Michigan Medicine, U-M Health West strengthen partnership and improve patient care with remote emergency radiology service

October 18, 2022  //  FOUND IN: Strategy & Leadership
Some of the team members who worked on the recent collaboration.

Approximately a 7-minute read

Key takeaways

  • In May, radiology launched an emergency remote imaging service between Michigan Medicine and U-M Health West.
  • U-M Health emergency radiologists now interpret all overnight and weekend urgent/emergent diagnostic radiology exams for U-M Health West.
  • The hope is for the success of the new program to pave the way for other specialties to create similar collaborations.

After years of planning and collaboration, Michigan Medicine and U-M Health West recently strengthened their partnership.

On May 16, the Michigan Medicine and U-M Health West radiology departments launched a remote emergency imaging interpretation service. Michigan Medicine’s dedicated emergency radiologists now interpret all overnight and weekend urgent/emergent diagnostic radiology exams for U-M Health West. This provides a vital service to patients who receive emergency room care or are admitted to U-M Health West.

Together, the two health systems initiated a comprehensive and streamlined service that supports a shared vision, improves workflows, provides optimal care, and re-envisions collaboration in health care.

The vision

Historically, a third party teleradiology group provided U-M Health West with urgent/emergency services. This prompted discussions to extend Michigan Medicine’s care:

“Rather than outsourcing radiology services to a third party, collaborating within our health system allows us to share Michigan Medicine’s radiology expertise around the state,” said Michael Todd, M.D., assistant professor of radiology and director of the Emergency Radiology Division. “This is an opportunity to expand our practice to more patients — whether they are in West Michigan or Ann Arbor.”

Scott Flanders, M.D., the chief clinical strategy officer at Michigan Medicine, added, “This service extends our ability to provide interpretations of more complex radiology studies to regions that may not always have the level of subspecialty expertise we have here in Ann Arbor.”

The Michigan Medicine Office of Strategy supported this project from the beginning, and leadership from the radiology group was vital to building the concrete vision and driving it forward.

Their shared goal was to expand Michigan Medicine’s reach and build a strong network for radiology support. It would soon become the mission of U-M Health West and Michigan Medicine to support the care of the patients who are critically ill with a unified after-hours emergency radiology service and to strengthen the partnership between both institutions.

Planning for an integrated system

Discussion around a remote radiology service began in 2019, when U-M Health West was still named Metro Health. Michigan Medicine was already planning a new Pictured Archiving and Communication System, commonly referred to as PACS, so the first step was to ensure U-M Health West used the same system.

A unified PACS allows both medical centers to keep radiology images under one repository that both can access. That repository is the foundation for collaboration between the two departments.

“Since radiology touches all medical specialties, we wanted to find the best practices for our departments,” said Augusto Elias, M.D., the service line clinical chief of U-M Health West radiology. “We sought to standardize care and protocols so that the images acquired in Ann Arbor are the same images acquired here.”

“The ability to provide a remote radiology service is the culmination of years of building a relationship between each radiology department,” said Jason Battaglia, manager of strategic initiatives for the Michigan Medicine Department of Radiology.

Health Information Technology & Services and technical teams at U-M Health West were also integral to project initiatives.

Aligning on the same PACS allows for standardization between Michigan Medicine and UM Health-West. As Elias stated, “nothing is a surprise” due to the two health centers alignment on protocols and procedures.

By December 2021, Michigan Medicine and U-M Health West established a direct circuit connection for data transfer. Michigan Medicine implemented a new PACS in January 2022, and U-M Health West installed the same system the following May.

Accounting for increased workload

The next question that arose was more complex: How would Michigan Medicine’s Emergency Radiology Division absorb U-M Health West’s volume of work into their own? Based on 2021 data, it was estimated that Michigan Medicine would see a 45 percent increase in overnight volume of radiology studies.

“We knew that if we were going to incorporate this increase, we were going to have to glean every bit of efficiency that we could,” Todd said. Finding the most efficient approach for interpreting radiologists to accommodate the high demand was critical, and Michigan Medicine spent “the better part of two years” finding and integrating the right tools, processes and workflows to make this work possible.

All the while, the team knew that “Adding volume has to take a backseat to quality and patient safety,” said Todd.

After matching Michigan Medicine’s throughput with the expected 45 percent increase in volume, the Emergency Radiology Division determined they needed to increase staffing levels by 20-25 percent, which would cover half of the additional workload. Coverage of the other half would come from economies of scale and IT solutions.

“We looked at every process in great detail — every keystroke, every mouse click — and found solutions to eliminate inefficiencies. For example, one simple programming solution can eliminate 100,000 mouse clicks a year,” said Todd.

“Both Michigan Medicine and U-M Health West technical teams spent many hours investigating solutions, modifying interfaces, testing system integrations and building a new dictation site to accommodate the technical changes required for the new workflow,” said Lamia Marouf, lead project manager for Michigan Medicine’s PACS replacement and remote radiology integration. “The goal is to make the new process as seamless as possible so that U-M Health West physicians can view the medical imaging results and provide their patients with the best care possible.”

The go-live

There was a lot at stake in the remote radiology go-live, but both teams knew what to expect because of thorough planning.

“We encountered a few bumps in the road, but no major surprises,” said Todd.

IT services teams worked very closely with the Emergency Radiology Division every night to provide immediate support for the first two weeks of go-live, and the whole process was “very well executed.”

Regarding the successful go-live, Elias said, I knew we had the right team to make this happen. We had the right people at the right time. ”

It is hard to think of a better collaborative effort,” stated Todd.

Future collaboration

The positive, symbiotic relationship between Michigan Medicine and U-M Health West has been growing stronger over time. While U-M Health West leadership has been working with teams in Ann Arbor to enhance clinical programs, Michigan Medicine looks to U-M Health West for innovation and experimentation in delivery of clinical care.

“While we will always have somewhat different clinical offerings between our two campuses, from the patient’s perspective, we want care quality and patient experience to be everything you would expect under the ‘block M’,” said Flanders.

With a successful go-live and immense support from the organization, Michigan Medicine and U-M Health West are looking forward to opportunities for partnership in the future.

“Consolidation and collaboration are the future of modern health care, but there is always resistance to change,” said Todd. “The integration of remote radiology between Michigan Medicine and U-M Health West builds confidence that this can be done and can be done effectively. The vision is that this is the first of many steps to be able to integrate the delivery of high-quality health care and extend our coverage to people outside of the Ann Arbor area.”Elias agreed: We are paving the road for the other services. Michigan Medicine and U-M Health West now have a blueprint for collaboration.”