Identifying and characterizing the 18 steps of medical imaging process workflow as a basis for targeting improvements in clinical practice

We reviewed initiatives to improve the quality and safety of health information technology in medical imaging through the lens of incident reports provided by healthcare professionals in each sequential step of the medical imaging process workflow. The 18 steps of imaging workflow were framed based on a literature review, visits to hospital radiology departments, interviews with radiologists, and iterative consultations with experts. Both inductive and deductive analyses were applied to 436 health information technology-related incidents identified from 4,915 medical imaging incident reports. In the 18 imaging workflow steps both human (58%) and technical factors (42%) were involved. Classification from the perspective of the 18 steps of the imaging workflow was useful because it orientates the reporter and analysts to the tasks at each stage, and it also informs the analysts as to where corrective strategies could be addressed. Most of the things that go wrong in healthcare occur infrequently, so collecting information after they have gone wrong is the only practical approach to identifying and characterizing them. This should become a routine part of clinical practice in a complex constantly changing system.