Traditionally, the bread and butter of a radiologist’s work is the written text report—the blow by blow description of what was observed from looking at a series of images.
The functions of the process—documentation of findings, interpretation, recommendations, communications and billing—hasn’t changed in more than a century. But with technology now able to deliver a more comprehensive report, and patient engagement now a priority, radiologists are likely to face more pressure to develop multimedia reports.
Increasingly, patients are looking at reports of treatments on patient portals, which draw information from providers’ electronic health records, says Tessa Cook, MD, assistant professor of radiology at the Perelman School of Medicine at the University of Pennsylvania.
Speaking at a session on patient-centric radiology at the annual conference of the Radiological Society of North America, Cook says the shift to value-based care and rising patient expectations are increasing the need for radiologists to more fully use available IT resources to bring images into their reports.
“How can we use this technology to foster the ability to communicate with our patients?”—a question that’s increasingly being debated says Cook, who also chairs the Commission on Patient and Family Centered Care for the American College of Radiologists. Producing reports purely based on text don’t help patients understand why imaging is important to the quality of their care, she adds.
At the University of Pennsylvania, work is beginning on a project called the Patient Oriented Radiology Reporter, developed by three clinicians with the intent of using technology to make radiologists’ reports more patient-friendly. Reports are interactive, including annotated, marked up images; the text of reports have hyperlinked words that, when they’re clicked upon, definitions or images pop up. And the report includes a picture of the radiologist who conducted the study.
Early results of the approach have proven successful, Cook says. “The conclusion has been that patients want better access to radiology images, the report and to us,” she says.
Seth Berkowitz, MD, agrees that “What our patients see and how we present our reports really makes a difference, and at Beth Israel Deaconess Medical Center in Boston. Speaking at the RSNA session, he says the basic textual form of radiology reports haven’t changed in more than a century.
But there are workflow and time challenges that need to be overcome by radiologists, says Berkowitz, who among his roles at Beth Israel is director of informatics innovation. There is existing segregation between the imaging and reporting systems that radiologists use, he explains; images are viewed on a PACS or other imaging system, then a report is generated through voice recognition applications, often being fed into a radiology information system or electronic health records system.
In addition, challenges exist in sending multimedia reports to recipients, whether they be patients or clinicians. “A lot of interfaces were not designed to handle complex reports, and receiving systems historically have been unable to display what’s been created,” he says.
Additionally, standards enabling the exchange of information from HL7 had not been able to exchange multimedia reports successfully, but newer versions of standards from HL7 and DICOM, as well as solutions from HIT vendors, have opened up new possibilities, Berkowitz adds.
Testing of multimedia reports with referring physicians has found wide acceptance. But making the shift to improving reports will be challenging, he admits. “This would take additional time for radiologists to produce a report, and it’s disruptive to normal workflow. And it’s also a major change in behavior for radiologists.”
At Beth Israel, attempts are being made to nudge the process along. Berkowitz says the facility is looking to fuse the reporting system and enterprise viewer, achieve automatic hyperlinking of text via natural language processing and enabling the report to be “a launching pad for widgets. Once we take the first step of freeing the radiology report from text, then the possibilities are endless.”
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