By Jenny Lower
In imaging circles, quality has become the watchword. But with so many pressures facing radiologists, pinning down the term’s meaning has become a slippery exercise. What exactly matters in a quality report—speed, accuracy, or something else?
Arnold Raizon, MD, is a practicing radiologist at an 800-bed hospital in Washington, DC. He’s also a consulting physician to 3M Health Information Systems, St Paul, Minn, for the development of ChartScriptMD for Radiology, a software tool to aid radiologists in creating, signing, and distributing reports. He says the meaning of a quality report is simple: it’s “one that the referring physician is able to utilize to provide the best and most appropriate care to the patient.” How to achieve that end is the complicated part.
Raizon points to three key factors: unequivocally stated findings, timeliness, and—perhaps least obvious—grammatical correctness. A report full of gobbledygook due to transcription errors hurts professionalism, and could lead to potential errors in diagnosis. “If there’s a garbage term in the report, the provider says to himself, ‘Can I rely on this report?’ You lose all credibility,” Raizon said.
ChartScriptMD aims to address these challenges with features that shorten turnaround times and ensure accuracy. Hundreds of available templates auto-format text according to standards set by the American College of Radiology and the Radiological Society of North America. Templates can then be linked to appropriate CPT billing codes. The system can embed images captured from the study at the bottom of the report. Front- and back-end speech recognition lets radiologists use both traditional transcription and automatic dictation. In the latter case, a critical phrases module highlights essential words or phrases to allow quick verification and ensure accurate capture by the software.
A streamlined user interface also frontloads important information, like the number of suspended reports and reports pending review, on a front page where the radiologist can’t miss them, leading to faster response time. A critical results reporting module allows radiologists to communicate urgent findings to those responsible for treatment decisions.
“There is pressure on radiologists, in terms of both turnaround time and transcription costs, to move to a more automated system,” Raizon said. ChartScriptMD’s tools simplify the radiologist’s workflow, producing a system that is easier on the radiologist—but also less likely to cause confusion or require clarification from referring physicians, keeping them happy and leading to better patient care.
That goal also serves as one of the driving forces behind the next generation of the Carestream Vue PACS platform still in development, currently being beta tested at Innovative Radiology PA. Randall Stenoien, MD, runs a practice that serves over 1,000 referring physicians at 40 locations throughout Texas and has served as a Carestream test site since 2002. For him, quality is an observable phenomenon that ties directly to speed and ease of use. He has seen both improve with the evolution of the Vue PACS, leading to spikes in adoption rates among referring physicians.
Under Stenoien’s previous RIS-driven system, referring physicians received online access to their patients’ images on the Carestream Vue Motion web portal through a link delivered to their inbox. Still, adoption hovered around 5%. Physicians treating patients who visited a variety of radiology practices didn’t have the time or inclination to learn to navigate dozens of separate systems.
Then last year, Innovative Radiology adopted Carestream’s MyVue patient portal, allowing patients to view their current and previous studies and even control image distribution. Patient uptake of the platform skyrocketed to 50%. Of that half, two-thirds were actually accessing their reports.
“The quandary was, okay, we’ve engaged the patient. We have a really good product to engage the doctor, but the doctor’s not using it. I knew that if we could make it easy for the docs, they would probably like the product,” Stenoien said.
The next Vue PACS beta version, rolled out at Stenoien’s offices in October 2013, allowed Innovative Radiology to make the jump to a PACS-driven, RIS-agnostic system. A Vue for Teleradiology module now aggregates patient information from different facilities serviced by Innovative Radiology into a single viewer using the physician’s NPI number. Referring physicians can access their patients’ records with one login, even if their patients visit different imaging centers. Native PACS dictation aligns spacing and headers into a visually pleasing, clean format. “We can make beautiful reports,” Stenoien said. “They’re very, very pleasant to look at.”
Like ChartScriptMD, the latest Vue PACS generation bypasses the clumsiness of faxing a report or mailing files on a hard drive by embedding key images into the report. As Stenoien observed, it’s one thing to describe a finding—it’s another to state the finding, and then show a picture. The system’s latest beta iteration, due to roll out any day, also allows users to hyperlink text directly to a diagnostic image when they report a finding. If a physician has any questions, the relevant image is just a click away.
The result is a report that’s “very powerful and very informative, and actually kind of fun for the docs,” Stenoien said. The system’s utilization rate for referring physicians subsequently jumped to 25% in 3 months.
Stenoien has witnessed firsthand the excitement the new tools generate. He recently got a call from a physician asking to send a batch of overflow patients who needed preemployment screenings; 19 patients received 25 MRIs and 38 x-rays. Around midday, Stenoien headed over to the physician’s office to show the staff in person how to access the reports. They oohed and aahed over the embedded images, but what most impressed them was the turnaround time: by 1 pm that day, 90% of the reports were available for the physician to download.
“All of a sudden, his workload became so easy. It’s so efficient and fast and user-friendly. I don’t think he’s ever had that experience before,” Stenoien said. The speed is partly due to the system’s native dictation, which like ChartScriptMD, transcribes the report using voice recognition tools and auto-correction. On average, reports are transcribed, signed, and available for download within 90 minutes of the exam—sometimes as quickly as half an hour.
The encounter had tangible outcomes for Stenoien’s practice. The next Thursday, the doctor sent over five more patients. On Monday, he referred 10 more, then another five on Tuesday. On Wednesday, he called to say he was sending Stenoien all his patients.
When PACS first emerged on the market, Stenoien thought it would improve his relationships with physicians. That turned out not to be the case, he said: human interaction dropped off considerably. Adopting the Vue PACS system has helped reverse that trend, generated faster outcomes, and helped his practice stand out from the competition in tough times.
“Being able to do things in real time, you develop really good relationships with physicians,” Stenoien said. “This is helping us engage more frequently with our referring doctors in a personal way and helping them take care of their patients.”
Jenny Lower is the associate editor for Axis Imaging News.