By Aine Cryts

On March 9, the U.S. Department of Health and Human Services (HHS) finalized rules to increase patients’ access to their health data. The goal of the rules was to “give patients unprecedented, safe, secure access to their health data,” according to an HHS announcement.

“Interoperability has been pursued by multiple administrations and numerous laws, and today, these rules finally deliver on giving patients true access to their healthcare data to make informed healthcare decisions and better manage their care. Putting patients in charge of their health records is a key piece of giving patients more control in healthcare,” per the announcement.

Matthew Michela, president and CEO at Newton, Mass.-based Life Image, which provides access to points of care and curated clinical and imaging data to healthcare clients, says the new interoperability rules provide patients with better access to all types of health information—and he’s taking the long view. “Think out a decade. All the silos are gone, and people are going to have access to all sorts of data,” he tells AXIS Imaging News.

AXIS recently discussed with Michela the impact of the new interoperability rules on the practice of radiology. The conversation that follows has been lightly edited for clarity.

AXIS Imaging News: Tell me about the data that patients will have access to at the start.

Matthew Michela: It’ll start in the first wave, which is very defined data. For example, the patient wants to see the radiology report and they have the right to get that now.

AXIS: What’s next in terms of the data that patients will have access to?

Michela: I anticipate that the government will continue to increase those standards to eventually make all data visible—and the government will do so on a periodic, routine basis. Right now, that doesn’t impact radiologists at all. Radiologists will read exams, make their diagnosis, and determine their treatment plan. They will be doing exactly what they’re doing today, without any change. But the time will come when everything they’re documenting will get into the hands of consumers.

Today, it doesn’t get into the hands of consumers. The radiologist’s voice recording doesn’t. Their notes don’t. What’s documented very carefully in the report is available to consumers. But ultimately, everything a radiologist has done, how they did it, and the time they did it will be tracked, visible, and available.

AXIS: If that’s in the cards, what’s your advice for radiologists and radiology leaders?

Michela: Radiologists need to start thinking about ways to reduce deviation in their diagnoses. They need to think about peer-reviewing their data, compliance, and legal liability around documentation. Ultimately, everything a radiologist does and everything they say and everything they type becomes visible to the world.

That’s visible not through a legal process, but through the normal course of business.

AXIS: What are some specific ways radiologists should approach this change?

Michela: Radiologists need to think about reducing errors and variation in the ways things are documented. That will affect the practice of radiology. That’s something I don’t think radiologists are paying enough attention to right now.

That’s what Radiological Society of North America, the American College of Radiology, and radiology leaders need to be thinking about: How do we make sure that the profession is not disrupted because all prior versions of a radiologist’s notes become visible to the world?

AXIS: Will radiologists have to articulate their findings so that they’re fully understandable to a patient?

Michela: The answer for radiologists is “no.” I don’t believe they’re going to have an obligation to translate the report so that a consumer can understand it. It’s not about having to take your radiology report and put it at a sixth-grade reading level. It’s not the same kind of requirements there are for consumer-based material.

The bodies that are responsible for standards won’t go that far because they don’t want to impair the radiologists. What it does mean is a preliminary note that would otherwise be only a preliminary note and would never make its way into a medical record could be seen by the patient, who can access it remotely by themselves. Radiologists have to recognize that they have to take great care around how their documentation from the point of view of compliance and legal liability, relative to errors.

As we know, radiology is as much an art as a science. We know that two radiologists could look at the same exam and come to two slightly different conclusions. That’s going to start to become much more visible over time.

Take, for example, a radiologist who looks at images from a mammogram and doesn’t have access to the priors. They make an initial indication and, later on, the priors come in and the radiologist has to re-read, update, and adapt the report. Both of those pieces of information become visible. That raises questions about the differences between the two findings.