of this series: $614,576

Additional outcomes from not using a CIIP include the following:

• Increased exam turnaround times, radiologist frustration, and wasted time
• Reduced patient and referrer satisfaction, budgetary funding for other projects, and radiologist morale

Support resources that are properly equipped to handle the expansive needs of a radiologist group have become harder to come by with the consolidation of support resources occurring industry-wide. Organizations must accept the fact that radiologists have special support needs that should be addressed by engaging resources with the proper skills and abilities. Look for professionals with CIIP credentials to properly support your radiologist group and lead your organization to a more efficient and more cost-effective imaging practice.

Luke Bideaux is the founder of Vega Imaging Informatics, a consulting agency offering managed services and software solutions related to imaging informatics. Luke holds a Bachelor of Science in radiologic technology and certifications in radiography (ARRT) and imaging informatics (ABII). He is an advocate for the advancement of imaging informatics and serves as a member of the IIP Task Force for the Society of Imaging Informatics in Medicine (SIIM).