We often talk about ‘flow’ in our daily lives, but do we really grasp the deeper meaning? Although ‘information flow’ is commonly used when describing the functions of a radiology IT system, the information overload radiologists face daily would suggest the ‘flow’ part of the equation has been neglected.
When examining the meaning of ‘flow’ in its original context, there are three predominant states: laminar, turbulent and transitional. Laminar flow describes water moving smoothly in orderly layers; turbulent flow describes a series of different currents running in random directions (and often against each other), while transitional flow describes the state between the two.
The opposing states of flow can be seen when a calm river comes up against an obstruction which generates a turbulence of white water (an eddy). The most striking demonstration of differing flow-states is a waterfall, where the laminar flow occurs upstream and the turbulent flow occurs in the plunge pool beneath the ‘transitional’ drop.
A ‘laminar information flow’ is driven by the same logic. It seeks to emulate the serene and unobstructed journey of the river, upstream of the waterfall.
Radiology is on the wrong side of the waterfall
Advancements in radiology IT have served as an enabler for more information with little consideration for how rads are supposed to manage it all. Image files increase in size, prior studies increase in number and there is an ever-increasing amount of regulations and documentation to consider. Every day feels like a deluge; certainly not a laminar flow.
The last 15 years has seen a quadrupling of radiology workload as measured by RVUs (Bruls and Kwee, Insights Imaging 2020), requiring radiologists to interpret an image every 3-4 seconds (McDonald et al, Academic Radiology 2015). To compound matters, wider advancements in technology mean a rad is more likely to be interrupted to discuss cases. With rads’ time at an increasing premium, it is vitally important to ensure the information they receive is unobstructed, relevant and timely; and the information they disseminate is done so with maximum efficiency.
Technology can flatten the obstructions in the river
Almost by accident, the evolution of the radiology IT stack has created more obstruction for rads. RIS, PACS, EHR and CDS were developed to solve specific technical issues, not with the entire rad workflow in mind, and the requirement for rads to multi-task across multiple applications is yet another source of disruption. The lack of smooth integration between the many entities in the IT stack makes for even more turbulence, e.g. the need to dictate a measurement into a reporter that was already made in the viewer.
A bi-directional link between viewer and reporter is a key enabler. Once established, the above problem could be solved easily by simply auto-importing measurements into the reporter. Voice-driven selection of viewer tools and the ability to link dictated findings with slices in the viewer are other simple gains that can be made here. Ultimately, a laminar information flow across all workflow functions enables rads to save valuable cognitive load to focus on doing what they do best: reviewing images and making clinical diagnosis to improve patient care.
The depth of meaning
The flow of a river is always determined by the obstacles it must encounter. A drop in height creates a waterfall, a boulder creates an eddy, and both scenarios create turbulence. When it comes to the flow of information in radiology, new technology normally equals new obstacles for the radiologist. Thankfully there is now a better way: a laminar information flow. No more obstacles, no more turbulence.