1. Electronic Radiology Consults & Chart Reviews

2. California Radiological Society, Imaging 3.0 Arnold C. Friedman M.D., FACR, FSAR. Chief of Radiology, VA Fresno. Professor of Clinical Radiology UCSF. arnief51@yahoo.com. Opinions expressed herein are solely those of the author and do not in any way reflect those of the Veteran’s Administration Electronic Radiology Consults & Chart Reviews

3. Disclosures I have no relevant disclosures related to this presentation

4. Problems Too many unnecessary exams ordered due to overcalling/over-recommending by nighthawks (inexperienced, defensive, lack of priors). Over-ordering of screening US for AAA (prior CTAP or LS-spine MR) and HCC (prior CT/MR Abd or US Abd/Ruq w/in 6 mos). Unindicated biopsy requests, unindicated exams encountered during protocoling. Time consuming to contact referring physician to cancel exam. No workload credit.

5. Solutions: Radiology E-consult Generated by referring doc. E-consults to other services already in use. Nighthawk recommends an exam: please send e-consult instead of just ordering it. Prompted to do US for AAA screen and prior CTAP or LS- spine MR done but not coded for AAA: order e-consult. Analogous for HCC screen US w/prior CT or MRI Abd. You want a biopsy? Don’t order it, get e-consult. Will tell you if it’s indicated, if it’s feasible, and whether US or CT is better guidance. Unindicated exams: not sure how to work-up a problem- get an e-consult.

6. Solutions: Radiology Chart Review Generated by radiologist during routine exam protocoling or if exam questioned by technologist. Unnecessary exams canceled; wrong exams changed to better exams. Unnecessary or premature screening US for AAA or HCC brought to radiologist by US tech and dealt with. Unindicated biopsy requests are canceled. Note in the chart is created with alert to referring. Anything potentially controversial discussed by phone with the referring.

7. Workload Credit E-consult/chart review either: 0-15 mins 15-30 mins 30-45 mins VA has system (DSS) for converting minutes to RVU’s. CT abd = 20 minutes currently. 0-15 minutes = 10 minutes = ½ a CT.

8. Radiology E-consult Radiologist informed by electronic alert; automatically printed out and put in physical inbox by admin assistant (backup). Virtually all complete in less than 1 business day.

24. Radiology Chart Review Go into CPRS, pick the patient.

42. 42 Radiologyleaders.org