Reports produce the tangible work product of diagnostic radiologists. Reports should reflect the expertise of the radiologist while clearly communicating complex information to prescribers.
Over time, many elements of the radiologist’s workflow have kept pace and adapted to technological advancements in the industry. But for a variety of reasons, radiologists continue to complete reports the same way they have for decades – in a standard plain text format.
An updated reporting method, known as interactive media reporting, allows the radiologist to insert enhanced content, such as images, tables, charts, and interactive hyperlinks to annotated results, directly into reports . These multimedia elements can then be viewed by downstream consumers, allowing the attending physician or patient a more interactive and comprehensive experience.
âIt’s really about updating the way we report to modern electronic communication methods to take advantage of those tools that are already widely used in other industries,â said Cree Gaskin, MD, vice president of clinical operations and informatics, division head of musculoskeletal imaging and intervention and deputy director of medical information at University of Virginia (UVA). UVA implemented early stage interactive multimedia reporting in its clinical environment in 2016 and continues to update technology for more advanced reporting.
In addition to providing a more robust report for the consumer, an interactive reporting system also enables efficient entry of information into the report. A radiologist can measure a result and then issue a voice command to connect that result to the report via a hyperlink. Information about the location of the lesion, such as image number, serial number and measurement, will automatically transfer from the viewer to the report application and then into the report. Likewise, details of previous studies viewed for comparison can also be automatically inserted.
âThe ability to automatically import information from the images into the report itself is a benefit because you don’t have to dictate all of that content,â Gaskin said. âIf you’re looking at the images and 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 dictation work and less likely to have a voice transcription error or speech recognition error.
Adding images, graphics, and hyperlinks to reports enriches the reporting experience and communicates results more effectively by providing easier and more direct access to imagery than plain text. Anecdotal evidence from vendors shows that embedded images and hyperlinks to annotated images make reporting clearer on the findings discussed.
When the originator clicks on a hyperlink in the report, it launches the viewer. The viewer displays the relevant annotated image of the study and the image stack can be scrolled to display adjacent images. The interactive report is also displayed, allowing access to other hyperlinked results. This helps the clinician navigate the report and images quickly and easily, increasing both confidence and efficiency when reviewing the report.
âI review a lot of reports myself. As I read current studies, I will review past studies and their reports for comparison. It’s faster for me to click on a link in the previous report and immediately see the main finding of the previous study, âsaid Gaskin. âEven though I’m able to find it, it might take me about eight seconds, or I can click on a link and see it instantly. So it’s pretty obvious that it’s a time saver, for anyone consuming the report. “
Interactive reporting in COVID-19
When the COVID-19 pandemic began and faculty radiologists began to have less in-person interactions with referring providers and trainees, UVA was able to prepare the same interactive reports remotely in their Philips Vue PACS System. The UVA team also relied on screen sharing to collaborate with colleagues, read a resident remotely or carry out consultations for ordering service providers.
âBefore COVID, I would sit next to the intern and go over the findings with him in person. Now that I am sometimes distant, we are not always side by side during the reading sessions. I can just read their reports while interpreting the pictures. If they’ve hyperlinked to a conclusion, I can see exactly what they’re talking about faster and more confidently, âGaskin said.
Create new workflow habits
From a radiologist’s workflow perspective, Gaskin estimates that the time required to prepare interactive reports is equal to a plain text report. Because the shift to interactive reports requires radiologists to learn a new workflow, components that are neutral or beneficial to the workflow are the most likely to be adopted. In Gaskin’s experience, interns who have less ingrained habits are more likely to adopt the new approach.
âIf you’ve been doing it a certain way for 15 years, you’ve got to think a little bit differently,â Gaskin said. “The more you use it, the more natural it becomes.”
In a 2018 to study1 published in the Journal of the American College of Radiology, the AVU researchers reviewed more than 559,000 diagnostic reports over a 20-month period for the presence of active hyperlinks in clinical imaging reports. The study found that more complex examples, like the PET CT, had almost half of the reports containing hyperlinks to key results.
âI think it’s pretty strong adoption to say that half of the reports used this new optional tool,â Gaskin said. âThis reflects that radiologists see the value of doing it and that it is not a significant burden. “
Economic and patient benefits
Interactive reports also have an economic benefit, for both radiologists and prescribing physicians. Interactive reports allow for expedited review of reports and images. Radiologists can report results faster, and providers are able to use them faster and with potentially better understanding. In a competitive market, this can provide a strategic advantage.
âIf you’re a clinical radiology group that publishes reports, there is a competitive advantage in having a superior product,â Gaskin said. âIf a radiology group in town provides interactive reports with keyframes, they look more sophisticated. “
Gaskin said the same is true for patients. UVA has integrated links to their images and interactive radiology reports in Epic MyChart, allowing patients to review and share their interactive multimedia reports and associated results tagged on live images through the hospital patient portal. Within five months of its launch, UVA saw a 7x increase2 in patients accessing their own X-ray images and interactive reports online.
âPatients can interact with the report and view the images, which helps them better understand what the radiologist is saying. Supporting patient engagement like this can improve satisfaction and delivery of care. Patients can choose where they go to receive ambulatory imaging, and they may prefer a site that offers easy access to online images and multiple interactive reports.
Obstacles to implementation
Interoperability is one of the biggest limitations to implementing interactive reports. It’s technically more difficult to integrate and share content seamlessly between separate viewing and reporting applications. A comprehensive application that combines both viewing and reporting functions into one, provides a much easier route for content sharing between user and reporting application.
Likewise, applications further downstream or outside of the radiologist’s workflow need an efficient method of translating multimedia material. Some Electronic Health Records (EHRs) may only be configured to receive plain text or require a separate viewer to display interactive multimedia reports issued in one system and consumed or viewed in another.
âI think it’s important to know that we’re on the verge of making this work in the EHR itself, and once that’s done there really aren’t any real hurdles,â Gaskin said. . âYou’re going to see vendors constantly seeing interactive multimedia reports in the EHR. Once this technical hurdle is overcome, we can pretty much expect our advanced reports to always reach our referring suppliers. “
Gaskin believes this will speed up the cultural adoption cycle for vendors, who will begin to expect more interactive reports.
âI am confident that as they see more reports with interactive content, they will recognize their time saving,â he said.
The results of the case studies are not predictive of the results in other cases. Results in other cases may vary.
For more information: www.philips.com/multimedia-reporting
- https://doi.org/10.1016/j.jacr.2018.10.009. Adoption of interactive multimedia reporting technology by radiologist. Journal of the American College of Radiology 2018
- https://doi.org/10.1016/j.jacr.200.12.028. Improve 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