# Patent

## Title
Method and apparatus for generating a clinician quality assurance scorecard

## Abstract

The present invention provides a quality assurance system and method that generates a quality assurance (QA) scorecard for clinicians that participate in a radiological-based medical imaging study using digital imaging technologies. According to one embodiment, client computers, servers, imaging devices, databases, and/or other components may be coupled to provided 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 clinician. The QA score provides a combined subjective and objective feedback system that includes performance evaluations from other users, including radiologists, technologists and patients. According to one embodiment, the feedback may be provided in real-time.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a continuation of U.S. patent application Ser. No. 11/699,351, filed Jan. 30, 2007, and 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 all 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” Ser. No. 11/699348 filed Jan. 30, 2007); “Method And Apparatus For Generating A Patient Quality Assurance Scorecard” Ser. No. 11/699349 filed Jan. 30, 2007); “Method And Apparatus For Generating An Administrative Quality Assurance Scorecard” 11/699350 filed Jan. 30, 2007); and “Method And Apparatus For Generating A Radiologist Quality Assurance Scorecard” Ser. No. 11/699344 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 may 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 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 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 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, a quantifiable list of pre-defined clinical performance parameters may be used by the program to measure overall performance of the clinician, or practicing physician, such as the utilization and medical imaging services that are provided in a clinical practice, among other pre-defined parameters.
According to one embodiment of the invention, clinical performance metrics may be calculated by the program based on predefined parameters, including completeness of data input, such as clinical history, laboratory data, physical exam findings; exam appropriateness, such as using defined appropriateness criteria; utilization patterns, including economic outcomes, clinical outcomes, and/or medico-legal outcomes; a patient safety profile, such as requested use of ionizing radiation, contrast, invasive procedures; communication/reporting, including the availability of imaging data, the receipt of imaging data, and/or radiologist consultations; timeliness, including time to initiate clinical action; feedback provided to the patient and specialists, such as the radiologist; participation in data collection and analysis, including outcomes analysis, reporting, and/or diagnostic accuracy; education and training, including imaging services and new technologies; peer review, including discretionary assessment of clinical performance as it relates to imaging services and patient diagnosis/treatment, among other predefined parameters.
According to one embodiment of the invention, the data that is collected during the imaging study may 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 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, the metrics module may analyze data that is associated with a defined list of quality assurance (QA) benchmarks to objectively evaluate clinicians, quantify a relative success of service delivery and provide educational (data-driven) feedback in order to optimize clinical performance, 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 practitioners that provide high levels of quality-oriented service deliverables.
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 CPOE entries to calculate metrics and generate a QA score for the clinician.
According to one embodiment of the invention, the QA metrics module may analyze various parameters to calculate a QA score for the clinician. According to one embodiment, the time-stamped data is a 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. After the image report is received, time-stamped data may be tracked by the program within the EMR, which records clinician actions, in the form of recording progress notes, consultations, and the ordering of clinical tests, imaging studies, and various treatment options (e.g. drug therapy). In either case, the QA scorecard program enables the clinician to enter data electronically into the EMR. 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, 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.
According to one embodiment, the QA scorecard program may track, record and analyze longitudinal patient-specific safety data and clinician-specific safety data, both an individual patient and group basis. This provides insight as to whether individual clinicians are over-utilizing certain types of “higher risk” imaging studies and provides educational feedback to specific clinicians. Additionally, mandatory educational resources may be forwarded to targeted clinicians for completion before imaging privileges are re-instated. This “clinician safety profile” data and trending analyses may be correlated by the program with local, regional, and national norms, with data available to third party payers and insurers to assist with economic incentive programs (P4P) to encourage improved performance and continuing medical education, as it relates to medical imaging safety factors.
According to one embodiment, a combined subjective and objective feedback system, method and computer program are provided that supply data to clinicians as to how their performance is perceived by imaging service providers, such as radiologists, and customers, such as patients. According to one embodiment, the feedback may be provided in real-time.
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.
FIGS. 3A and 3B illustrate a flow chart of a workflow sequence quality assurance program for image ordering from the perspective of a clinician, according to one embodiment of the present invention.
FIG. 4 illustrates a flow chart of a workflow sequence quality assurance program for communication and reporting from the perspective of a clinician, according to one embodiment consistent with 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, an administrator may be 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 101a-101n (hereinafter client computers 101), one or more servers 120, the imaging devices 210a-210n (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/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 scheduling module 244 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 220a-220n (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 222a-222n (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 224a-224n (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 226a-226n (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 219a-219n (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 216a-216n (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 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 the 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 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 clinicians, quantify a relative success of service delivery and provide educational (data-driven) feedback in order to optimize clinical performance, 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 practitioners that provide high levels of quality-oriented service deliverables.
According to one embodiment, a quantifiable list of pre-defined clinical performance parameters may be used by the program 110 to measure overall performance of the clinician, or practicing physician, such as the utilization and medical imaging services that are provided in a clinical practice, among other pre-defined parameters. According to one embodiment of the invention, clinical performance metrics may be calculated by the program 110 from various parameters, including completeness of data input, such as clinical history, laboratory data, physical exam findings; exam appropriateness, such as using defined appropriateness criteria; utilization patterns, including economic outcomes, clinical outcomes, and/or medico-legal outcomes; a patient safety profile, such as requested use of ionizing radiation, contrast, invasive procedures; communication/reporting, including the availability of imaging data, the receipt of imaging data, and/or radiologist consultations; timeliness, including time to initiate clinical action; feedback provided to the patient and specialists, such as the radiologist; participation in data collection and analysis, including outcomes analysis, reporting, and/or diagnostic accuracy; education and training, including imaging services and new technologies; peer review, including discretionary assessment of clinical performance as it relates to imaging services and patient diagnosis/treatment, among other predetermined parameters.
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 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 in formational 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. 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 system. 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 306, the QA scorecard program 110 may determine whether or not the user is assigned full privileges to perform actions within the QA scorecard program 110. If the user has full privileges, then the QA scorecard program 110 requests patient information or a patient identification number in operation 314.
According to one embodiment of the invention, a reduction of privileges may be prescribed for various predefined reasons, including failure to follow a predefined protocol, frequently misdiagnosing an ailment, failure to follow a cost effective treatment plan, and/or failure to complete continuing medical education (CME) credits, among other predefined reasons.
According to one embodiment of the invention, if the user does not have full privileges, then in operation 309, the QA scorecard program 110 displays a warning message on the user interface advising the user that less than full privileges are associated with the log-in criteria. In operation 310 the QA scorecard program 110 may identify and recommend re-credentialing programs, including approved CME courses, computer training, or other re-credentialing programs. The QA scorecard program 110 will enable the user to immediately access the recommended re-credentialing programs through the QA scorecard program 110. According to one embodiment, the user may defer starting the recommended re-credentialing programs until a future date. After users successfully complete the re-credentialing program, the QA scorecard program 110 may restore full privileges to the user.
According to one embodiment of the invention, policies governing removal and re-institution of imaging privileges may be under the jurisdiction of a multi-disciplinary QA team including radiologists, administrators, and chief technologists, who would all have input into the overall process of reviewing data from the CPOE system.
According to one embodiment of the invention, the warning message displayed in operation 309 also may identify a grace period that is granted for regaining full privileges before all the privileges are revoked. According to one embodiment of the invention, the grace-period may be defined by a threshold, such as a number of log-ins, a number of days, or other threshold that may not be exceeded before all privileges are revoked.
According to one embodiment of the invention, the grace period threshold may be determined by the program 110 based on predetermined factors, such as the frequency of occurrence of one of predefined triggers, the severity of a clinician error, the amount of time required to complete a re-credentialing program, and/or other factors. In operation 312, the QA scorecard program 110 determines if the user has exceeded the allowed number of grace period log-ins. If the number of allowed grace period log-ins are exceeded, then the QA scorecard program 110 may revoke all privileges and the user may be presented with an alert that all privileges are revoked. The QA scorecard program 110 may prevent the user from proceeding further in the QA scorecard program 110 and the QA scorecard program 110 may return to the welcome screen. The QA scorecard program 110 may provide the user with contact information for re-establishing privileges.
If the grace period threshold has not been exceeded, then the QA scorecard program 110 prompts the user for patient information or a patient identification number in operation 314.
In operation 316, the QA scorecard program 110 accesses 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.
In operation 318, the QA scorecard program 110 displays the information and/or records that are associated with the selected patient. 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 provides 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. The QA scorecard program 110 facilitates creation of a universal, patient-specific imaging datasheet for digital images that could be stored in the EMR, RIS, and/or PACS, among other information systems.
According to one embodiment of the invention, each time a new entry or modification is made to the imaging data sheet, 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, each user may create profiles for the imaging data sheet and may customize the imaging data sheet display to their own individual preferences. According to one embodiment of the invention, the customized imaging data sheet may be linked by the program 110 to users via a log-in criteria.
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.
In operation 320, the QA scorecard program 110 presents the clinician with a computerized physician order entry (CPOE) application to initiate an exam order. In operation 322, the QA scorecard program 110 receives data that includes all pertinent clinical data elements that are related to the diagnosis being evaluated. According to one embodiment of the invention, the data elements include past medical and surgical history; allergies, with particular emphasis directed to contrast media used in medical imaging; risk factors, including family history and tumor markers; non-imaging data, including laboratory, clinical testing, pathology; clinical indication and presumptive diagnosis, which prompted the ordered imaging exam; findings on physical examination; historical imaging data, including outside imaging exams and findings; and/or other data elements.
According to one embodiment of the invention, a standard tag may be created by the program 110 within the various informational sources to identify individual QA data parameters. The communication module 230 may extract the parameters from the CPOE entries to calculate metrics and generate a QA score for the clinician. For example, the metric module 232 may reduce a QA score if data elements are “missing,” such as if key information fields are not filled in or are incomplete. In this case of missing elements, the QA scorecard program 110 may not process the request.
According to one embodiment of the invention, the radiologist and/or technologist may review the data elements that are entered into the CPOE system before the requested imaging exam is performed. The availability of the data elements provides an opportunity for the technologist and/or radiologist to clarify any discrepancies or clinical questions. The QA scorecard program 110 enables the technologist and/or radiologist to make adjustment to the exam protocol and/or to optimize the image exam prior to performing the image exam. According to one embodiment of the invention, discrepancies are defined to include data that is inconsistent with other information that is included in the record. For example, the clinician may input data indicating that no prior history of cancer exists. However, a prior imaging report may show past medical history of cancer.
In operation 324, the QA scorecard program 110 determines whether or not the clinician's image exam order is appropriate in view of clinical imaging variables. Exam order appropriateness is a quantitative analysis that evaluates the clinical efficacy of the image exam ordered, based on an evaluation of the data elements associated with the examination request. According to one embodiment of the invention, the QA scorecard program 110 may objectively track the exam order appropriateness using pre-defined appropriateness criteria, such as linking clinical and historical data with different types of imaging exams. For example, if a clinician orders a chest CT to evaluate for lung cancer without first ordering a chest radiograph, the CPOE system may require the less expensive screening study (radiograph) to be performed before performing a more expensive CT. If, for example, the patient is being evaluated for kidney stones (urolithiasis) and has a past history of allergic reaction to intravenous contrast dye, the CPOE system will recommend a non-contrast CT or ultrasound (US) in lieu of an intravenous pyelogram (IVP), which requires contrast.
If the exam order is determined to be inappropriate, then the QA scorecard program 110 may display recommendations in operation 325 for modifying the imaging exam order. According to one embodiment of the invention, the QA scorecard program 110 may use algorithms to generate mandatory and optional recommendations for the clinician. For example, if the patient has a past history of allergic reaction to contrast, then an IVP is contraindicated and cannot be performed. If, on the other hand, both a CT and US will provide comparable data, the program 110 may recommend the US over the CT, at least due to the fact that US does not have ionizing radiation, while CT does. In the end, the QA scorecard program 110 defers to the discretion of the ordering clinician. According to one embodiment of the invention, the willingness and availability of the requesting clinician to receive and modify the exam request may be included by the program 110 in the exam appropriateness analysis.
According to one embodiment of the invention, availability may defined as the ability to communicate in a timely fashion (i.e. accessibility). For example, availability may be a combined measure of the time requirements to document receipt of data and confirm a response. Electronic communication pathways may be created by the program 110 to automate the communication process as defined through each clinician user profile. For example, clinicians may prefer text messaging, e-mail alerts, cell phone, faxing, and/or other communication methods.
According to one embodiment of the invention, willingness may be defined as a degree with which an individual modified the imaging requisitions in accordance with appropriateness criteria data and recommendations of departmental staff. While there are situations where the clinician may insist on following a prescribed order, trending analysis may be performed by the program 110 to demonstrate outliers, in terms of those clinicians that consistently over-ride standard guidelines.
The appropriateness criteria are designed to take into account a multitude of clinical and imaging variables and provide objective feedback data by the program 110 to the ordering clinician in order to maximize patient safety, cost, and diagnostic accuracy. According to one embodiment of the invention, the metrics module 232 may generate a QA score for the clinician based on an evaluation of the appropriateness data.
According to one embodiment, the QA scorecard program 110 may request the clinician to provide additional data in operation 325 for further evaluating the image exam order. According to one embodiment of the invention, the QA scorecard program 110 may electronically track, store, and analyze recommendations regarding exam appropriateness to create physician profiles on ordering habits, completeness of input data, and compliance with appropriateness standards, among other elements. This profile data may in turn be used for clinician education and training.
According to one embodiment of the invention, another component of exam appropriateness may be the routine ordering of preventative screening imaging exams (e.g. screening mammography), in accordance with community standards and patient/family risk factors. As genetic markers become an integral part of the patient clinical profile, these preventative screening studies will take on greater importance in disease prevention and will also become an important component in the assessment of exam appropriateness.
Upon completion of operation 325, the QA scorecard program 110 returns to operation 322 in order to allow modification of the pertinent clinical data elements. In operation 324, the QA scorecard program 110 again evaluates the modified CPOE to determine whether or not the clinician's exam order is appropriate in view of clinical imaging variables. If the exam order again determined to be inappropriate, then the QA scorecard program 110 proceeds to operation 325.
On the other hand, if the exam order is determined to be appropriate, then the QA scorecard program 110 proceeds to operation 326, where the data derived from this appropriateness analysis may be stored in a database, such as RIS 20, among other databases. In operation 328, the QA scorecard program 110 may analyze the patients data obtained from the HIS 10, RIS 20, EMR or other information source against a patient's clinician profile. In operation 330, the QA scorecard program 110 may present an automated list of preventative screening imaging exams for the selected patient based on surveillance guidelines.
In operation 332, the QA scorecard program 110 may present additional preventative screening imaging exams that may be added to the image order exam. In operation 333, the QA scorecard program 110 may forward the imaging exam to the clinician's staff for scheduling.
According to one embodiment of the invention, the QA scorecard program 110 may evaluate the utilization patterns of ordering clinicians during the appropriateness evaluation. In operation 334, the QA scorecard program 110 may retrieve, store, and analyze the utilization data from the HIS 10 and/or RIS 20 and may correlate the utilization data with each individual patient's clinical profile. According to one embodiment, the correlation may be defined by disease-specific current procedural terminology (CPT) codes. These codes are contained within the HIS 10 for inpatient hospitalizations and the EMR, among other databases.
According to one embodiment of the invention, the QA scorecard program 110 may periodically track and analyze this data in order to provide insight as to specific clinical indications and diagnoses requiring remedial education on the part of the clinician. The frequency of analysis may be established by each individual site and may be performed monthly or quarterly basis, for example. The QA scorecard program 110 may analyze variables, such as patient safety, cost, redundancy, and clinical efficacy, among other variables. According to one embodiment of the invention, patient safety may include elements such as contrast administration, radiation exposure, and invasive procedures (e.g. biopsies). According to one embodiment of the invention, cost may include an analysis that takes into account whether less expensive imaging studies are being utilized in lieu of more expensive, technology intensive exams. For example, if a patient presents with headaches, CT is a less expensive exam that provides comparable diagnostic information to a more expensive MRI. According to one embodiment of the invention, redundancy is the duplication of imaging exams to provide similar imaging data. One of the problems with over-utilization is that physicians often order multiple imaging exams that individually answer the same clinical questions. If, for example, a patient is being evaluated for elevated liver enzymes there is little yield in ordering both an abdominal US and CT, yet it occurs quite frequently. Invasive procedures are fraught with potential morbidity and mortality. As a result, they should only be performed after all non-invasive diagnostic work-ups have been exhausted.
Adverse effects of over-utilization of medical imaging services may be determined from these variables. Adverse effects of over-utilization of medical imaging services may include economic factors, such as increased costs for overall healthcare delivery; timeliness, such as potential delay in diagnosis and treatment planning; decreased accessibility, such as diminished capacity and increased exam backlog; diffusion of responsibility, such as increased number of consultants and tests with diminished clinical focus on primary care provider; increased reliance on technology, such as depersonalization of medical practice; patient safety, such as increased risk of adverse actions associated with contrast and ionizing radiation; diminished R & D, such as potential to decrease innovation and new product development due to medico-legal risk; among other factors.
In operation 336, the QA scorecard program 110 may perform trend analysis of clinician medical imaging utilization. The trend analysis may be evaluated on an individual patient and patient group basis, with patient groups classified according to demographics, medical histories, and clinical profiles. According to one embodiment of the invention, the QA scorecard program 110 may perform trend analysis to identify specific trends in imaging utilization patterns. Since patient, institution, and clinical indication are unique, they should be taken in the overall context of multiple data points. For example, if a physician inappropriately orders the wrong study on a single patient than it is recorded and taken into context. If, on the other hand, that same physician repeatedly orders the wrong imaging study on multiple patients, then the overall trend is one which identified a need for intervention, such as in the form of education.
In operation 338, the QA scorecard program 110 may correlate utilization data trends with local, regional, and national norms. The QA scorecard program 110 may provide data-driven feedback to each clinician relative to their peer group for educational purposes. The QA scorecard program 110 may separate utilization patterns into categories including, preventative medicine, diagnosis, treatment, and disease surveillance, among other categories. In operation 340, the QA scorecard program 110 may present feedback to the clinician regarding the utilization data.
In operation 342, the QA scorecard program 110 may derive apply the utilization data to create best practice guidelines and assist in technology allocation, development of new imaging services, and improved appropriation of healthcare funding.
Best practice guidelines refer to what are shown to be the most effective imaging studies for specific clinical indications, based on a large number of data from multiple institutions. For example, in the evaluation of osteomyelitis for the diabetic foot, it may be demonstrated through scientific study, that contrast enhanced MRI is the best imaging study (analyzing cost, safety, and clinical efficacy), as opposed to alternative imaging exams (CT, radionuclide bone scan or white blood cell scan).
Regarding technology allocation, if the QA scorecard program 110 generates cumulative data from the utilization analysis showing a need for a second MRI scanner, than this evidence may be provided to support a request for a second MRI during the next capital equipment cycle. In this regard, some states require certificates of need (CON) for certain types of advanced technologies (e.g. PET scanner) and this data provides an objective means to justify (or refute) requests for CON.
Regarding education, the QA scorecard program 110 may distinguish between intra-departmental or on-line educational courses that are designed to educate clinicians as to new imaging technologies and applications. The QA scorecard program 110 may also direct users to information regarding the best utilization of these services. If for example, a clinician continues to inappropriately order the same type of imaging exam for a specific clinical indication/diagnosis, then they may be made aware of existing recommendations. These educational programs may be automated and customized to a specific problem by the program 110, such as by bookmarking certain on-line education materials to specific imaging data. For example, maybe a website has an overview on new MRI applications for neuro-imaging. If a clinician is inappropriately ordering brain MRI exams, the program 110 may identify the error and direct the clinician to the on-line educational program that best fits the area of concern. Once the educational program has been completed, as documented by CME credits, for example, the QA scorecard program 110 may restore any temporarily removed privileges.
FIG. 4 illustrates a communication and reporting process that may be presented to a clinician after a radiologist has interpreted the imaging study, according to one embodiment of the invention. Communication and reporting procedures of the program 110 ensure that the information contained within the medical imaging report is received in a timely fashion and appropriately utilized for clinical management. The QA scorecard program 110 may alert the clinician after the radiologist has interpreted the images.
In operation 400, the QA scorecard program 110 presents imaging results to the clinician from information sources, such as HIS 10, RIS 20, PACS 30, among other information sources. In operation 402, the QA scorecard program 110 receives an assessment regarding whether or not the imaging study contains unexpected results or emergent findings.
If the imaging study does not include unexpected results or emergent findings, then the clinician is presented with the results by the program 110 pursuant to standard protocol. If the imaging study includes unexpected results or emergent findings, then the clinician is presented with the results by the program 110 pursuant to special protocol. When the QA scorecard program 110 receives information of clinically unexpected or emergent findings by the radiologist during the course of imaging exam interpretation, the QA scorecard program 110 generates an alert that notifies the ordering clinician to immediately contact the radiologist to directly receive these emergent findings.
When the imaging study includes unexpected results or emergent findings, the QA scorecard program 110 sends an alert to the clinician in operation 404 with instructions for contacting the radiologist. Whether the communication occurs electronically or verbally, the QA scorecard program 110 documents the communication by time stamping and storing the communication for future analysis. Upon receipt of the alert, the clinician may immediately contact the imaging department staff (i.e. radiologists, technologists, administrators) to discuss the clinical concerns. In operation 406, the clinician may contact the patient to advise of the results. The QA scorecard program 110 documents the communication between the clinician and patient by time stamping and storing the communication for future analysis. According to one embodiment of the invention, QA scorecard parameters for reporting and communication may include criteria such as, time from order entry to report completion; time from report completion to receipt by clinician; 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 criteria.
According to one embodiment, the time-stamped data is a component part of objective data analysis. Imaging departments are able to utilize program 110 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. After the image report is received, time-stamped data may be tracked by the program 110 within the EMR, which records clinician actions, in the form of recording progress notes, consultations, and the ordering of clinical tests, imaging studies, and various treatment options (e.g. drug therapy). In either case, the QA scorecard program 110 enables the clinician to enter data electronically into the EMR. 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, a clinician may order a chest CT angiography (CTA) in the assessment of suspected pulmonary embolism. Due to the emergent nature of the clinical indication, the QA scorecard program 110 may be accessed to order the imaging exam (within the CPOE system) as “stat”. The exam order time is recorded by the QA scorecard program 110, for example at 18:08 hours. The patient arrival time to the imaging department may also be recorded by the QA scorecard program 110, for example at 18:32 hours. The individual components of the examination performance time also may be recorded within the RIS by the QA scorecard program 110, including the exam begin time, for example at 18:40 hours and exam completion time, for example at 18:45 hours. The image exam may be transferred and saved to the PACS upon completion by the QA scorecard program 110. Once the exam is saved to the PACS, the QA scorecard program 110 may make the exam available to the radiologist and the radiologist may be alerted accordingly. The time that the image exam is recorded within the PACS, along with the time the imaging exam was displayed and the time dictation was completed may be recorded by the QA scorecard program 110, for example at 19:01 hours. If, in this example, the radiologist used speech recognition software to transcribe the dictated report, the report completion time may be identical to the time dictation was completed, for example at 19:01 hours.
Due to the emergent nature of the imaging exam (ordered stat), the QA scorecard program 110 may immediately send the imaging report to the referring clinician, such as via a Critical Results Reporting program within the PACS. Receipt by the clinician may be acknowledged and confirmed electronically by the QA scorecard program 110, via the clinician's PDA, for example at 19:10 hours. Based on the positive findings of pulmonary embolism (on the CTA report), the clinician in turn may access the QA scorecard program 110 to immediately order initiation of anti-coagulation therapy, with the time-stamped order recorded in the EMR, for example at 19:14 hours.
Since all these events are recorded electronically within the various information systems, they are available to be recorded into the QA database, along with any corresponding analysis. The QA scorecard program 110 may calculate metrics from various parameters, including the exam completion time, such as the time from order entry to exam completion: 37 minutes; reporting time, such as the time from exam reviewed by radiologist to time report received by clinician: 25 minutes; the time to initiate clinical action, such as the time from report receipt to order entry into EMR: 4 minutes; and the total exam to treatment cycle time, such as time from exam order to treatment order: 66 minutes; among other parameters.
According to one embodiment, the QA database and time-stamped data elements within the QA database enable the various time requirements to be quantified by the program 110 for various components within the overall imaging/treatment cycle. By doing so, an objective methodology is provided by the program 110 to assess clinician availability and responsiveness with regard to imaging examination data. This time-stamped data becomes a valuable tool for users, such as administrators and clinicians, to assess overall workflow and identify bottlenecks and limitations within the system. The QA database also provides valuable data to the community at large as to the time efficiency of imaging service and clinical providers.
When the imaging study does not include unexpected results or emergent findings, the process proceeds to operation 408, where the QA scorecard program 110 presents the imaging results to the clinician. In operation 410, the QA scorecard program 110 may present the clinician with support tools and facilitate a consultation with the radiologist, as needed. The QA scorecard program 110 may present decision support tools, including computer-aided detection (CAD), specialized image processing, electronic teaching files and other on-line educational resources for patient management, such as the National Library of Medicine (NLM) for literature searches.
In operation 412, the QA scorecard program 110 presents the imaging study data including exposure levels and other parameters of the imaging study. The imaging study data may be provided by the program 110 from multiple sources, including the imaging modality, such as acquisition parameters used to calculate radiation dose; contrast injector technology, such as contrast-related data; EMR, such as patient historical data; and radiology personnel (radiologist, technologist, nurse). In operation 414, the QA scorecard program 110 may store the imaging study data in a storage device associated with RIS 20, among other storage devices. The imaging study data may be associated by the program 110 with clinical feedback information.
In operation 416, the QA scorecard program 110 calculates an amount of patient radiation exposure. For example, the QA scorecard program 110 may calculate the ionizing radiation that is associated with each individual medical imaging exam, based on acquisition and exposure parameters. The calculation may be performed prospectively by the program 110 and may be stored to track longitudinal radiation dose and carcinogenesis risk. In operation 418, HIS 10 and RIS 20, and/or other information sources, may be updated by the program 110 to include the calculated safety factors.
According to one embodiment, in order to optimize safety concerns and record/track cumulative data, the QA scorecard program 110 provides patient safety data at any location where the patient is seeking and/or receiving medical imaging services. In the event that the patient had a previous allergic reaction to contrast at another medical imaging facility and the patient now presents with altered mental status and cannot provide accurate historical data, the QA scorecard program 110 provides access to the pre-existing safety data before any imaging exam is performed. By storing the QA Scorecard data within a universal EMR, this data is made accessible by the program 110 to appropriate healthcare providers at any location.
One method of providing universal accessibility for the data is to use 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 track, record and analyze longitudinal patient-specific safety data and clinician-specific safety data, both an individual patient and group basis. This provides insight as to whether individual clinicians are over-utilizing certain types of “higher risk” imaging studies and provides educational feedback to specific clinicians. Additionally, mandatory educational resources may be forwarded to targeted clinicians for completion before imaging privileges are re-instated. This “clinician safety profile” data and trending analyses may be correlated by the program 110 with local, regional, and national norms, with data available to third party payers and insurers to assist with economic incentive programs (P4P) to encourage improved performance and continuing medical education, as it relates to medical imaging safety factors.
In operation 420, the QA scorecard program 110 may determine whether or not patient safety factors are exceeded. If patient safety factors are exceeded, then the QA scorecard program 110 may refer the radiologist and technologist to a QA committee in operation 422.
If patient safety factors are not exceeded, then the QA scorecard program 110 may proceed to present the clinician with external peer review results in operation 424. External peer review serves as a mechanism for each clinician to be evaluated both prospectively and retrospectively by their medical peers. According to one embodiment, prospective evaluation may be provided by radiologists that serve as imaging consultants and provide feedback as to the efficacy of imaging exam utilization. According to one embodiment, clinician peers may provide both prospective and retrospective feedback as to the efficacy of clinical management, following completion of the initial imaging exam. According to one embodiment, utilization of consultants, laboratory and clinical tests, and invasive procedures (e.g. surgical biopsy) play an important role in diagnosis, while medical, surgical, and radiation therapy all play a role in disease treatment. By random electronic auditing of the CPOE and EMR, peer review can be directly incorporated into patient management and provide an important subjective tool for providing feedback to the clinician on imaging service and clinical management. The data derived from this peer review would be entered into a comprehensive QA database and provided to the clinician on a periodic basis for educational purposes, with trending analyses documenting “best practice” guidelines relative to local, regional, and national peer groups.
According to one embodiment, combined subjective and objective feedback provides data to clinicians as to how their performance is perceived by imaging service providers, such as radiologists, and customers, such as patients. Radiologist may provide feedback regarding availability and accessibility for reporting, consultations, and queries related to the patient and exam ordered. In addition, radiologists may provide data as to the frequency and reliability of clinical feedback provided to them by the clinicians. For example, if a radiologist reported a nonspecific lung nodule on a chest CT exam and recommended PET scan correlation, it is instructive for that radiologist to receive follow-up information, in the event that the recommended PET scan was performed at an outside institution. According to one embodiment of the invention, feedback may be provided in an automated fashion by the program 110 with the introduction of pop-up menus and electronic auditing tools that track clinician review of the imaging report and record their preferences. The bi-directional nature of this feedback is ultimately aimed at improving clinical outcomes and is equally important to both the radiologist and the clinician. Clinician feedback is critical in the overall evaluation of medical imaging services, including report accuracy, recommended follow-up, and timeliness in diagnosis.
According to one embodiment of the invention, the clinician may also obtain feedback from the patient 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 tend to be biased (some people grade too harshly, others too easily), the scored answers may be extrapolated by the program 110 based on individual biases relative to the larger group. Subjective answers may be reviewed by an impartial administrator who records information into the QA database to identify consistent trends.
Active participation in prospective data collection and analysis is a component of the QA Scorecard and pay for performance system. The data that is collected and analyzed by the program 110 provides the foundation for evaluating reports, diagnostic accuracy, and clinical outcomes analysis.
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. A computer system for generating a quality assurance scorecard, comprising: at least one memory containing at least one program, and a processor which executes the at least one program, the program comprising the steps of:
receiving and storing data elements in said memory of a computer system on a particular patient prior to performing an imaging examination;
receiving and storing in said memory, a patient imaging examination order and/or protocol from a clinician;
comparing and analyzing said patient imaging examination order and/or said protocol with said data elements stored in memory;
evaluating said date elements associated with said imaging examination order, including a completeness of said data elements, in view of pre-defined appropriateness criteria;
evaluating a clinician profile of said clinician's examination ordering history, including said examination order and/or protocol's compliance with community standards;
determining an appropriateness of said imaging examination order and/or protocol based on a result of said comparison and analysis and evaluations;
providing a recommendation of whether to proceed with said imaging examination order and/or protocol based on said determination of appropriateness; and
generating a clinician quality assurance scorecard including a quality assurance score based on said determination of appropriate and said recommendation;
wherein said quality assurance score objectively quantifies the clinicians's performance With respect to the particular patient being examined, prior to initiating said imaging examination.

2. The system according to claim 1, further comprising:
an authentication module which provides biometrics to identify users of said computer system.

3. The system according to claim 2, further comprising:
a report generating module which generates reports based on predetermined events, including at least one of a predetermined status of an imaging study, and/or a finding forwarded by said clinician.

4. The system according to claim 1, further comprising:
a notification module which generates notifications and/or alerts based on at least one of a completion of an imaging report, scheduling of examinations, and release of status information.

5. A computer implemented method of generating a quality assurance scorecard on a clinician, comprising:
receiving and storing data elements on a particular patient, at a database of a computer system, prior to performing an imaging examination using an imaging apparatus;
receiving and storing a patient imaging examination order and/or protocol from a clinician, at said database of said computer system;
comparing and analyzing said patient imaging examination order and/or said protocol with said data elements stored in said database, using a processor of said computer system;
evaluating said data elements associated with said imaging examination order, including a completeness of said data elements, in view of pre-defined appropriateness criteria;
evaluating a clinician's profile of said clinician's examination ordering history, including said examination order and/or protocol's compliance with community standards;
determining an appropriateness of said imaging examination order and/or protocol based on a result of said comparison and analysis and evaluations;
providing a recommendation of whether to proceed with said imaging examination order and/or protocol based on said determination of appropriateness; and generating a clinician quality assurance scorecard including a quality assurance score based on said determination of appropriateness and said recommendation;
wherein said quality assurance score objectively quantifies the clinician's performance with respect to the particular patient being examined, prior to initiating said imaging examination.

6. The method according to claim 5, further comprising:
performing an authentication procedure using a biometrics apparatus, on a clinician prior to authorizing said request for said imaging exam.

7. The method according to claim 6, further comprising:
alerting said clinician when less than full privileges are associated with said clinician;
identifying and recommending at least one re-credentialing program to said clinician; and
restoring full privileges to said clinician after completion of said re-credentialing program; wherein
said at least one re-credentialing program includes CME courses or computer training.

8. The method according to claim 7, further comprising:
granting a grace period for regaining full privileges before all of said privileges are revoked;
wherein said grace period is defined by a threshold, such as a number of log-ins into said computer system, a number of days, or another threshold that may not be exceeded before all privileges are revoked.

9. The method according to claim 5, wherein said database includes information from at least one of an electronic medical record (EMR), a hospital information system (HIS), a radiology information system (RIS), and PACS.

10. The method according to claim 9, wherein said information is an imaging data sheet which includes at least one aspect of said patient's medical history; and
enabling a user comprising at least one of said clinician, a radiologist, or a technologist, to customize said imaging data sheet for said patient, including:
enabling said user to create profiles for said imaging data sheet; and
enabling said user to customize said imaging data sheet's display to said users own individual preferences.

11. The method according to claim 10, wherein said aspect includes at least one of prior imaging exams and results, including those performed at outside facilities, current clinical problems, pertinent findings on a physical exam, pertinent laboratory and pathology data, ancillary data, procedural findings, operative or consultation notes, clinical testing, technical information related to a previous imaging exam performed, technologist observations, including pertinent findings and measurements, technologist notes, including complications, and exam limitations.

12. The method according to claim 11, further comprising:
recording a. time-stamp each time a new entry or modification is made to said imaging data sheet.

13. The method according to claim 10, further comprising:
linking said customized imaging data sheet to log-in criteria of said user.

14. The method according to claim 13, further comprising:
presenting a user with a computerized physician order entry (CPOE) application to initiate said imaging examination; and
enabling said user to enter said data elements into said CPOE.

15. The method according to claim 14, wherein said data elements include at least one of a past medical and surgical history, allergies, with particular emphasis directed to contrast media used in medical imaging, risk factors, including family history and tumor markers, non-imaging data, including laboratory and clinical testing, pathology, clinical indication and presumptive diagnosis, which prompted said imaging examination, findings on physical examination, historical imaging data, and outside imaging examinations and findings.

16. The method according to claim 15, further comprising:
creating a standard tag within said imaging data sheet to identify individual quality assurance data parameters.

17. The method according to claim 16, further comprising:
enabling a second user comprising at least one of said radiologist, or said technologist, to review said data elements that are entered into said CPOE system; and
enabling said second user to make adjustments to at least one of said examination protocol and an optimization of said imaging examination prior to said imaging examination being performed.

18. The method according to claim 17, further comprising:
generating mandatory and optional recommendations for at least one of said clinician, radiologist, or technologist, regarding said evaluation, including recommending modifications to said imaging examination when said imaging examination is deemed inappropriate; and
adjusting said imaging examination protocol to optimize said imaging examination prior to said imaging examination.

19. The method according to claim 18, further comprising:
requesting additional data from said user for further evaluating said request for said imaging examination.

20. The method according to claim 19, further comprising:
tracking, storing, and analyzing recommendations on appropriateness of said imaging exam; and
wherein tracking and analyzing appropriateness data is performed in order to provide an analysis of specific clinical indications and diagnoses requiring remedial education on the part of said user, including analyzing variables, such as patient safety, cost, redundancy, and clinical efficacy.

21. The method according to claim 20, further comprising:
presenting an automated list of preventative screening imaging examinations for said patient based on at least one surveillance guideline; and
presenting said clinician with additional preventative screening imaging examinations that may be added to said imaging examination.

22. The method according to claim 21, further comprising:
forwarding said imaging examination to an individual for scheduling when said evaluation deems said imaging examination is appropriate.

23. The method according to claim 22, further comprising:
alerting said clinician that said imaging examination is one of redundant, that a less expensive imaging examination exists, or that a less evasive imaging examination exists.

24. The method according to claim 23, further comprising:
performing a trend analysis of medical imaging utilization of said clinician;
wherein said trend analysis may be evaluated on said patient and a patient group basis, with said patient groups are classified according to demographics, medical histories, and clinical profiles.

25. The method according to claim 24, further comprising:
correlating at least one utilization data trend with local, regional, and national norms; and
providing data-driven feedback to said clinician, wherein said data-driven feedback is relative to a peer group for educational purposes.

26. The method according to claim 25, further comprising:
creating at least one best practice guideline for technology allocation, development of new imaging services, and improved appropriation of healthcare funding.

27. The method according to claim 26, further comprising:
identifying unexpected results or emergent findings from said imaging examination; and
alerting said clinician of said unexpected results via special protocol; and
creating a time-stamp when communication between said user and said patient occurs.

28. The method according to claim 27, further comprising:
presenting said user with support tools;
wherein said support tools include at least one of computer-aided detection (CAD), specialized image processing, electronic teaching files and on-line educational resources for patient management; and
facilitating a consultation with said second user.

29. The method according to claim 28, further comprising:
calculating patient safety factors;
wherein said patient safety factors include an amount of radiation exposure; and
updating said database to include said calculated safety factors.

30. The method according to claim 29, further comprising:
determining when said patient safety factors are exceeded;
referring said clinician to a quality assurance committee; and
presenting said clinician with an external peer review.

31. A non-transitory computer-readable medium containing instructions for generating a quality assurance scorecard on a clinician, comprising:
receiving and storing data elements on a particular patient, at a database of a computer system, prior to performing an imaging examination using an imaging apparatus;
receiving and storing a patient imaging examination order and/or protocol from a clinician, at said database of said computer system;
comparing and analyzing said patient imaging examination order and/or said protocol with said data elements stored in said database, using a processor of said computer system;
evaluating said data elements associated with said imaging examination order, including a completeness of said data elements, in view of pre-defined appropriateness criteria;
evaluating a clinician profile of said clinician's examination ordering history, including said examination order and/or protocol's compliance with community standards;
determining an appropriateness of said imaging examination order and/or protocol based on said comparison and analysis and evaluations;
providing a recommendation of whether to proceed with said imaging examination order and/or protocol based on said determination of appropriateness; and
generating a clinician quality assurance scorecard including a quality assurance score based on said determination of appropriateness and said recommendation;
wherein said quality assurance score objectively quantifies the clinician's performance with respect to the particular patient being examined, prior to initiating said imaging examination.

32. The computer-readable medium according to claim 31, further comprising instructions for providing an instantaneous notification of the performance to the clinician.

33. The computer system according to claim 1, wherein the objective quantification of the clinician's performance is provided to the clinician instantaneously.

34. The method of claim 5, further comprising the step of providing an instantaneous notification of the performance to the clinician.