By Deborah Borfitz
March 25, 2019 | At most provider organizations today, radiology reports are static, plain-text documents with the formatting pizzazz of a 1980s newspaper—which is fine for normal studies where radiologists have no significant news to share with referring physicians. But such plain text reports may be more difficult to understand, or take longer to consume, when there are complex findings. And, there’s risk of confusion for the referring provider when reviewing subtle imaging findings described in the report.
The potential to improve communication is behind a movement at the University of Virginia (UVA) Health System to popularize the use of interactive, multimedia radiology reports where “a picture is worth a thousand words,” according to Cree Gaskin, associate chief medical information officer. The long-term goal is to have the enhanced reports display directly in the electronic health record (EHR) “similar to the way interactive multimedia content appears in many articles on the internet today,” he says. “We are very close.”
UVA Health System is one of few U.S. institutions offering enriched, EHR-based radiology reports that include hyperlinks connecting readers back to referenced images, Gaskin says. The enabling technology is Vue PACS, and its interactive multimedia reporting module Vue Reporting, of Carestream Health.
Plain-text radiology reports remain the norm elsewhere primarily because they’re vendor-agnostic, allowing reports to effortlessly move between different proprietary information systems. UVA Health System made the switch to interactive reports three years ago by standardizing on Carestream technology for both viewing images and summarizing imaging test results, says Gaskin.
A significant proportion of radiology reports in clinical production at UVA Health System include interactive elements connecting back to imaging findings, he continues. Radiologists can easily create “state-of-the-art reports” with minimal training. With a few clicks and voice commands, a preconfigured template can be enhanced with annotated images, links to comparison studies, and links that connect back to arrows pointing at the exact findings under discussion. Some UVA radiologists also include a personal photo in their multimedia reports to increase their visibility to patients and referring providers.
Because advanced reports support URL activation, it is also theoretically possible for report consumers to access other internet-based content. Referring physicians could “rate” radiology reports, or patients could access patient-facing content relevant to their study, such as via RadiologyInfo.org, says Gaskin. Researchers are still working on a report interface designed for patients where hovering over a clinical term would bring up a lay definition. Next-generation reporting tools are also likely to be “contextually aware” and know what anatomical structures radiologists are marking up, he adds.
The interactive multimedia radiology reports are readily available to physicians and clinicians in the EHR thanks to one of two workarounds, says Gaskin. One is to create a PDF report and access it via a connector between the EHR and a document management system. The other is to put a link in the EHR that launches Carestream’s lite digital viewing software, Vue Motion, to display the report and images simultaneously.
Cultural Shift
In a study recently published in the Journal of the American College of Radiology, Gaskin and his colleagues showed that over a 20-month period at UVA Health System creation of hyperlinked reports grew significantly to include 49% of PET/CT studies, 26% of CTs and 11% of MRIs among the roughly 100 clinical faculty, residents, and fellows comprising the radiology department.
Variable adoption among subspecialists has probably been “about variations in training, personality and established habits,” Gaskin says. And clinicians don’t always click through an extra step to view an enriched radiology report when it is available—largely because the old-school plain text version is familiar and currently more easily accessed.
At the National Institutes of Health Clinical Center in Bethesda, Maryland, 80% of CT reports now contain hyperlinks to imaging findings, according to lead radiologist Les Folio, DO, a co-presenter with Gaskin at the recent Health Information and Management Systems Society 2019 conference in Orlando.
Folio cited a 2017 study published in the American Journal of Roentgenology that found that in cancer trials, concordance on target lesion selection was greater for multimedia-enhanced radiology reports (78%) than text-only reports (52%)—suggesting the enriched version may have positive implications for patient treatment and outcomes.
The enriched reports might logically result in fewer phone calls and emails from referring physicians asking for an explanation of findings, says Gaskin, because the reports are easier to digest with a lot of wayfinding support. If doctors aren’t clear about what is being referenced, they can jump right to the relevant study and zoom in on the targeted area to see even a subtle finding (e.g. a stress reaction or “hairline” fracture).
Gaskin adds that he has been “dabbling” in the application of artificial intelligence (AI) to radiology reporting, and he’s optimistic about its long-term promise in reducing some of the manual labor of image interpretation so radiologists can focus more on the cognitive task of summarizing their findings. In the future, AI tools may also be deployed to bring workflow efficiency to the report creation process and automate lesion tracking, he adds.