Assignment 3 - HIM6350

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1 Assignment 4 Stephen Skinner University of South Florida HIM6350: e-Medicine Business Models Week 4 May 28, 2023

2 The process chosen for this assignment is titled ‘X-ray ED Patients.’ This particular emergency department (ED) serves a large patient population in a level one trauma center. In a study by Valtchinov et al. (2019), a total of 56,793 patients presented to the ED and 49.5% of them underwent imaging. These numbers indicate that medical imaging within any ED is highly utilized to guide treatment for acute injuries and disease processes. When patients arrive with suspected broken bones or severe chest pain, they will likely undergo some form of imaging in order to diagnose or rule out pathologies. Sharp and McDermott (2009) define a customer as “the recipient or beneficiary of the result produced by the business process.” Customers for this process include patients who come to the ED to receive medical treatment, referring physicians who order imaging studies in order to properly treat patients, radiographers who perform imaging studies and maintain productivity, radiologists who read images and make diagnostic reports, nursing staff who actively treat the patients, and the organization itself that the ED is housed in and collects revenue from imaging. The service being provided is medical imaging for patients. Competitors include any surrounding hospital, urgent care, orthopedic office, etc. that offers medical imaging within their facilities. Moreover, there are several activities within this process. A patient arrives to the ED for imaging. The front desk staff registers the patient. When available, the triage provider brings the patient in to collect history, vitals, and other information. The provider checks over the history and orders the appropriate imaging studies. The order is transmitted to the radiology information system (RIS). The radiographer moves the order over on the worklist and prints out an order sheet. The patient will either be back in the waiting room, in a hallway bed, or in an actual room. If the patient is in a room and the imaging can be done portably, then the radiographer brings the portable X-ray machine to them and takes images. If the patient is in the waiting room, nursing

3 staff will bring them over to the X-ray department when ready. Depending on which hallway bed the patient is assigned to, either the radiographer or nursing staff will transport them back to the department. Nonetheless, imaging is acquired and sent to the picture archiving and communication system (PACS). If the patient receives imaging within the department, they are then taken back to the appropriate area. The radiographer closes out orders in the RIS and sends imaging to be read by radiologists. The radiologist reads the images and creates a diagnostic report to be sent back to the patient’s chart within the EHR and the PACS. Lastly, the ordering ED physician reads the report and is able to use the report to guide the course of treatment for the patient. There are several types of triggering events for this process. Sharp and McDermott (2009) describe the three types of events which include action, temporal, and condition or rule. Action events occur when a patient arrives to the ED and requests to be seen by a physician and wants X-rays taken for an injury. Temporal events can occur in the ED as well. For instance, if a trauma patient has a chest tube placed and is kept in the ED, then he or she will receive follow- up chest X-rays at certain time intervals in order to confirm that any chest pathologies are being treated properly. Condition or rule events certainly happen too. As an example, protocols such as sepsis or stroke within the ED automatically include chest X-rays to be performed as part of the order sets for patients based on histories, vitals, laboratory results, and other diagnostic tools. Stakeholders are defined as “any identifiable individual or group who is impacted by the business process” (Sharp & McDermott, 2009). In this process, stakeholders include individual patients, ED physicians, radiographers, nursing staff, radiologists, the hospital, and the community that the ED serves. Patients want to know what is causing their medical issues and be able to feel better. ED physicians use medical imaging to guide their course of treatments for

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4 patients. Radiographers perform imaging to serve patients, provide diagnostics for providers, and maintain productivity to stay employed. Nursing staff use the results of the imaging in order to carry out and help with treatment plans. Radiologists depend on imaging so they can read and dictate studies to help ED physicians determine the best courses of treatment. The hospital itself depends on imaging in order to bring in revenue and serve the community as a facility with all appropriate methods of diagnostics and treatments. The community depends on a nearby ED that can properly diagnose and treat patients. Lastly, Sharp and McDermott (2009) define subprocesses as “the significant milestones that must be accomplished between the triggering event and the results.” In the ‘X-ray ED Patients’ process, the subprocesses include the imaging order being placed, the patient being imaged, the orders being closed out and images sent to the radiologist, the radiologist reading the images and sending a report to the ED physician, and the report being received and read by the ED physician. Participating organizations include patients, doctors, the imaging department, nursing staff, and biomedical companies that ensure imaging equipment works. The individual actors within each participating organization include members of the community needing treatment, ED physicians, resident physicians, referring physicians outside of the ED, consulting physicians (orthopedic, neuro, etc.), ED midlevel providers, radiographers, radiologists, RNs, CNAs, PCTs, EMTs, and biomedical technicians. Process measures of performance can vary. These include patient outcomes, patient volumes, hospital imaging revenue, number of X-rays performed, time lapsed from the time an order is placed to the time the images are acquired, the time it takes for radiologists to create a report and send results, the time it takes for ED physicians to treat patients after results come back, overall length of stay for patients, clinical appropriateness for orders, and more.

5 References Sharp, A. & McDermott, P. (2009). Workflow modeling: Tools for process improvement and application development. (2nd Edition). Artech House. Valtchinov, V. I., Ip, I. K., Khorasani, R., Schuur, J. D., Zurakowski, D., Lee, J., & Raja, A. S. (2019). Use of imaging in the emergency department: Do individual physicians contribute to variation? American Journal of Roentgenology , 213 (3), 637–643. https://doi.org/10.2214/ajr.18.21065

Assignment 3 - HIM6350

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