Among healthcare reforms currently underway, there is one that most radiologists need to deal with immediately: Patients are increasingly likely to be reading the reports that were formerly written exclusively for referring physicians.
“It used to be that medicine was one-directional,” said Elliot Fishman, M.D., professor of radiology, surgery and oncology at Johns Hopkins Hospital, Baltimore, and co-chair of the RSNA-American College of Radiology (ACR) Public Information Website Committee. “Everything was like Marcus Welby where your doctor told you what to do. Now you go to the doctor, you look online and you ask your 10,000 closest friends if you’re doing the right thing.”
That online component often includes access to the patient’s own health records. One survey of 104 healthcare IT executives indicated that at least half of hospitals and clinics provide some kind of online portal where patients can e-mail their physicians, make appointments, view lab results and otherwise take charge of their own care. The 2012 poll was conducted by KLAS Research of Orem, Utah, which tracks the healthcare software market.
The number of online portals is set to rise dramatically as the federal Meaningful Use standards for promoting the use of electronic health records increasingly incorporate patient involvement as a requirement. Under the law, physicians and hospitals must not only provide patients electronic access to their health information, but also must demonstrate at least 5 percent of their patients are actually using that access.
Although offering radiology reports is the next logical step for patient portals that already include lab data, that step has some potentially treacherous implications, experts say. Unlike lab data, which can be contextualized by including the normal limits with the results, imaging studies often don’t have such tidy norms. Moreover, radiologists are used to addressing the reports to referring physicians, who are experts in interpreting phraseology that may be confusing to the patient. Dr. Fishman said radiologists may have to modify their style to suit to their new lay readership and also pay closer attention to the precision of their wording.
“Patients read the reports with a fine tooth comb,” Dr. Fishman said. “Simple typos that don’t matter in the big picture do matter to the patient. If it looks sloppy or doesn’t make sense, patients tend to lose confidence in the report.”
At the Hospital of the University of Pennsylvania (HUP), Philadelphia, giving patients online access to their radiology reports has proven to be popular, according to Seetharam Chadalavada, M.D., a fourth-year radiology resident who presented results of the portal’s effectiveness at RSNA 2013.
Since the portal’s inception in May 2012, more than 150,000 patients have activated portal accounts. Results show that patients read about half of available reports, a rate comparable to review of lab results, Dr. Chadalavada said. Researchers found no change in the number of patient calls to clinics and radiologists during the study period, from May 2012 to March 2013, compared with call rates in the period before radiology reports were available online.
Dr. Chadalavada says referring physicians are often uncomfortable with the idea that a patient can access his or her radiology report before they have had a chance to review it. For that reason, release of the information is delayed for three days to give the referring physician a chance to review the report and call the patient if indicated.
The only exception is mammogram results, which are available as soon as the radiologist finalizes the report, allowing the patient to arrange for follow-up as soon as possible. “Patients getting mammograms are more likely to have an ongoing relationship with the referring physician,” Dr. Chadalavada said.
Putting imaging reports in context will be increasingly important, Dr. Fishman said. “People may read these reports and not understand what the radiologist is saying.” He cites one report where a radiologist noted the presence of a Bosniak Category 1 cyst in a kidney—a term that upset the patient when a notation of a “simple cyst” would have been adequate and less confusing. Dr. Fishman expects that routine patient access to reports will eventually lead to less medical jargon and a more standardized vocabulary.
Researchers at the University of California, Los Angeles (UCLA), addressed the context issue by designing an interface that provides patients educational material as part of their online medical report. In research presented at RSNA 2013, Mary McNamara, M.L.I.S., and colleagues presented results of a survey on patient portal preferences at UCLA.
After surveying 50 patients with non-small cell lung cancer about their patient portal preferences, researchers used their responses to develop a framework linking the patient’s health issues, radiology reports and images to medical guideline content provided by the National Institutes of Health (NIH) MedlinePlus website for patients.
A natural language processing module identified concepts in pathology, oncology, radiology and laboratory documents and determined which MedlinePlus content would be most relevant to the patient. The portal automatically inserted links to the explanatory material. Concepts in the health issue list can also be linked to key slice radiological images featuring the ROI.
“This eliminates the need for patients to search consumer health websites to determine what content is applicable to their personal health situation,” according to the researchers.
“Patients in our survey responded positively to the idea of accessing radiology content; and rated diagnosis problem lists, radiology report content and imaging as important in helping them to understand their medical record,” according to researchers.
For more than five years, RSNA has been part of the growing movement to give patients a more active role in their own healthcare.
Funded by the National Institute for Biomedical Imaging and Bioengineering (NIBIB) and administered by RSNA, RSNA Image Share Network enables radiologists to share medical images with patients using personal health record (PHR) accounts.
With RSNA Image Share, patients can access copies of their medical images—X-Rays, CTs, MR imaging scans and ultrasounds—and keep them in online Personal Health Record (PHR) accounts. The network allows patients to build a secure online personal medical history and securely share information with healthcare providers.
For providers, the network eliminates the need to give patients CD copies of medical images and reports, which can be cumbersome and frustrating.
Sites interested in joining RSNA Image Share can contact email@example.com. For more information about RSNA Image Share and to view an online demo, go to RSNA.org/Image_Share.aspx.
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