Imaging Informatics Improve Patient Care in Radiology
Reading Time: 5 minutes read
An imaging informatics fellowship director and fellow share their insights.
By Dr. Teresa Martin-Carreras and Dr. Tessa S. Cook, Hospital of the University of Pennsylvania.
At first glance, the principles of patient care in radiology and imaging informatics might seem at odds. Patient care being very personal, whereas imaging informatics is a very data-oriented, machine-driven and evidence-based field. However, there is a great deal of synergy between these two areas and, as we will discuss in this article, imaging informatics can facilitate better delivery of patient care in radiology.
A comprehensive discussion on patient-centered imaging informatics innovation should begin by reviewing the core principles of patient and family-centered care:
- Respect and dignity
- Information sharing
Despite the many advances in radiology since the discovery of the X-ray in 1895, our patients still face many challenges as they try to navigate care within our specialty. These challenges are often amplified when they interconnect with fields like IT and imaging informatics. Some of the current challenges include:
- Accessing radiology reports and images
- Transferring images between care facilities and physicians
- Accessing and understanding radiology reports and impact on care
- Understanding the rationale for imaging
- Inability to communicate directly with radiologists
At our institution, in an effort to address these challenges, we have trialed several informatics innovations with the central goal of improving the delivery of patient and family-centered care in radiology. Abbreviated descriptions of these innovations are provided below:
Patient-Oriented Radiology Reporter (PORTER)
Developed in our department by Drs. Charles E. Kahn Jr., Dr. Seong Oh and Dr. Tessa S. Cook, PORTER was created in an effort to enhance patient empowerment to participate in their medical care and decision-making. The team analyzed 100 knee MRI reports to identify the most commonly utilized terms. Within the PORTER platform, a glossary of 313 terms was then constructed along with their lay-language definitions. When available, links to reference resources (i.e.Wikipedia) and public domain illustrations also were included. The photograph and name of the interpreting radiologist was also displayed within the platform to convey to our patients that there was a specialist physician interpreting their imaging examination.
After several years of collaboration and development of the PORTER glossary, it now has over 14,000 terms. Also, additional pilots have been carried out within the realm of mammography and CT-guided biopsies. As of February 2020, PORTER is now fully integrated into the Penn Medicine patient portal for patient use.
Connecting patients with radiologists
Dr. Nathan Cross, Dr. Tessa Cook and colleagues established a system to connect patients with radiologists by telephone. The group created an alias phone number that forwarded calls to the mobile devices of participating radiologists during allowed scheduled consultation hours. An invitation was included within the radiology reports to call with questions about the exam. This message was included in nearly 4,000 radiology reports.
IT solutions can facilitate patient-facing activities within radiology.
Participants received calls for less than 1% of the total reports with an average call length of approximately 8 minutes. Patients had a range of questions including those about report meaning, medical terminology, impact on management, findings not mentioned, and errors in the reports. The average total time requirement for the responding radiologist was approximately 12 minutes, with the extra 4 minutes used to review the report/images, patient chart, look up references or consult a colleague. Encouraged by the success of this initial pilot, the team is now working on expanding these efforts to include in-person and video consultations with patients to review their imaging.
Increasing imaging screening for at-risk patients
With the support of an Innovation Accelerator Award from the Center for Health Care, Dr. Tessa S. Cook and her team set out to improve screening rates for patients at risk for Hepatocellular Carcinoma (HCC). The researchers noted that of the patients eligible for screening in this population, only about 60% of them were found to have screening exams ordered. As a result, their intervention focused on identifying patients at risk for HCC and creating a pended screening ultrasound imaging order. The order included instructions for the patient’s provider to approve the order if they agreed with the imaging recommendation. For patients, reminders were sent via the patient portal, and a same day “pop-up” clinic was also established to allow patients to have their screening exam performed on the same day as their other medical appointments.
Improving radiology report readability
Radiology reports often contain complex concepts and terminology unfamiliar to patients and their caregivers. With funding support from the Beryl Institute, Dr. Joshua Cho, Dr. Tessa Cook and colleagues utilized the Amazon Mechanical Turk crowdsourcing platform to recruit individuals for completion of small tasks as surrogates for patients. Participants were shown a variety of styles of radiology reports for oncologic imaging (i.e. unstructured, structured, patient summary etc.). Perhaps not surprisingly, the group found that when patient summaries were displayed, the number of incorrectly interpreted reports decreased, and the number of reports interpreted correctly increased.
In summary, patients want better access to radiology images, reports, and to their radiologists. Informatics and IT solutions can facilitate patient-facing activities within radiology, and they can ultimately serve to narrow the gap between patients and their radiologists.
About the authors:
Teresa Martin-Carreras MD is a senior diagnostic radiology resident (PGY-5) and imaging informatics fellow at the Hospital of the University of Pennsylvania.
Tessa S. Cook, MD, PhD, CIIP, is Chief, 3D and Advanced Imaging; and an Assistant Professor of Radiology at the Hospital of the University of Pennsylvania.