Diagnostic Radiology
January/February 2011
Diagnostic Radiology
Critical Communication: Improving Patient Safety
The written diagnostic imaging report is the key method of communication between radiologists and referring clinicians. However, the radiology report is valuable not only for its contents, but also for the timeliness of delivery given the important subject matter of radiologic results, including, in some cases, critical findings. To ensure timely delivery, healthcare facilities are increasingly implementing communications solutions. These solutions can take many forms, including email programs on electronic medical records, staff hired to contact physicians, and critical test result management software.
Effective communication of diagnostic radiology results has been shown to yield significant benefits. This article examines the current market situation and industry challenges as well as the implications of Meaningful Use rules and American College of Radiology (ACR) communication of diagnostic imaging results guideline. The article also examines the benefits of establishing effective communication of radiologic test results.
Market Situation
The traditional role of the radiologist has been to interpret the radiologic exam accurately and render a report, and for many years that was the sole extent of what was expected. Today however, the responsibility of radiologists is expanding. As the capture, storage, and transfer of radiologic images have become digitized, the pressure to provide timely communication of significant radiologic test results has increased.
As they relate to report turnaround times and documentation, traditional transcription services may introduce communication delays and increase financial costs due to communication breakdowns. In some cases, physicians’ offices may not track the receipt of patients’ results of diagnostic tests, referrals, or procedures. That can lead to delayed or undelivered patient findings that in some cases may pose a threat to patient safety. Eighty-three percent of internal medicine physicians surveyed as part of an Archives of Internal Medicine study (Poon, et al., 2004) reported at least one significant delay in viewing outpatient test results in the 2 months preceding the survey.
One initial step to facilitate communication of radiologic results is to decrease the turnaround time of the written radiologic report. The implementation of speech recognition technology is one way to accomplish this, as radiologic report turnaround times in many cases decrease with speech recognition (Mardini & Mehta, 2006, p. 482). Main Line Health (MLH) Radiology in suburban Philadelphia is one example. This nine-location facility experienced a significant reduction in turnaround time through the use of radiology speech recognition, which decreased the dictation-to-delivery cycle from 23 hours to just 3.5 hours for nearly 500,000 exams per year. NorthShore University HealthSystem, a group of four teaching hospitals in the northern suburbs of Chicago, has also experienced significant reductions in radiologic report time since adopting speech recognition.
In addition to voice or speech recognition, communication of significant radiologic tests results can be increased through an awareness of the importance of critical test results delivery. In their practice guideline for the communication of diagnostic imaging findings, the ACR opines, “in emergent or other non-routine clinical situations, the diagnosing imager should expedite the delivery of a diagnostic imaging report (preliminary or final) in a manner that reasonably ensures timely receipt of the findings” (2010). In response, a growing number of hospitals and health systems now see the implementation of a plan to facilitate the communication of critical patient test results as a strategic pathway to improved patient safety and patient outcomes. While diagnostic clinicians have powerful tools at their disposal to identify disease processes, communicating critical test results in a timely manner in some cases can be a weak link in healthcare, and can contribute to accelerating costs and less than optimal outcomes.
Industry Challenges
The role of radiology reporting technology such as speech recognition continues to evolve as financial pressures combined with the need for quick radiologic results turnaround times increase (Schildt, 2007). Technology such as speech recognition has become increasingly attractive for many radiology departments given the high cost of manual transcription, increased pressure to deliver results more efficiently, and pressure to deliver timely results.
In many ways, radiology has led the healthcare industry with its adoption of reporting technology such as speech-enabled reporting workflows. This has, in turn, led advanced innovation for radiology-specific reporting technology. For example, speech recognition systems that formerly were used solely to decrease transcription costs and improve report turnaround times now, in some cases, include options for documenting communication of critical test results, external data capture, multi-site workflow support, and structured reporting into a single solution.
The benefit of incorporating a broader radiology workflow into a single interface is beginning to demonstrate value. Studies related to communication of critical test results, suggest that suboptimal communication accounts for a high proportion of medical malpractice claims against radiologists. One study suggested that nearly 75% of the claims against radiologists involved communication in some fashion (Berlin, 2002). Another study found that the delay or ineffective communication in the diagnosis of breast cancer resulted in malpractice awards significantly higher as when effective communication was employed (Brenner, 2005). The diagnostic value of radiology now relies on more than just radiologist interpretation skills; communication delivery as part of reporting is also the radiologist’s responsibility in some cases.
Critical test results are subject to errors partly because:
- Large numbers of tests are ordered.
- There is a relative infrequency of urgent results that require immediate attention.
- There may be less person-to-person communication in the current digitized healthcare environment.
Until the diagnostic ordering, interpretation, and results delivery process is managed and continuously evaluated in a single workflow, the potential for undelivered radiologic results exists.
Implications of Meaningful Use and Industry Best Practices
On July 13, 2010, the Department of Health and Human Services released final Meaningful Use incentive payment objectives for hospitals and eligible professionals. Among other criteria, the report cites the meaningful use objectives of providing patients with an electronic copy of their health information upon request and exchanging key clinical information electronically among providers of care and patient authorized entities (Beaudoin, 2009).
Beyond criteria outlined as part of the HITECH Act, the ACR, in its practice guideline concerning the communication of diagnostic imaging findings opines, “non-routine communications (of critical results should be) handled in a manner most likely to reach the…treating or referring physician…in time to…benefit…the patient.” The ACR guideline does not specify the type of communication to be used to accomplish critical communication; rather the guideline focuses on the value of communication and the importance of insuring that communication was accomplished successfully (2010).
Courts have also emphasized the role of the radiologist in the communication of critical test results, finding in some cases that the radiologist was negligent by not ensuring the communication of critical findings to the patient or their caretaker (Lucey et al., 2010).
Speech Recognition and Critical Communication Solutions
While there is no single “one size fits all” solution to the communications conundrum, in some cases technology such as speech recognition with critical result test management can prove to be effective. Recently, significant improvements in the accuracy of speech recognition products have led the way to greater clinical adoption and widespread use. In some cases, radiology departments are also using technologic critical result test management solutions. Implementing speech recognition with integrated communication software can in some cases yield significant improved patient outcomes and financial benefits.
Some customers of a market-leading speech reporting solution for radiology have reported achieving significant reduction in transcription costs with payback of their speech recognition technology investment in less than 12 months. Increased financial savings can be achieved with greater “self-editing” by radiologists. It is important to realize however, that in addition to financial factors, other factors such as the effect of speech recognition on radiology department operations should be considered as well if speech recognition technology is contemplated.
While saving on transcription costs and improving turnaround times can be significant benefits of using speech recognition technology, instituting an effective solution to the problem of radiologic results communication can have a synergistic effect for radiology departments.
What to Look for in a Solutions Provider
If a technologic solution that integrates speech recognition reporting and critical test result communication solution is considered, radiology departments should consider the following:
- Minimal impact on existing systems and workflows. Seek a provider that can implement speech recognition and critical test result communication solutions with minimal altered workflow and no significant disruption of existing systems and IT investments.
- Strategic technologic integration within the radiology industry. Try to select providers that have established relationships with a wide range of RIS, PACS and Advanced Visualization providers. This will increase the likelihood of efficient integration with existing technology investments.
- Proven market experience. As with any healthcare IT investment, a speech recognition and critical test result management provider that offers experience implementing and supporting healthcare IT systems at medical facilities is preferable to a provider without an established reputation.
Conclusion
The communication of significant radiologic test results is becoming increasingly important. Radiology departments and healthcare organizations should consider implementing plans to formalize the communication of critical test results. There are many effective methods to facilitate communication including some of the technologic and non-technologic solutions addressed in this article.
Jonathan Berlin is clinical associate professor of radiology at the University of Chicago Pritzker School of Medicine and a radiologist at NorthShore University HealthSystem in the northern Chicago suburbs. Dr. Berlin has an MBA from Northwestern’s Kellogg School of Management and frequently writes and lectures on healthcare business and economics topics. He may be contacted at jonathanberlin@yahoo.com.
Technology Overview
NorthShore University HealthSystem uses Powerscribe by Nuance for speech recognition.