Building Scalable, High-Impact POCUS Workflows Across the Health System
Point-of-care ultrasound (POCUS) has reached a tidal wave of interest across medical specialties. However, during a recent Becker’s Hospital Review webinar, Dr Matt Riscinti, the System-Wide Ultrasound Director for Denver health stated traditional EHR-based workflows often create a “Wild West” scenario where 85% of studies go undocumented, leading to professional liability and significant revenue leakage. Clinical and IT leaders from Baylor Scott & White Health, Yale New Haven Health, and University of Maryland Medical System joined Dr. Riscinti to share how they have moved POCUS from fragmented, department-level efforts to scalable, systemwide programs. This summary outlines how top health systems can change from fragmented “phantom scans” to a sustainable, enterprise-wide program.
1. The Financial Case: Beyond Simple Billing
While capturing professional fees is a baseline, the panelists emphasized that the true ROI is found in operational efficiency and global technical fees.
- Revenue Multipliers: Capturing the global technical fee provides a 6–7x multiplier over professional fees alone.
- Throughput Gains: Implementing POCUS in fast-track settings can reduce length of stay for specific complaints (e.g., first-trimester pregnancy) by nearly two hours per patient.
- System-Wide Savings: Peer-reviewed data shows POCUS can reduce hospitalizations costs by 50% and reduce length of stay for high-acuity patients by over 4 days.
2. The Workflow Pivot: Order-Based vs. Encounter-Based
A central theme was the friction caused by “traditional” order-based workflows in acute settings.
- The Problem with Orders: Requiring a provider to step out of a room to place an order for a critical or unstable patient often leads to undocumented “phantom scans”.
- The Encounter-Based Solution: Moving to an encounter-based workflow—where providers scan a patient’s wristband at the bedside—can be a “game changer”. Dr. Matt Riscinti reported doubling their charges in a single month simply by making it easier for providers to do the right thing.
3. Infrastructure & IT Governance
Scaling POCUS requires more than just buying devices; it requires an Enterprise Imaging strategy.
- VNA Integration: Images must be stored in a Vendor Neutral Archive (VNA) and linked to the EHR. This ensures transparency, allowing specialists (e.g., surgeons or cardiologists) to view images even if they don’t have access to a specific department’s POCUS manager.
- Device Agnostic: To scale across multiple departments, service lines, or hospitals, software must be device-agnostic, working seamlessly across various handheld and cart-based machines.
4. Overcoming Scalability “Walls”
Health systems often hit a wall when expanding beyond the Emergency Department into ICU, Anesthesia, or Ambulatory care.
- Credentialing Menus: To handle diverse specialties, some systems use a “privileging menu” where providers check off specific organ systems (e.g., heart, lungs, IVC) and submit a case log for those specific skills.
- Standardized SOPs: Success depends on having a system-wide director, committee, and formal governance that represents the entire health system, not just local interests.
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