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

Author Department

Emergency Medicine

Document Type

Article, Peer-reviewed

Publication Date



Background: Point-of-care ultrasound (POCUS) is a central component of emergency medical care. However, clinicians often fail to adequately document their exams, causing problems for downstream clinicians and quality assurance (QA) 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 exam ordering, documentation, selective archival, and billing on POCUS documentation in a large academic emergency department METHODS: 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 archiving and communication system (PACS) and/or POCUS archive Ultralinq (Ultralinq Healthcare Solutions, New York, NY), generation of an EHR report, and integrated billing triggers. Data was retrieved using current procedural terminology (CPT) codes for billed POCUS exams during the study period. We also collected monthly hospital registry data to quantify emergency department visits in order 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.

Results: In the 22-month pre-implementation period, 209,725 Emergency Department (ED) visits occurred. During this period, POCUS was completely documented in 13,514, or in 6.4% of ED visits. There was an average of 614 scans documented per month. In the 12-month post-implementation period, 97,418 ED visits occurred. During this period, POCUS was completely documented in 10,001 visits, or 10.3% of ED visits. There was 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.

Conclusions: 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.

Keywords: Billing; Emergency Department; POCUS; Ultrasound; Workflow.