While diagnostic radiologists are experts at reading and reviewing imaging studies, the reports that radiologists issue to referring providers and patients typically contain only plain text.

The University of Virginia (UVA) Health System, Charlottesville, Va., is working to change this dichotomy. In 2015, radiologists began issuing interactive, multimedia reports that incorporate annotated images of key findings as well as hyperlinks that enable referring physicians to launch a study and go straight to bookmarked findings.

UVA Health System’s Christopher Gaskin, MD, professor and vice chair of operations and informatics, and associate chief medical information officer, believes adding multimedia content to prose-oriented reports makes them more functional and easier-to-understand.

Christopher Gaskin, MD
Christopher Gaskin, MD

“If I put a picture of a complicated finding in a report, people can see that finding in a split second, rather than having to try and understand what I’m saying in a paragraph of prose,” he says.

The interactive, multimedia approach can decrease the time it takes radiologists to develop reports because it enables them to simply point to findings rather than describe them. Using UVA Health System’s picture archiving and communication system (PACS), which incorporates digital dictation capabilities, Gaskin measures a finding on an image, such as kidney lesion, and then dictates “Lesion in the right kidney. Hyperlink.”

The PACS automatically creates a bookmarked image, which includes the annotated measurement, and turns his dictated text into a hyperlink within the report. The PACS also enables radiologists to copy and paste key images directly into the report, rather than hyperlinking to them.

“The effort on my part as the radiologist is small,” says Gaskin. “I simply draw the measurement and say ‘hyperlink,’ yet providers who are reading the report can see there’s a lesion in the right kidney measuring 4 x 8 millimeters, on series 3, image 320. If they click on the hyperlink, the study will launch immediately in a browser-based viewer, and they will be taken straight to the relevant image with my markings.”

UVA Health System radiologists like being able to create richer image-laden and interactive reports, as well as the time-saving aspects of the functionality, Gaskin says. The multimedia reports are particularly helpful for imaging studies that include multiple abnormalities, such as for cancer patients who have multiple lesions that need to be tracked over time. Additionally, the reports improve clarity on subtle findings because referring providers can find and view the abnormalities.

“I think these multimedia reports make more sense for certain findings than others,” Gaskin says. “I like to use this for subtle findings so that people don’t have to hunt through the study for the finding I’m describing.”

Initially, it was challenging to get the advanced reports into UVA Health System’s electronic health record (EHR) because information systems tend to be designed around plain text, Gaskin says. But that technical hurdle has been resolved and the multimedia reports now display in the EHR.

However, like any change, it is taking time for all UVA Health System radiologists to embrace multimedia reporting. “We’re in a period of cultural change as people learn to add hyperlinks and images to reports,” Gaskin says. “If you’ve been dictating prose reports for 25 years, you don’t necessarily think in terms of adding images or hyperlinks to bookmarked findings. The new radiologists, the ones who are in training, pick it up very easily. They tend to be more tech savvy as a group.”

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