The use of point of care ultrasound (POCUS) is rapidly expanding. From pocket-based devices to bedside consoles, its user base is constantly growing. POCUS is a valuable diagnostic tool that is revolutionizing the way healthcare providers engage with patients across various settings. It brings imaging closer to the patient, providing actionable, real-time data that can aid in diagnoses, patient triage and treatment planning. Despite its numerous benefits, the rise in POCUS utilization also highlights the need for encounter-based imaging governance, documentation and integration.
The Rise of POCUS in Diverse Medical Fields
POCUS has become an indispensable diagnostic tool in a variety of clinical settings. Its real-time imaging offers immediate patient insights, aiding rapid decision-making. This instant result capability has revolutionized patient assessment and management, making it an essential component of modern healthcare.
Cardiologists and emergency medicine physicians were among the early adopters of handheld ultrasound devices. As technology has evolved and pocket-sized devices have become more prevalent alongside traditional console ultrasound devices, the user base for POCUS has expanded to include specialists in orthopedics, urology, gastroenterology, pain management, and vascular medicine. Handheld ultrasound is now also increasingly used in primary care, physical therapy, aesthetics, and even in-home care.
Inconsistent Integration and Documentation
In enterprise imaging, the 'last mile' refers to the technical workflow that connects an exam to the institutional archive, making it accessible to all providers through the electronic health record (EHR). Traditional order-based imaging workflows naturally address this issue by linking exams to a pre-existing order. This order contains patient details, the type of imaging needed, and the clinical reason for the study. It also assigns a unique accession number to the exam, which facilitates the integration of the imaging data with the picture archiving and communication system (PACS).
POCUS exams, on the other hand, are encounter-based imaging, also aptly referred to as ‘on-the-fly’ imaging. These studies are performed on a patient without a pre-existing order. A key advantage of this type of imaging is the immediate availability of the images for clinical decision making, but because they are not associated with an order, documentation may be inconsistent or non-existent, and exams may not be automatically pushed to an enterprise archive.
A peer-reviewed study of the use of POCUS in emergency departments found that the documentation of these exams is often incomplete. Specifically, the study revealed that only 75.7% of the POCUS exams included documentation of the clinical question or indication, and 90.8% included a conclusion. This indicates that a significant portion of POCUS exams (around 24.3% for clinical questions and 9.2% for conclusions) are not fully reported.1
Integrating the Healthcare Enterprise (IHE) is an international initiative aimed at improving the way healthcare systems communicate with each other. It promotes the use of existing standards like DICOM, HL7, and others to improve the interoperability of healthcare information systems and develops profiles that specify how these standards should be implemented in real-world healthcare scenarios to ensure seamless data exchange and integration across different systems and institutions. IHE’s profile on encounter-based imaging workflow mentions the need for robust integration and data management to ensure images are well-documented and linked to the medical record. However, it acknowledges that the effective use of these images depends on thorough documentation and integration, implying that gaps in these processes can lead to images not being properly archived or indexed in PACS.
Why POCUS Reporting is Essential
Inadequate documentation of POCUS exams can lead to significant issues, including incomplete patient records. To ensure continuity of care and support clinical decision-making, diagnostic insights from POCUS should be accessible to all treating physicians, regardless of where or when an exam was performed.
POCUS billing is also a consideration. Proper documentation and archiving of POCUS exams is necessary to optimize reimbursement for every procedure performed. Incomplete documentation or lack of integration can lead to 'phantom scans,' where ultrasound exams are performed but not billed correctly, potentially resulting in revenue loss.
Integrated workflows are vital for medico-legal reasons as well. Consistently recording who conducted the exam, the patient, the reason for the exam, and the findings mitigates risks and enhances accountability. Failing to capture these details can lead to undocumented diagnoses and gaps in patient records, posing compliance risks and potential legal liabilities, especially when diagnostic images are not properly archived.
Who Should Own POCUS Governance?
Despite its widespread adoption, many organizations lack a cohesive enterprise policy for managing POCUS. Traditionally, imaging was a domain owned by radiology departments, but the decentralized nature of POCUS does not fit neatly into this model. No single specialty owns point-of-care imaging, leading to a fragmented approach across different departments. While some hospitals might allow emergency departments or other specialties to lead, the lack of a unified owner often results in inconsistent practices.
The optimal strategy might involve appointing a central figure like the Chief Information Officer (CIO), Chief Medical Information Officer (CMIO), or Chief Operating Officer (COO) to oversee POCUS at the enterprise level. This approach ensures that imaging workflows are integrated into the broader organizational structure and meet both clinical and operational needs.
A Checklist for a POCUS Reporting Solution
To ensure enterprise-wide POCUS documentation, healthcare organizations should implement solutions that provide end-to-end workflow. Here are three core capabilities to look for in a POCUS reporting solution:
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A unified platform for multiple departments: Adopt one POCUS platform that can adapt to and support the POCUS documentation needs of different service lines—from cardiology to women’s health to radiology.
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Ease of use for clinicians: Look for a solution that is intuitive and easy for clinical end-users. They should be able to quickly and accurately document POCUS exams without disrupting their routine.
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Interoperability with multiple vendors: Ensure the solution works with different ultrasound devices and devices from different vendors. This flexibility supports interoperability, allowing healthcare providers to use various devices without compatibility issues. It also ensures your POCUS workflows can adapt as new technologies and devices are introduced.
ViewPoint 6 for POCUS Optimization
GE HealthCare Verisound’s ViewPoint™ 6 Ultrasound Reporting Software for Point of Care is designed to optimize POCUS exam workflows across a healthcare enterprise. It provides configurable templates tailored to the specific needs of different clinical settings and types of ultrasound exams so that all necessary patient and exam information can be captured accurately and efficiently. ViewPoint 6’s user-friendly interface and portable capabilities make it ideal for bedside ultrasound exams, allowing clinicians to perform and document exams wherever the patient is located. This flexibility is essential for providing timely and effective care, particularly in emergency and critical care settings. A timing study showed that when it is fully implemented in the ED, clinicians can save up to 79% of the time previously spent on manual workflows.2 This efficiency is crucial in busy clinical environments where time and accuracy are paramount.
Lakeland Regional Health is using ViewPoint 6 to overcome its POCUS workflow challenges. Learn more from this organization’s director of emergency ultrasound: https://share.vidyard.com/watch/72ws9DytdSvrtY8SpxxYWr
REFERENCES:
1. Larissa van Essen et al, “Quality Assessment of Point-of-Care Ultrasound Reports for Patients at the Emergency Department Treated by Internists,” The Ultrasound Journal 14, no. 15 (2022).
2. Data from GE HealthCare internal timing study https://gehealthcare.showpad.com/share/h57eBWyBpg1jqsnu64kap)
