Intake to report cut from 16 days to 7, in a post-approval REMS imaging program

The situation

A post-approval risk management program required patients to complete a cardiac echocardiogram at defined intervals in order to stay eligible for therapy. Missing one does not just create a protocol deviation, it can interrupt treatment. The population includes children and adults who travel poorly, and the imaging had to be read by a credentialed cardiologist matched to the patient’s age group.

The program was running, but the cycle from patient intake to a report reaching the prescriber was taking more than two weeks, and volume was climbing.

What made it difficult

• Every visit needed a sonographer within reach of the patient and a cardiologist licensed in that state, in the right age segment, which is two independent coverage problems on the same appointment.
• The program spans pediatric and adult patients, so coverage had to be built twice over in every state rather than once.
• Volume was rising month on month throughout, so any process change had to hold while the load increased rather than in a steady state.
• Scheduling ran through a third party at the front of the workflow, which meant turnaround depended on a handoff we did not control.

What we did

• Took direct ownership of scheduling and patient confirmation rather than leaving it to the upstream handoff, and added automated visit reminders.
• Matched sonographers by proximity and specialty from a national network, with pediatric and adult capability held separately.
• Built a second and third layer of cardiologist coverage state by state, so a single unavailable reader could not stall a report.
• Standardized the visit workflow and documentation so the report format reaching each prescriber was identical regardless of who performed the study.

Result

Median time from patient intake to report delivery fell from 16 days in April 2025 to 7 days in November 2025, while monthly completed visits rose across the same period. 95% of visits were scheduled within two business days of intake.

Visit volume ran ahead of forecast in every quarter of 2025, at 101%, 111%, 113% and 133%, and has been over forecast every month since March 2025. From January to August 2026 the program delivered 2,099 at-home echo visits, across 135 sonographers and 63 cardiologists covering pediatric and adult imaging.

Prescribers came back: 351 of the 664 who used the program referred more than one patient. So did patients. Asked how satisfied they were with their overall visit, 634 of 641 chose the top point on the scale, across 131 different clinicians, with no difference between first visits and repeat visits. 99.4% rated the visit timely and thorough.