Reporting produces the tangible work product of diagnostic radiologists. Reports should reflect the expertise of the radiologist while clearly communicating complex information for ordering providers.
随着时间的推移，放射科医生工作流程的许多要素已经跟上并适应了行业的技术进步。但是由于各种各样的原因，放射科医生继续以几十年来相同的方式完成报告——以标准的纯文本格式。
An updated method of reporting, known asinteractive multimedia reporting, enables the radiologist to insert enhanced content, such as images, charts, graphs and interactive hyperlinks to annotated findings, directly into reports. Thesemultimedia elementscan then be accessed by downstream consumers, allowing the referring physician or patient a more interactive and comprehensive experience.
“It's really about updating the way we report to modern electronic communication methods to take advantage of those tools that are already used widely in other industries,” saidCree Gaskin, M.D., vice chair of clinical operations and informatics, division chief of musculoskeletal imaging and intervention, and associate chief medical information officer at theUniversity of Virginia(UVA). UVA implemented early-stage interactive multimedia reporting to their clinical environment in 2016 and continue to update technology for more advanced reporting.
Clinical Benefits
除了为消费者提供更健壮的报告外，交互式报告系统还允许将信息高效地输入到报告中。放射科医生可以测量一个发现，然后发出语音命令，通过超链接将该发现与报告连接起来。关于病变位置的信息，如图像编号、系列编号和测量，将自动从查看器传输到报告应用程序，然后传输到报告。类似地，以前的研究细节也可以被查看以进行比较，也可以自动插入。
“The ability to have information automatically import from the images into the report itself is an advantage because you don't have to dictate all of that content,” Gaskin said. “If you're looking at the images, and you want some of that information to end up in the report, you can use commands to automatically import certain information without having to dictate it. It's less labor of dictation, and less likely to have a voice transcription error, or speech recognition error.”
The addition of images, graphs and hyperlinks into reports enriches the reporting experience, and more effectively communicates results by providing easier and more direct access to imaging than plain text. Anecdotal evidence from providers shows that embedded images and hyperlinks to annotated images make the reports clearer about which findings are being discussed.
When the ordering provider clicks a hyperlink in the report, it launches the viewer. The viewer displays the relevant annotated image from the study and the image stack is scrollable to view adjacent images. The interactive report is also displayed, allowing access to other hyperlinked findings. This helps the clinician quickly and easily navigate between the report and images, increasing both confidence and efficiency during report review.
“I review a lot of reports myself. When reading current studies, I’ll review the prior studies and their reports for comparison. It is faster for me to click on a link in the prior report and immediately see the key finding on the prior study,” Gaskin said. “Even though I'm capable of finding it, it might take me eight seconds or so, or I can click a link and see it instantly. So it's pretty obvious that it's time saving, for anyone consuming the report.”
Interactive Reporting In COVID-19
When theCOVID-19pandemic began and faculty radiologists began to have fewer in-person interactions with referring providers and trainees, UVA was able to prepare the same interactive reports remotely in theirPhilips Vue PACS system. The team at UVA also relied on screen sharing to collaborate with colleagues, read a resident out remotely or perform consultations for ordering providers.
“Pre-COVID, I would sit next to the trainee and go over the findings with him or her in person. Now that I'm sometimes remote, we're not always side-by-side during readout sessions. I may just read their reports while interpreting the images. If they've inserted a hyperlink to a finding, I can more quickly and confidently see exactly what they're talking about,” Gaskin said.
Creating New Workflow Habits
从放射科医生的工作流程角度来看，Gaskin估计准备交互式报告所需的时间与纯文本报告相同。因为向交互式报告的转变需要放射科医生学习一个新的工作流程，那些对工作流程中立或有益的组件最有可能被采用。根据加斯金的经验，那些没有多少根深蒂固的习惯的学员更有可能接受新方法。
“If you've been doing it a certain way for 15 years, you have to think a little bit differently,” Gaskin said. “The more you use it, the more natural it becomes.”
In a 2018study1published in theJournal of the American College of Radiology， UVA的研究人员回顾了20个月期间超过55.9万份临床成像报告中活跃超链接的存在的诊断报告。The study found that more complex examples, likePET CT, had nearly half of reports containing hyperlinks to key findings.
“I think that’s pretty strong adoption to say that half of the reports had this elective new tool used,” Gaskin said. “That reflects that radiologists see value in doing it, and that it's not a significant burden.”
Economic and Patient Benefits
There is also economic advantage to interactive reporting, for both radiologists and ordering physicians. Interactive reports allow for expedited report and image review. Radiologists can report results faster, and providers are able to consume them more quickly and with potentially greater understanding. In a competitive market, this can offer a strategic advantage.
Gaskin说:“如果你是一个发布报告的临床放射学组织，那么拥有一个优秀的产品是一种竞争优势。”“如果城里有一个放射科小组提供的报告是交互式的，里面有关键图像，它们看起来会更复杂。”
Gaskin said the same holds true for the patients. UVA embedded links to their images and interactive radiology reports intoEpic MyChart，允许患者通过医院的患者门户查看和分享他们的交互式多媒体报告以及标记在实时图像上的相关发现。Within five months of launch, UVA saw a7x increase2in patients accessing their own radiology images and interactive reports online.
“患者能够与报告互动，并看到图像，帮助他们更好地理解放射科医生在说什么。像这样支持患者参与可以提高满意度和护理提供。患者可以选择他们去哪里接受门诊成像，他们可能更喜欢一个可以轻松访问在线图像和交互式多重报告的网站。”
Barriers to Implementation
One of the biggest limitations to implementing interactive reporting is interoperability. It is technically more difficult to seamlessly integrate and share content between separate viewing and reporting applications. One overarching application that combines both viewing and reporting functions into one, provides a much easier pathway for sharing content between the viewer and the reporting application.
Similarly, applications further downstream or outside of the radiologist workflow need an effective method for translating multimedia material. Some electronic health records (EHRs) may only be configured to intake plain text, or require a separate viewer to display interactive multimedia reports that are issued in one system and consumed or displayed in another.
“I think it's important to know that we're right on the edge of enabling that to work in the EHR itself, and once we complete that, there really are not any real remaining barriers,” Gaskin said. “You're going to see providers consistently seeing interactive multimedia reports in the EHR. Once that technical hurdle is completed, then we can pretty much expect our advanced reports will always reach our referring providers.”
Gaskin believes this will accelerate the cycle of cultural adoption for providers, who will begin to expect more interactive reporting.
“I'm confident that as they see more reports with interactive content, they'll recognize their time savings,” he said.
Results from case studies are not predictive of results in other cases. Results in other cases may vary.
For more information:www.philips.com/multimedia-reporting
References:
- https://doi.org/10.1016/j.jacr.2018.10.009. Radiologist Adoption of Interactive Multimedia Reporting Technology. Journal of the American College of Radiology 2018
- https://doi.org/10.1016/j.jacr.2020.12.028. Improving Patient Access to Medical Images by Integrating an Imaging Portal With the Electronic Health Record Patient Portal. Journal of the American College of Radiology 2021
August 17, 2022
