Radiology Report: Satisfying Various Stakeholders

One of the biggest motivators behind today's changing health care system is greater patient satisfaction: shorter wait times, increased provider empathy, improved outcomes.

For radiology, however, it means a better final report. In the past, your report has been designed solely for the referring physician who requested the diagnostic test. That's not the case today. Patients are more than ever engaged in their own health care, and that means they want to know what you're seeing.

"We're in the midst of changing the way we provide patient care, and we're learning more about how patients approach it," said Christoph Lee, MD, associate professor of radiology at the University of Washington and radiologist at Seattle Cancer Care Alliance. "Patients need to be informed to make their own decisions."

But, patients aren't alone in their need for improved radiology reports. Your referring providers could also benefit from a few tweaks to your findings, as well.

For a radiology report to be more useful, though, you and your colleagues must make some changes, Lee and other industry experts said. But, not everyone agrees changing how complex medical images are handled and discussed is a good idea.

A Desire for Access and Understanding
Simply put, patients want information -- they have a growing thirst for knowledge about their treatment and care. Research shows, when offered, they'll view their images with or without referring or primary provider input.

According to a 2016 Academic Radiology study,  more than half of patients view their diagnostic images when they're available online. Based on the study of patients who had online patient portal access, roughly 61,000 of approximately 130,000 patients had at least one diagnostic study posted electronically. Of that group, 51% looked at the image. Women (56%), 25-to-39-year-olds (59%), and English-speakers (53%) were the groups who viewed their images most often.

Another study, conducted at Wake Forest Baptist Health and published in the JACR in 2012, also found patients are highly interested in first-hand imaging study knowledge. The study presented participants with three simulations to gauge their interest in using a patient portal - a head CT conducted for headaches, an MRI to investigate double-vision, and an MRI to determine the cause of leg weakness and back pain.

Results indicated 81% were interested in using the patient portal, and 43% preferred online access over other communication methods, such as regular mail. Additionally, 80% wanted access to their images within three days. Wake Forest used this information when designing its online patient portal, offering a three-day turnaround time for imaging.

Referring Providers
Making changes to the radiology report will also help referring providers. Currently, many complain that radiology reports are too broad, the results too generalized.[[{"type":"media","view_mode":"media_crop","fid":"61391","attributes":{"alt":"Radiology report","class":"media-image media-image-right","id":"media_crop_5162215161072","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7763","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Vadym-Nechyporenko/Shutterstock.com","typeof":"foaf:Image"}}]]

"The frequent complaint is the report could point to anything. Radiologists are often blinded to a patient's previous history and symptoms," said Arum Krishnaraj, MD, associate professor of radiology and medical imaging at the University of Virginia Health System. . "So, we go for the lowest common denominator to make sure we include any possible diagnosis."

This tactic isn't helpful, he said, because referring providers count on radiologists for expert-level opinions. If you change your final report, you can more frequently hit that target, he said.

What Can You Do?
Ultimately, improving radiology reports falls to radiologists. Unfortunately, it means more daily work, but the pay-offs can be significant in the long run.

Consider each of these tactics:

Increase electronic medical record use: If you're at a larger health system, you're likely familiar with electronic medical records (EMRs). But, you might not know you can use them to improve your reports, said Krishnaraj. Mine the EMR for as much of a patient's history as possible. Research their symptoms and previous medical issues. That knowledge will underscore how you view their images. 

Synthesize findings: Instead of checking off a list of abnormalities, take the time to put your findings into context. For example, Krishnaraj said, if you diagnose pancreatitis, include other pertinent positive and negative information. These details will help referring physicians in discussions with patients.

Structured reporting: A hot topic in radiology for years, implementing structured reporting can improve your reports. Templates designed for specific types of imaging can ensure you check all parts of an image. You're less likely to overlook important structures that could alter your ultimate findings.

Actionable impressions: Don't bury the most important nuggets of information at the bottom of your report. Prominently place your findings and recommendations at the beginning.

Patient portals: If your institution has an online patient portal, be sure you're using it, said Richard Taxin, MD, a radiologist with Crozer-Keystone Health System. Making images and analysis available through patients' private medical channel helps them feel more involved in the care they receive.

Limited jargon: You easily rattle off your findings in radiology-speak, but patients, in particular, are less likely to understand what you mean. And, confusion breeds anxiety. Try to use as little complex medical terminology as you can to increase patient - and sometimes referring provider- understanding.

"This will be a gradual process because it's a hard habit to break," Taxin said. "But, words themselves can be scary to patients, so we need to make things more understandable."

Include key images: Each study can contain thousands of images. Pick and mark a few that most clearly show your findings. For example, if you find a tumor, point it out with an arrow. It will help inform the discussion about diagnosis and treatment options.

Make yourself available: Let your patients contact you. Create a telephone hotline, an email address, or a web portal so they can ask you questions. Research into offering contact options has shown very few actually do it, said David Naeger, MD, associate professor of clinical imaging at the University of California, San Francisco.

Targeted reports: After you've completed your report, summarize your findings in lay-friendly language, Naeger said.

"Writing a few sentences to help patients understand your findings might take more of your time, but your patients will love it," he said. "Not only will they understand the images more, but it will also show them the value you bring to their health care."

In-person clinics: Carve time out to meet patients face-to-face in clinic to answer questions about their imaging. As with phone calls and emails, Naeger said, few patients will do this. But, for those who do, you've improved their experience with your report.

For example, Lee said, Massachusetts General Hospital already offers a radiology consultation clinic for outpatients interested in discussing their diagnostic imaging findings.

Disadvantages
But, the verdict on making radiology reports more accessible and more understandable isn't 100% favorable, Naeger said. Making changes introduces potholes to navigate within a system dedicated to protecting a patient's privacy with stringent regulations.

Patients: Accessing complex radiology reports can be frightening for patients. The medical language used to analyze images is unfamiliar, Naeger said. If a patient reads a report without the proper context, it can create anxiety left unaddressed for days before they see their primary provider.

Referring provider: For decades, referring providers have resisted increased radiology interaction with patients, believing it could infringe upon or damage the primary provider-patient relationship because radiologists don't have a full understanding of the patient's history. With the expansion of EMRs, though, this concern waning, he said.

Radiologist: The biggest negative for radiologists is any work done to improve the radiology report and access to it is all completely unpaid. Every minute you spend tweaking a report to make it more patient- or referring provider-friendly is a minute you could have spent earning reimbursement dollars.

The Final Word
Your radiology reports clearly offer referring providers and patients information needed to determine the course of a patient's treatment plan.

However, if radiology wants to bolster its image as a value-added patient-care partner, the report should step out of the shadows as a tool meant only for a medical provider, Krishnaraj said. It must become an easier-to-understand analysis that can stand alone and represent your hard work.

"Radiologists need to make reports more accessible and digestible," Krishnaraj said. "It has to be done simply because we can't always be there to discuss the outcomes with the patient."