{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:40:50Z","timestamp":1792197650139,"version":"4.4.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Digit Imaging. Inform. med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Point-of-care ultrasound (POCUS) is integral to emergency department (ED) care, but traditional order-based imaging workflows (OBIWs) are poorly aligned with unscheduled encounters and dynamic bedside imaging needs. We describe an accountable encounter-based imaging workflow (EBIW) that integrates patient identification, clinician attribution, encounter-linked image routing, and documentation accountability into a unified imaging informatics architecture. We performed a retrospective observational analysis of aggregated ED POCUS charge data from January 2018 through December 2025 at a single urban academic ED. Three sequential workflows were evaluated: a legacy electronic health record (EHR)-based OBIW, a POCUS Manager\u2013based OBIW, and an accountable EBIW. The accountable EBIW links ultrasound images directly to the ED encounter using barcode-based patient and clinician identification and a centralized Digital Imaging and Communications in Medicine (DICOM) router that generates an image availability message. This enables immediate image access in the picture archiving and communication system, EHR, and POCUS management platform before report completion. Charges were not used as a measure of reimbursement or financial return. Because a charge could only be generated after image archival, encounter linkage, documentation, and clinician attestation, charge capture served as a longitudinal system-level marker of completed workflow execution. Charges were normalized by ED visit volume and analyzed using interrupted time series analysis. Transition from the EHR-based OBIW to the POCUS Manager\u2013based OBIW was not associated with an immediate increase in charges. Implementation of the accountable EBIW was associated with an immediate level increase of $11,746 per 1000 visits and a sustained positive quarterly slope thereafter. An accountable EBIW integrating encounter-level acquisition, DICOM routing, immediate image availability, clinician attribution, and documentation accountability was associated with improved capture of ED POCUS utilization.<\/jats:p>","DOI":"10.1007\/s10278-026-02365-5","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:56:52Z","timestamp":1792195012000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Accountable Encounter-Based Imaging Workflow for Point-of-Care Ultrasound: Integrating Image Availability, Clinician Attribution, and Documentation Accountability"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-3577","authenticated-orcid":false,"given":"Matthew","family":"Riscinti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhu-Nguyen","family":"Le","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Milgrim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Rast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Bottemiller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Baird","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Toney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"3","key":"2365_CR1","doi-asserted-by":"publisher","first-page":"e115","DOI":"10.1016\/j.annemergmed.2023.06.005","volume":"82","author":"American College of Emergency Physicians","year":"2023","unstructured":"American College of Emergency Physicians. Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2023;82(3):e115\u2013e155.","journal-title":"Ann Emerg Med."},{"issue":"8","key":"2365_CR2","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1056\/NEJMra0909487","volume":"364","author":"CL Moore","year":"2011","unstructured":"Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749\u2013757.","journal-title":"N Engl J Med."},{"key":"2365_CR3","unstructured":"American College of Emergency Physicians. Emergency ultrasound workflow white paper. Irving, TX: American College of Emergency Physicians; 2023. Available at: https:\/\/www.acep.org\/siteassets\/uploads\/uploaded-files\/acep\/membership\/sections-of-membership\/ultra\/workflow-white-paper.pdf. Accessed 2\/6\/2026."},{"issue":"6","key":"2365_CR4","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1016\/j.ajem.2014.02.051","volume":"32","author":"S Adhikari","year":"2014","unstructured":"Adhikari S, Amini R, Stolz L, O\u2019Brien K, Gross A, Jones T, Fiorello A, Keim SM. Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact. Am J Emerg Med. 2014;32(6):592\u2013595. https:\/\/doi.org\/10.1016\/j.ajem.2014.02.051.","journal-title":"Am J Emerg Med."},{"key":"2365_CR5","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/978-3-031-86341-7_19","volume-title":"Ultrasound program management","author":"RM Ferre","year":"2025","unstructured":"Ferre RM, Lobo V. Workflow and middleware. In: Tayal VS, Foster TR, Liu R, Duran-Gehring PE, editors. Ultrasound program management. 2nd ed. Cham, Switzerland: Springer; 2025. p. 263\u2013272.","edition":"2"},{"issue":"1","key":"2365_CR6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12913-025-12234-6","volume":"25","author":"J Rowland","year":"2025","unstructured":"Rowland J, Baker J, Dunn N, Whited M, Saadat S, Fox JC. Impact of worklist selection on point-of-care ultrasound workflow: a quality improvement project. BMC Health Serv Res. 2025;25(1):76. https:\/\/doi.org\/10.1186\/s12913-025-12234-6.","journal-title":"BMC Health Serv Res."},{"key":"2365_CR7","unstructured":"Integrating the Healthcare Enterprise (IHE) Radiology Technical Committee. IHE radiology technical framework supplement: encounter-based imaging workflow (EBIW) with extensions for lightweight devices and point-of-care ultrasound image management and reporting. Rev 3.1 (trial implementation). Oak Brook, IL: IHE International; 2025."},{"key":"2365_CR8","unstructured":"Denver Health Emergency Ultrasound Program. Accountable encounter-based imaging workflow for point-of-care ultrasound [video]. Denver, CO: Denver Health; 2024. Available at: https:\/\/www.denverultrasound.org\/system. Accessed 2\/6\/2026."},{"key":"2365_CR9","unstructured":"Epic Systems Corporation. Epic electronic health record system. Verona, WI: Epic Systems Corporation; 2026. Available at: https:\/\/www.epic.com. Accessed 2\/6\/2026."},{"issue":"12","key":"2365_CR10","doi-asserted-by":"publisher","first-page":"2467","DOI":"10.1002\/jum.14284","volume":"36","author":"M Flannigan","year":"2017","unstructured":"Flannigan M, Adhikari S. Point-of-care ultrasound workflow innovation: impact on documentation and billing. J Ultrasound Med.2017;36(12):2467\u20132474.","journal-title":"J Ultrasound Med."},{"key":"2365_CR11","unstructured":"Centers for Medicare & Medicaid Services. Medicare claims processing manual. Chapter 13: Radiology services and other diagnostic procedures. 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Accessed 2\/6\/2026."}],"container-title":["Journal of Imaging Informatics in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10278-026-02365-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10278-026-02365-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10278-026-02365-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:56:54Z","timestamp":1792195014000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10278-026-02365-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":17,"alternative-id":["2365"],"URL":"https:\/\/doi.org\/10.1007\/s10278-026-02365-5","relation":{},"ISSN":["2948-2933"],"issn-type":[{"value":"2948-2933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"14 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This was a technical innovation and a retrospective quality improvement study. This project was reviewed by the Denver Health Quality Improvement Review Committee (QuIRC), authorized by the Colorado Multiple Institutional Review Board (COMIRB) at the University of Colorado Denver, and was determined not to be human subjects research.","order":1,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Financial interests: authors Nhu-Nguyen Le, Fred Milgrim, Jessica Rast, Allan Bottemiller, Jon Baird, Victor Johnson, Hee Yoon, Amanda Toney, and Stephen Wolf declare that they have no relevant financial interests. Matthew Riscinti has previously consulted for B. Braun, Butterfly Network, Exo Works, and Philips. Nhu-Nguyen Le, Fred Milgrim, and Matthew Riscinti have contracted research with the Department of Homeland Security, Mindray Ultrasound and Rivanna. Matthew Riscinti has previously had contracted grant-funded research with the Department of Defense. None of these organizations reviewed the manuscript or had any role in the development, analysis, authorship, or decision to submit the materials presented here.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}