Editor's Note: This article was reprinted with permission from ECG Management Consultants. 

Health systems often underestimate the strategic value of diagnostic imaging in driving clinical quality, operational efficiency, and financial success. Diagnostic imaging is often a key component of an accurate and timely diagnosis, as well as a prerequisite for other downstream services and complex medical and surgical care options. Moreover, diagnostic imaging is both a self-sustaining service, typically commanding a strong return on investment, and an enabler of more complex specialty services, such as cardiovascular, oncology, and orthopedic care.

To maximize these impacts, however, health systems must closely examine system efficiency and patient access capabilities. Despite their potential to be a proactive enabler of care, imaging operations are frequently reactive, characterized by limited scheduling windows, misaligned order workflows, and persistent bottlenecks that frustrate both patients and referring providers. Below are five operational strategies that high-performing organizations can adopt to maximize the financial and operational returns of their diagnostic imaging services and strengthen the benefit to patients.

Strategy 1: Extend Hours and Balance IP/OP Demand

As demand rises, health systems must move beyond simply extending imaging hours of operation; they need to adopt flexible, patient-centered scheduling that allows outpatient (OP) visits at times most convenient for patients. This means prioritizing peak OP hours while strategically shifting nonurgent inpatient (IP) imaging to off-peak windows, such as early mornings or evenings. For example, if peak OP hours are between 11:00 AM to 1:00 PM and 4:00 PM to 6:00 PM, those slots should be reserved exclusively for OP scheduling. IP studies, particularly nonurgent ones, can then be accommodated during extended hours, such as from 6:00 PM to 8:00 PM. This scheduling approach enhances accessibility, promotes health equity, and allows systems to balance demand more effectively and variably throughout the day.

In addition, systems with strong triage and scheduling practices are achieving greater efficiency by strategically managing IP and OP imaging demand. By tracking peak times for ambulatory imaging and reserving those slots exclusively for OP services, they avoid overloading routine IP workflows. Furthermore, collaborating with referring physicians to establish imaging and triage protocols—such as assigning routine versus stat protocols and building workflows based on urgency—enables these organizations to fully utilize their resources and distribute volume more evenly across locations, reducing pressure on any single site.

Strategy 2: Shift Low-Priority IP Orders to OP Setting after Discharge

A persistent operational bottleneck is the scheduling of clinically inappropriate IP imaging prior to patient discharge. For example, two large academic tertiary care centers found that nearly half of IP MRI orders took more than 12 hours to complete, delaying patient discharge and increasing avoidable hospital days. Factors contributing to these delays include:

• A lack of standardized processes for evaluating the clinical necessity of IP imaging.
• The absence of clear appropriate use criteria to assess whether an imaging study should be performed in the IP or OP setting.
  • Although the Centers for Medicare & Medicaid Services (CMS) repealed the appropriate use criteria mandate, health systems should still adopt strong processes to ensure resources are used responsibly. It also remains likely that CMS will revisit the policy in future rulemaking.
• The lack of a coordinated system for OP imaging orders, leading to an inability to connect patients with providers and ensure follow-through.
• Limited OP imaging capacity.
• Low provider confidence in the OP process, leading to unnecessary IP orders (e.g., emergency department [ED] bridge orders, hospitalists ordering MRIs on behalf of specialists).

To address this bottleneck directly, health systems should:

• Develop clear clinical guidelines and appropriate use criteria for each imaging modality.
• Align workflows to strengthen care coordination.
• Ensure patients receive timely follow-up with their primary care provider and appropriate ongoing management.
• Maximize resource efficiency.

These efforts must be supported by OP capacity and a robust OP infrastructure that enables smooth transitions from IP to OP care, including a feedback loop that ensures patients are discharged with a scheduled OP study, a timely return date, a referral (if necessary), and a clear connection to the specialist or provider responsible for interpreting the study. As a result, the ordering provider can easily transition care to the appropriate specialist, streamlining follow-up and improving continuity.

Strategy 3: Match Appointment Lengths to Clinical Protocols

Health systems should evaluate how imaging study appointments are scheduled to ensure appointment lengths more accurately reflect service time averages. Many organizations still rely on a “one size fits all” approach, assigning the maximum time slot to all exams, even when many can be safely and consistently completed in shorter durations. By analyzing exam types, developing evidence-based scheduling templates, and standardizing practices across sites, health systems can uncover hidden capacity lost between appointments. This approach enables increased patient throughput without requiring additional assets or new capital investment.

For example, a brain MRI with contrast may require 45 to 60 minutes due to its complexity and the need for detailed imaging of small structures. However, applying that same time slot to a simpler exam, such as a knee MRI without contrast, can result in up to 30 minutes of unused scanner time. By restructuring appointment lengths to align with actual test requirements, organizations can reclaim that time, optimize resource use, and improve throughput.

Strategy 4: Redesign Referral and Order Workflows

Long wait times for referrals and imaging orders lead to out-migration when patients try to receive care sooner. This impacts the financial performance not only of diagnostic imaging services but also of complex specialty services, as patients receiving advanced imaging related to cardiac or oncology services may then seek other tertiary care outside the system. Streamlining the referral and order process is a critical step in avoiding leakage.

Health systems should consider using modern, innovative metrics to better understand referral and order workflows. These insights will enable them to pinpoint imaging delays, identify true inefficiencies, and design scheduling models that address root causes rather than just symptoms, thereby avoiding unnecessary investments in equipment when the real issue may lie elsewhere in the workflow.

Outlined below are three metric-driven tactics for strategically redesigning referral and order workflows.

• Understand lag time in ambulatory imaging. Reducing lag times can lead to faster diagnoses, improved provider satisfaction, and stronger patient retention. Lag time between order placement and scan performance can be understood through two distinct metrics: order lag and appointment lag. Order lag refers to the time between when a provider places an imaging order, and the scheduling event occurs. Appointment lag refers to the time between that scheduling event and the date the study is performed. Together, these metrics provide a clearer picture of delays in imaging workflows and allow process improvement initiatives to target specific components of the total scheduling process.
• Distinguish between scheduling delays and appointment availability delays. Scheduling delay refers to the time it takes to book an appointment after an order is placed (e.g., time spent on hold or delays in referral queues), while availability delay reflects how far the first available appointment is. Understanding this distinction allows for targeted improvements in either scheduling efficiency or imaging capacity, depending on where the performance opportunity exists.
• Shift to using percentage-based timelines instead of averages. Evaluating percentage-based timelines helps avoid misleading averages that can hide significant variability. For example, instead of reporting that the average time to schedule an OP MRI order is 10 days, an organization could report that 70% of referrals are scheduled within seven to eight days. This approach removes outliers that can distort performance insights and offers a clearer, more consistent view of performance, enabling more actionable decision-making. To support this tactic, organizations will need a tight analytic design to ensure accurate management, including careful consideration of how cancellations and no-shows may affect calculations.

Strategy 5: Prioritize Point-of-Service (POS) Scheduling

Finally, health systems should prioritize POS scheduling as a primary scheduling approach. Traditionally, health systems rely on schedulers to follow up with patients or offer online pathways for patients to book imaging appointments themselves, which can be confusing and difficult to navigate. Shifting to POS scheduling—where staff schedule imaging appointments while the patient is still on site—eliminates the need for additional outreach and reduces the risk of patients falling through the cracks due to scheduling complexity.

By making scheduling immediate and seamless, organizations improve the patient experience, reduce network leakage, and ensure better placement within the system. Moreover, POS scheduling serves as a bridge to more effective online scheduling. By having scheduling agents follow structured algorithms during the office visit, patients become more familiar with the process in real time, laying the groundwork for future self-scheduling capabilities and reinforcing confidence in the system.

Coordination: The Key to Moving from Strategy to Reality

While not exhaustive, the five strategies discussed offer a solid roadmap for addressing the imaging barriers that should be top of mind for operators. Together, they represent foundational patient access capabilities health systems must get right to enhance the clinical quality, operational efficiency, and financial success of their diagnostic imaging programs. It should be noted, however, that these strategies will be unsuccessful if other key functions (e.g., scheduling, order management, capacity planning) operate in silos, so leaders must ensure their execution is coordinated across these areas to ensure improvements are not only attained but also sustained.