Making Follow-ups Count with Process, People and AI

In pursuit of better patient outcomes, meaningful quality improvement often begins with a simple question: How can we do better? For the past three years, the ACR Learning Network’s ImPower Program has been helping radiology practices and departments answer that question with clarity, structure and results.

Participants apply to the ImPower Programs to pursue quality improvement in different areas of their practices, including prostate MR image quality, mammography patient positioning, lung cancer screening compliance, and compliance with incidental pulmonary nodule follow-up recommendations. These groups, called “improvement collaboratives,” work together in cohorts to learn from one another and work together to improve quality.

In addition to shared learning among the participants, another critical element of the ImPower Program is its ecosystem of technology partners. These partners bring innovative tools and fresh perspectives to complement the structured improvement methodology. One such collaboration, between the ACR Learning Network and Inflo Health, has become a blueprint for what’s possible when mission and innovation intersect.

Bringing East Alabama Medical Center to ImPower

For Mary Carter Gilbert, RN, clinical outcomes coordinator at East Alabama Medical Center (EAMC), joining the ImPower Program, alongside their vendor Inflo Health, was a turning point in their journey to improve follow-up of incidental findings. “Initially, I thought it would be a great opportunity for us to figure out what we were missing,” Gilbert recalls. “We didn’t know what we didn’t know. We had no baseline initially, so I knew this was our chance to start from the bottom and work our way up.”

Serving a growing and diverse population in Opelika, Alabama, EAMC faced a challenge familiar to many health systems: how to reliably track and act on follow-up recommendations in radiology reports, specifically for incidental findings. Before partnering with ACR and Inflo Health, there was no formal tracking system in place. “We didn’t have a way to know who was following up on recommendations, whose responsibility it was or when it needed to happen,” Gilbert says.

That all changed with the support of the ImPower process improvement methodology and Inflo Health’s cutting-edge artificial-intelligence technology. Together, they built a process that worked for EAMC to better manage follow-up recommendations for pulmonary nodules, a pilot of sorts for EAMC, before moving on to improving follow-ups for all incidental findings.

Inflo Health’s solution, powered by a large language model, automatically reads radiology reports, identifies actionable findings and creates smart worklists integrated with clinical systems. The Inflo Health software then goes a step further to communicate findings to a patient’s provider and the patient. 

Investing in a Cultural Shift

“The breakthrough wasn’t just the technology,” Gilbert says. “It was the relationships we built — with our frontline staff, with our radiologists and with Inflo Health. That’s what really drove the change.”

The change wasn’t only related to people and process but also outcomes. Through the ImPower Program, EAMC increased completion rates for recommended pulmonary nodule follow-ups by 74%.

Adams echoes that sentiment. When her team first engaged with the ACR ImPower cohort focused on follow-up recommendations, they weren’t just offering a tool; they were looking to learn and contribute. “We’re a technology company — we work with follow-up every day,” Adams explains. “But this wasn’t about selling software. We asked ourselves, ‘What can we learn? And what can we offer to help this work better?’”

Adams and her staff embedded themselves into the improvement collaborative, learning alongside the clinicians and adopting the ImPower framework. “The program taught us to slow down and really understand the problem before jumping into a solution,” Adams says. “That was hard for us as a tech company but incredibly valuable.”

The result wasn’t just a smoother workflow — it was a cultural shift. At EAMC, teams across departments, from radiology to primary care to operations, came together around a common goal. “By the end, we were a quality family unit,” Adams says. “We believed in what we built because we built it together.”

Going Beyond Surface-Level Fixes

That collaborative spirit is at the heart of the ImPower Program, and it’s exactly what Kandice Garcia Tomkins, quality improvement director for the ACR Learning Network, who also co-created ImPower with Chair of the ACR Commission on Quality and Safety David B. Larson, MD, MBA, FACR, envisioned. “This is my baby,” she says of ImPower. “It started more than a decade ago at Stanford and was developed under the vision and leadership of Dr. Larson. We then brought the program to the ACR to create a national platform for radiology departments across the country.”

Tomkins and her QI coaching consultants also support organizations, guiding teams through complex challenges like follow-up on incidental findings. Her role goes far beyond training — she helps organizations navigate the often messy intersection of people, processes and technology. “Improvement doesn’t come from surface-level fixes,” Tomkins says. “It requires deep understanding and humility.”

In the case of EAMC, that understanding led to remarkable transformation. Within six months of joining the ImPower collaborative, the team had implemented a functioning follow-up system, exceeded their goals and laid the foundation for sustainable, long-term impact. “It wasn’t about a quick fix,” Gilbert emphasizes. “We built something that lasts — for our patients, their care and their outcomes.”

Today, Inflo Health sponsors all its clients through ImPower, covering the cost of participation in the program. “That’s how strongly we believe in ImPower,” says Adams. “Because if you want to create high-reliability systems, you need the technology, the people and the process to work in harmony.”

Success at EAMC has already drawn executive support and new resources, but for everyone involved, the greatest achievement is broader: proving that real, sustainable improvement is possible when it’s done together.

“There is hope,” Tomkins says to practices or departments who feel overwhelmed. “Improvement is hard, but it’s easier — and more powerful — when we do it together.”

By Raina Keefer, contributing writer, ACR Press