Transition From an Order- to an Encounter-Based Point-of-Care Ultrasound Workflow Increases Scan Numbers and Compliance

Point-of-care ultrasound (POCUS) plays a significant role in treating patients. An important consideration in POCUS is how accessible the workflow is to providers. There are two basic types of workflows: order-based workflows where an order must be placed prior to acquisition of images and an encounter-based workflow where images can be associated with any active patient encounters. Choosing the correct workflow for your department can have a significant impact on POCUS billing and compliance. Our department recently transitioned from an order-based to an encounter-based workflow and report here how such a change has affected our POCUS billing and documentation.

Our single center recently transitioned from an order-based workflow embedded in our electronic medical record (Epic, Verona, WI) to an encounter-based workflow (QpathE, Coquitam, BC). The transition occurred on May 19, 2025. Our internal pictorial archival and image storage (PACS) was queried for all POCUS exams for a 6-month period before and after the transition. Educational scans were not included. The primary outcomes were the total number of diagnostic scans as well as how frequently the diagnostic scans were submitted for billing. Secondary outcomes included assessing the modality of scans and the emergency department (ED) census during the study period. Statistical analysis was done with Wilcoxon signed-rank testing with a p-value of <0.05 used as the measure for significance.

Our order-based workflow had 2,192 diagnostic scans in the 6 months before transition, of which 1,636 (74.6%) were submitted for billing. Our encounter-based workflow had 3,201 scans in the 6 months after transition of which 2,855 (89.2%) scans were submitted for billing. The increase in scans and billing compliance were both statistically significant (p = 0.008 and p = 0.002, respectively). The POCUS modalities most affected were lung (33 to 185), soft tissue (33 to 163) and peripheral vascular access (109 to 229). No POCUS modality saw a decrease in scans. There was also not a significant change in ED census in the pre- and post-transition periods (pre: 54215, post: 55865, p = 0.11).

The authors feel the benefits of the encounter-based workflow contributed to the increase in scan numbers and billing compliance. We hope this data helps others in consideration of transitioning from order-based workflows to encounter-based workflows.