Informatics Methods to Enable Patient-centered Radiology

Informatics methods and systems in support of clinical care are well established in the health care enterprise. The new paradigm of patient-centered radiology creates new requirements and challenges that can be enabled by informatics. In particular, computer support can help referring physicians tailor their imaging requests to those procedures that would be most helpful for their patients’clinical context. Informatics methods can assist radiologists in recognizing important findings in images as well as helping them decide the best course of action for patients given the radiologic imaging results and other clinical data. Finally, informatics methods can help engage patients in their care by providing information about their imaging procedures and results. All of these informatics technologies share in common the ability to bring together critical knowledge filtered according to the specific requirements of patients undergoing radiologic imaging, a key component of patient-centered radiology. The goals of this article are to review the opportunities for informatics in supporting patient-centered radiology, to demonstrate the potential utility of these methods, and to point radiologists to the ways that informatics will help them provide care that is tailored to each patient.

Patient-centered radiology is a topic of increasing importance in radiology, motivated by both physicians and patients. From the physician perspective, patient-centered radiology is being driven by the rapidly evolving medical and molecular knowledge that promises personalized medicine . Patients are also driving patient-centered radiology, with increasing expectations of accessing and reviewing their medical information and participating more actively in their care . Patient-centered radiology practice is crucial, affecting the visibility of radiologists in health care .

The patient-centered radiology paradigm brings important challenges to both physicians and patients. From the physician perspective, two important challenges are selecting the appropriate imaging procedure for specific patients and rendering the best imaging interpretation that is personalized to the particular patient (eg, by incorporating historical and clinical data). In selecting an imaging procedure for specific patients, radiologists have an increasing number of choices. There are many new diagnostic agents and imaging techniques, increasingly tailored on the basis of patient-specific information. Radiology is evolving from generic imaging protocols for broad categories of indications to specific, often complex, image acquisition protocols designed to answer specific clinical questions. Radiology procedures and the selection of imaging agents will be increasingly customized according to each patient’s underlying or suspected disease process, particularly in the era of molecular imaging.

Rendering the best patient-specific imaging interpretation is another requirement for radiologists in the patient-centered radiology paradigm. The pace of discovery in radiology is rapid, and radiologists are challenged by the information explosion and their ability to keep pace with the latest knowledge that could affect their imaging interpretations. Tools are needed to help radiologists access and use current knowledge, to guide them in customizing imaging to each patient, and to help them render the most accurate diagnoses.

From the patient perspective in patient-centered radiology, the expectation is that they will assume active roles in their care, particularly being informed about the results of imaging procedures and participating in medical decision making after receiving those results. Patients, like physicians, are overwhelmed by the amount of information related to imaging available online from diverse sources of questionable validity, and they are looking for help. Informing patients about the diagnostic imaging options available as well as the results of their studies is a crucial way radiologists can help patients to be engaged in their care as well as to ensure that critical results are communicated to them. This is a particularly important opportunity because the volume of information in physician practices and the lack of systems to manage the flow of information sometimes result in delayed communication of results from referring physician to patients . Radiologists can adopt informatics methods to manage the information glut and can help communicate results to patients. At the same time, radiologists will become more visible in the care process and make patients aware that radiologists serve an integral role in patient care.

A second aspect of the patient perspective in patient-centered radiology is enabling patients to participate in the medical decision-making process. Just as personalized medicine is changing how radiologists will approach interpreting images, shared decision making personalizes the patient management process. In many cases, the results of imaging are suggestive, but not conclusive, for disease. The choice of next steps (additional imaging, biopsy, or watchful waiting) often is affected by patient preferences. Shared medical decision making permits patients to weigh the trade-offs in their utility of the different outcomes, the likelihood of each outcome, and their risk tolerance.

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Figure 1

Informatics aspects supporting patient-centered radiology. Informatics supports patient-centered radiology throughout the imaging work flow, in aspects of care that involve the radiologist (dashed boxes) and the patient (dotted boxes) , beginning with the imaging request (just-in-time appropriateness methods), followed by the radiologist’s interpreting the images (diagnostic decision support systems), and finally by ensuring that the patient is informed of the imaging results (results communication systems) and is involved in the subsequent management decisions (shared decision making).

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Guidance for procedure appropriateness

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Defining and Encoding Guidelines for Imaging

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Order Entry Decision Support

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Diagnostic decision support for interpretation

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Results communcation and shared decision making

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Structured Reporting and Controlled Terminology

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Electronic Notification and Reminder Systems

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Shared Decision Making

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Discussion

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Conclusion

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Acknowledgment

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Informatics Methods to Enable Patient-centered Radiology

Guidance for procedure appropriateness

Defining and Encoding Guidelines for Imaging

Order Entry Decision Support

Diagnostic decision support for interpretation

Results communcation and shared decision making

Structured Reporting and Controlled Terminology

Electronic Notification and Reminder Systems

Shared Decision Making

Discussion

Conclusion

Acknowledgment

References

Further Reading

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