Imaging Productivity: Harnessing RIS data to meet reporting targets

Diagnostics is moving into focus

The focus for efficiency gains has traditionally been on theatres, inpatient and outpatient activity and more recently the growing elective backlog. Diagnostics, however, have acquired a new emphasis since COVID. This is because significant backlog in diagnostics is causing delays in finding cancers (you can read more about this on our blog).  

As a response, NHSE has included diagnostics activity targets in the NHS Constitution, stating that all tests must be performed within 6 weeks from request. This puts pressure on trusts to understand their testing activity, capacity and bottlenecks in imaging reporting that cause downstream delays in the 18-week referral to treatment (RTT) target.

Trusts have not historically analysed diagnostics data in depth

Gathering these insights requires analysis and data flows which are not yet set-up well across Trusts. Data from radiology information systems (RIS) has not been used as extensively in the past and existed in lower quality than, for example, theatre data. In this context, Trusts now struggle making sense of their imaging data to action NHSE targets.

We were recently asked to support a large specialist NHS Trust in helping with this.

The ask: time-sensitive solutions to guide management

We did this in three stages:

1. Analyse national data to get a high-level picture.
2. Engage with team on the ground to understand what actionable insights are needed where and why they are not provided.
3. Deploying expert clinicians and analysts to provide the insight in a repeatable way.

We outline each of the below in turn and give some detail on the issues under the hood.

First: Public data

First, we explored publicly available data on the Trust’s diagnostics to form the start of meaningful conversation and gain a high-level understanding of some of their challenges. The two charts below showed that our client (Comparator 1 in the chart on the left) had above average waiting times for a scan to be reported, following testing. The time between testing and reporting had also seen a significant increase in 2022/23 compared to 2019/20, particularly for MRI, Nuclear Medicine and Single Photon Emission CT.

Second: Working with team on the ground to understand the problems

We then sat with stakeholders to map the imaging data journey at the Trust and uncovered the key issues within it (outlined below).

Issues we found were the below:

1. Complicated set-up: Before an end-user could reach any insight, four pieces of software needed to interact: a requesting software like ICE, a RIS software, a PACS software and finally a BI software, QlikView in the client’s case. All insights needed to wait till the analytics team had curated the data.
2. No quick way around it: Managers trying to extract data from RIS directly were faced with a complex interface that was both hard to work with and at risk of producing unreliable metrics. This step was incredibly time-consuming for managers, adding to undue stress.
3. Lack of resources: There were no dedicated imaging analysts at the Trust, which meant the imaging team had to compete with other teams to get the insights they needed from the busy BI department.

We supported the trust outlining a variety of solutions, including:

• Increasing workforce, such as a specialist PACS or analytics team member.
• Changing work practices, such as setting a cap on highly time-consuming MDT requests to focus on internal workload, and upskilling radiographers to report imaging.
• Upgrading software to one that included basic analytics, timed with a contract soon to expire.

In order to tie the department over with an urgent need for insights, we also delivered a fast turn-around reporting solution ourselves, embedded in their current BI environment.

Third: Delivering a trusted solution

We were onboarded on the Trust’s system to work within their environment and built a relationship with the BI and analytics team to ensure seamless knowledge transfer and accuracy of outputs.

Engaging with stakeholders also helped build trust in the outputs and ensure that it was truly useful to the team and met expectations.

Early draft of one of our reporting interfaces showing high-detail overview of reporting activity by radiologist and imaging modality, and reporting waiting times at a glance.

By the time the tool was ready to be shared Trust-wide, it had received the seal of approval from the imaging manager, the clinical director, and the BI lead. The final product was fully handed over to the Trust’s BI team to use as a starting point for more analysis and maintain as required in the future.

Specifically, it provided a high-detail overview of reporting activity by radiologist and imaging modality, and reporting waiting times at a glance.

This is enabling the Trust to:

• understand pressures on the imaging department
• manage workflows more effectively
• back department investments and business cases with evidence
• improve their performance against NHS diagnostic targets.