Implementation of an automated, user-centered point-of-care ultrasound workflow improves documentation and billing

Point-of-care ultrasound (POCUS) is a central component of emergency medical care. However, clinicians often fail to adequately document their examinations, causing problems for downstream clinicians and quality assurance processes as well as loss of revenue. The objective of this study was to evaluate the impact of a user-centered POCUS documentation workflow system for examination ordering, documentation, selective archival, and billing on POCUS documentation in a large academic emergency department (ED).

In this quasi-experimental study, we examined POCUS documentation 22 months before and 12 months after implementation of a user-centered, automated ultrasound workflow (October 2018-July 2021). The workflow allows for electronic health record (EHR) order entry to populate a virtual ultrasound worklist, automatic demographic information retrieval to ultrasound machines, selective image storage to a hospital picture archive and communications system and/or POCUS archive Ultralinq, generation of an EHR report, and integrated billing triggers. Data were retrieved using Current Procedural Terminology codes for billed POCUS examinations during the study period. We also collected monthly hospital registry data to quantify ED visits to control for volume. We compared the number and per-visit rate of POCUS documented using descriptive statistics and segmented linear regression before and after implementation of the workflow.

In the 22-month preimplementation period, 209,725 ED visits occurred. During this period, POCUS was completely documented in 13,514 or in 6.4% of ED visits. There were an average of 614 scans documented per month. In the 12-month postimplementation period, 97,418 ED visits occurred. During this period, POCUS was completely documented in 10,001 visits, or 10.3% of ED visits. There were an average of 833 scans documented per month. Linear regression analysis showed a significant increase in average monthly POCUS documentation of 265.34 scans/month (95% CI 150.60-380.09, p < 0.001) at the time of the intervention.

In this single-center study, POCUS documentation increased by more than 60% following the implementation of a user-centered POCUS workflow that reduced the burden on the clinician by automating data entry, improving data flow between ultrasound machines and the EHR and integrating billing.