Veronica Shim, MD

Drs. Michael Rizzo, Veronica Shim, and Steven LeVine know very well that incidental findings on a thoracic imaging study may mean nothing — or they may mean everything, including cancer. So they joined forces to develop a system that would “guarantee rapid and consistent follow-up on all unexpected cancer discoveries at imaging,” says Dr. Rizzo.

Mission accomplished. And then much more.

Their efforts began with a 2007 pilot project in the East Bay Area in which radiologists flagged all incidental findings with an “R1” alert. Flagged images were tracked by a case manager who ensured timely follow-up; occasionally, cancers that might have otherwise escaped early detection were caught. As a safety net, their innovative process of tagging and systematically tracking abnormal images had more than proven its worth. Still, they saw even greater potential.

Leveraging Kaiser Permanente’s strategic combination of multispecialty integration and KP HealthConnect, in 2011 they convened a team of thoracic surgeons, radiologists, and pulmonologists led by Ashish Patel, MD, to review all newly flagged cases and make recommendations for further workup and treatment to patients’ primary care physicians.

The benefits of this new workflow – which involves specialists with the greatest expertise as early as possible in the decision-making process – were manifest from the start. Not only did it standardize the best possible care as determined by a multispecialty physician team, but the average time from imaging to definitive diagnosis was cut in half. When cancer is detected, treatment begins sooner.

Looking ahead, the potential for further innovation in medical population management is immense. R1 has spawned additional surveillance systems using the same KP HealthConnect paradigm.

“Every now and then you come across a really transformational innovation,” says James Chang, MD, Associate Executive Director. “This is one of them.”