Workflow Lexicons in Healthcare: Validation of the SWIM Lexicon

System approach to prevent lost studies and improve radiology report turnaround time

Purpose

On our picture archiving and communication system worklist, there was no way to differentiate body imaging (BI) from musculoskeletal (MSK) MR pelvis examinations. They were listed on only the BI worklist. This resulted in ‘lost’ MSK MR pelvis studies with high report turnaround time (TAT). Some exams had preliminary reports with substantiative changes made days later when found. The goals of this project were to create a solution to prevent ‘lost’ exams and improve TAT.

Methods

A report of 3 months of MR pelvis studies was reviewed to determine time to first view by MSK radiologists, time of completion, time of preliminary report and time of final signature. Mean TAT was calculated and exams with delays in reporting resident misinterpretation recorded.

An MSK reserve flag was created for the BI radiologists to use when they found an MSK study on their worklist. The flag moved them onto the MSK reserve worklist. A second intervention included technologists placing the reserve on examination completion. After this, another 3 months of data was analysed.

Results

There was a significant improvement (p=0.0018) in time to view by MSK from preintervention mean of 1125 min (n=107) to postintervention mean of 526 min (n=127). There was also a significant improvement (p=0.0033) in time to view inpatient and Emergency department cases from 927 min to 357 min. Time from study completion to final signature also improved from a mean of 1764 min to 838 min, though not statistically significant (p=0.08). There were five cases of delay in reporting resident misinterpretation preintervention and none postintervention.

Conclusion

Our intervention shows the importance of modifying human and informatics factors to solve a patient safety issue. Introduction

Standard Lexicons, Coding Systems and Ontologies for Interoperability and Semantic Computation in Imaging

Standard clinical terms, codes, and ontologies promote clarity and interoperability. Within radiology, there is a variety of relevant content resources, tools and technologies. These provide the basis for fundamental imaging workflows such as reporting and billing, and also facilitate a range of applications in quality improvement and research. This article reviews the key characteristics of lexicons, coding systems, and ontologies. A number of standards are described, including International Classification of Diseases-10-Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT), Logical Observation Identifiers Names and Codes (LOINC), and RadLex. Tools for accessing this material are reviewed, such as the National Center for Biomedical Ontology BioPortal system. Web services are discussed as a mechanism for semantic application development. Several example systems, workflows, and research applications using semantic technology are also surveyed.