With widespread adoption of web portals and unfettered patient access to online radiology reports, these previous end products are quickly becoming springboards for direct radiologist-patient interactions, further increasing the value proposition for radiologists in an era of patient-centered care. Here, we provide a real-world scenario demonstrating a teachable moment on how imaging examination reporting in the digital era is expanding the radiologist’s role in patient consultation.
Three hours after receiving the unexpected page, we found ourselves sitting face-to-face in the consultation room with our patient and her husband. A few days prior, the patient had undergone a screening mammogram at our breast imaging clinic. Her images had demonstrated a mass, but we were unable to compare them to prior mammograms because she had recently moved to the area and the prior examinations were not available. Following our reporting protocol, we issued a Breast Imaging Reporting and Data System “0” assessment, suggesting an incomplete examination and the need to compare to prior images.
With increasing demands among patients for more timely access to their test results and electronic health record (EHR), finalized radiology reports at our institution are uploaded and available for patients to view via an online patient portal within days. In this case, our patient received a notification that her mammography report had been finalized, logged into the patient portal, and read the report immediately. Given the finding of a mass with incomplete assessment, she was concerned due to her personal history of a breast biopsy. Referencing the attending radiologist of record from the imaging report, she and her husband (a physician at an unaffiliated local institution) managed to reach us as the care team via page to request a consultation to review her mammography images in person.
In an era of digital connectivity and increasingly patient-centered radiology (ie, Imaging 3.0 ), the expectations for radiologists’ services to referring physicians and patients are changing. Although value manifests itself differently in different specialties, digital technology provides an important mechanism for advancing patient-centered radiology. This is not only because radiology reports, by virtue of digitization, are particularly well suited for electronic platforms, but it is also because major policy and practice changes continue to drive the proliferation of these platforms among providers across the country .
For example, through the Health Information Technology for Economic and Clinical Health (HITECH) Act , the federal government committed more than $25 billion to promote the uptake of EHRs in hopes that they would be used in service of patient care to achieve true improvements. One of the ways providers could meet the requirements of meaningful use is to provide patients with timely electronic access to portions of their health record. This charge has been consolidated and continued under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 , which incorporates use of EHRs in its Merit-Based Incentive Payments System and alternative payment models. Radiologists are also being called upon to integrate their workflows with EHRs to satisfy existing performance measures and create new value-based measures for health-care systems .
In response to these policies, many providers and organizations, including ours, have turned to web-based patient portals: platforms that provide patients the ability to directly access elements of their medical records in near real time. Although individuals vary in how and from whom they prefer to receive radiology examination results (eg, via the interpreting radiologist, ordering provider, or “the fastest way possible”), they nonetheless clearly and strongly favor having web access to their radiology reports . The use of portals to view radiology reports is likely to continue growing, with more than half of our institution’s patients reviewing their available radiology reports online in a 2014 cross-sectional analysis .
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
References
1. American College of Radiology : Imaging 3.0. Available at https://www.acr.org/Advocacy/Economics-Health-Policy/Imaging-3
2. Liao J.M., Emanuel E.J., Navathe A.S.: Six health care trends that will reshape the patient-provider dynamic. Healthc (Amst) 2016; 4: pp. 148-150.
3. Centers for Medicare & Medicaid Services : EHR/HITECH. Available at https://www.cms.gov/Outreach-and-Education/Look-Up-Topics/EHR-and-HITECH/EHR-HITECH-page.html
4. Centers for Medicare & Medicaid Services : MACRA: MIPS & APMs. Available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
5. Nicola G.N., Rosenkrantz A.B., Hirsch J.A., et. al.: Expanding role of certified electronic health records technology in radiology: the MACRA mandate. J Am Coll Radiol 2018; 15: pp. 29-33. Epub 2017 Apr 21
6. Cabarrus M., Naeger D.M., Rybkin A., et. al.: Patients prefer results from the ordering provider and access to their radiology reports. J Am Coll Radiol 2015; 12: pp. 556-562.
7. Henshaw D., Okawa G., Ching K., et. al.: Access to radiology reports via an online patient portal: experiences of referring physicians and patients. J Am Coll Radiol 2015; 12: pp. 582-586. e581
8. Johnson A.J., Easterling D., Williams L.S., et. al.: Insight from patients for radiologists: improving our reporting systems. J Am Coll Radiol 2009; 6: pp. 786-794.
9. Miles R.C., Hippe D.S., Elmore J.G., et. al.: Patient access to online radiology reports: frequency and sociodemographic characteristics associated with use. Acad Radiol 2016; 23: pp. 1162-1169.
10. Erdogan N., Imamoglu H., Gorkem S.B., et. al.: Preferences of referring physicians regarding the role of radiologists as direct communicators of test results. Diagn Interv Radiol 2017; 23: pp. 81-85.
11. Lee C.I., Langlotz C.P., Elmore J.G.: Implications of direct patient online access to radiology reports through patient web portals. J Am Coll Radiol 2016; 13: pp. 1608-1614.
12. Levitsky D.B., Frank M.S., Richardson M.L., et. al.: How should radiologists reply when patients ask about their diagnoses? A survey of radiologists’ and clinicians’ preferences. AJR Am J Roentgenol 1993; 161: pp. 433-436.
13. Cross N., Wildenberg J., Liao G., et. al.: The voice of the radiologist: direct patient access to radiologist. Paper presented at the American College of Radiology Annual Meeting, Washington, DC, May 21,2017.
14. Gefen R., Bruno M.A., Abujudeh H.H.: Online portals: gateway to patient-centered radiology. AJR Am J Roentgenol 2017; 209: pp. 987-991.