Radiology Strategic Partner Review Session #1 January 31, 2011

1. Radiology Strategic PartnerReview Session #1January 31, 2011 Philip Costello MD, FACR Professor and Chairman Radiology and Radiological Science Raymond Manigault, MBA, RT (R) Radiology Director

2. Tab 1 • COM Departments involved in Strategic Partnership • SP Strategic Goals (3-5 year big bets) • 2010-2011 Progress towards Strategic Goals • What is going well in SP? • Opportunities for improvement in SP • SP Leaders input on SP as a structure Tab 2 – SP Dashboard Tab 3 – SP Goal (LEM) Performance • Executive Summary – Annual LEM Performance • Executive Summary – 2011 Pillar Performance YTD • 2011 LEM Monthly Report Card Tab 4 – SP 5/10 Plans • Performance YTD towards goal • Plan Tab 5 – SP Miscellaneous Reports 1. Monthly Statistics 2. Shared and Support Services 3. Radiology Capital Expenditure History 4. OCIO Capital Expenditure History 5. Capital Equipment ( 5 year plan)

3. COM Departments involved in SP Significant Trauma/Critical & Acute Care Children’s & Perinatal Musculoskeletal Neurosciences Heart & Vascular Hollings Cancer Center Digestive Disease Center Others Transplant Psychiatry Anesthesiology Clinic Business Operations Laboratory Prep/Post Procedure Recovery Urology

4. SP Big Bets (3-5 year strategic goals) • Consolidate breast/ and possibly women’s imaging services in one center which includes breast surgery,medical oncology and radiation therapy • Further development and expansion of Neuro Interventional Spine program to support Dr. Cianfoni • Support in Neuro Interventional Laboratories • Support for spine fixation, vertebroplasty, and nerve blocks • Development and implementation of a Clinical Support Decision tool to improve the appropriateness of imaging utilization • Diversify and increase our workload through teleradiology services • Musculoskeletal Services • Five (5) orthopedic surgeons will be hired • Rutledge Tower Seventh Floor will require diagnostic imaging in footprint, and will also require support of fluoroscopy procedures and MRI Guided procedure support • Create a research infrastructure that will support grant publication, submission, reporting, and compliance • Further development and expansion in Vascular Interventional Radiology • Hire an additional IR attending in the next two (2) years to cope with increasing demands and acquire second angiography suite at ART • Collaborate with Dr. Greenberg, from Hematology and Oncology to create a DVT and Pulmonary embolism group as a clinical and research endeavor. • Institute an IR clinic at ART and a screening program for peripheral vascular diseases in the dialysis population

5. 2010-2011 Progress towards Big Bets • Consolidate breast/ and possibly women’s imaging services in one center which includes breast surgery, medical oncology and radiation therapy • Neuro Interventional Radiology • Nurse practitioner assisting Spine Interventional Radiology (IR) physician • Recruitment of neuroradiology fellow with special dedication to spine IR • Partial access to bi-plane angiography room for spine IR cases • Research assistant to coordinate spine IR trials • Ideas in progress regarding new multimodal spine IR room (CT and Fluoroscopy) • Development and implementation of a Clinical Support Decision tool to improve the appropriateness of imaging utilization • Musculoskeletal Services • Five (5) orthopedic surgeons will be hired • Rutledge Tower Seventh Floor will require diagnostic imaging in footprint, and will also require support of fluoroscopy procedures and MRI Guided procedure support • Diversify and increase our workload through teleradiology services • We are currently having discussions with teleradiology providers to become a statewide resource from small rural hospitals in South Carolina • Create a research infrastructure that will support grant publication, submission, reporting, and compliance • Recruited Dr. Joseph Helpern as vice-chair for Research • Realignment of equipment access to patient needs, especially with CT demand • Dr. Cianfoni possibly using CT on 5th floor Main Hospital Development and implementation of a Clinical Support Decision tool to improve the appropriateness of imaging utilization

6. What is going well in SP? • SP Director and Radiology Chair collaboration • Bi-weekly meetings to discuss patient care issues, equipment, IT, registration, nursing, and technologist matters; and, develop action plans • 40% improvement in Diagnostic Report TAR Times due to Voice Recognition • Improvements in scheduling and patient access • 80% Reduction in Overtime Hours • Standardization of Protocols and on-line Protocols • 90% reduction in radiation dose for heart CTs with FLASH protocol • Major contribution to supporting certification of Bariatric Center of Excellence • ACR Breast Ultrasound accreditation through July, 2013 • Breast Center of Excellence Award • Opened in January 2010 New Mammography and Bone Density Facility at Two Island Court in Mt. Pleasant • Our Clinical Faculty has expanded from 21 to 36 and research PhD faculty from 4 to 10.

7. Facility and Construction work on 3rd Floor Main Hospital for better CT/MRI/GA Induction and overall better patient flow Realignment of equipment access to patient needs, especially with CT demand Decrease inefficiency Example: CT on 5th floor Main Hospital and ART under utilized Radiologist utilizes and then other Radiologist require authorization to utilize Delayed patient care and throughput Better support for General Anesthesia cases in Radiology Anesthesiologist must be present during phases of induction and the ratio of Anesthesiologist to CRNA is indicative of lack of coverage Pre-Op calls are not getting to a percentage of scheduled patients, resulting in cancellations Better support Nuclear Medicine Cardiac Stress tests by Cardiology Lack of consistency in education and knowledge of persons responsible for the stress tests (cardiology fellow or nurse practitioner) Inconsistency for providing support for stress tests at ART and Main Hospital Opportunities for improvement in SP

8. Input on SP as a structure • Promotes interdisciplinary care of the patient • Within the SL • Between SLs • Exemplified by Integrated services/Combined programs with: • Vascular Surgeons and Interventional Radiologists • Neurosurgery and Neuro-Interventional Radiologists • Neuro-Interventional Spine Radiologists and Dr. Sachs spine fixation/intervention • Dr. Bolster and Dexa Scan initiatives • Cardiologists and Radiologists in cardiac CT/MR and Nuclear Medicine • General Surgery • SACC/ MACC • Pediatrics • Bariatric surgery • Breast surgery • Gamma Knife surgery planning stage • Women’s Health Initiative • Optimizes patient centered care • Helps to break down the “silo” effect

9. Tab 2SP Dashboard • December 2010 dashboard from MUHA Radiology

11. Tab 3Goal Performance • Executive Summary – Annual LEM performance • Executive Summary – 2011 Pillar performance YTD • 2011 LEM Monthly Report Card

12. SP Goal (LEM) PerformanceExecutive Summary - Annual Green – 4; Yellow – 3; Red - <2.5 Scale 1-5; 4 is goal attainment

13. SP Goal (LEM) PerformanceExecutive Summary – YTD Green – 4; Yellow – 3; Red - <2.5 Scale 1-5; 4 is goal attainment

14. Tab 4SP 5/10 Performance YTD • 5/10 Performance YTD • 5/10 Plan Executive Summary

15. SP 5/10 Performance YTD

16. SP 5/10 Performance YTD

17. Monthly Statistics Report

18. Shared and Support Services

19. Radiology Capital Expenditure History

20. Radiology Capital Expenditure History

21. Radiology Capital Expenditure History

22. OCIO Capital Expenditure History

23. Capital Equipment – Five Year Plan

24. Capital Equipment Five Year Plan

25. Capital Equipment – Five Year Plan