Unquestionably, a movement to make radiology reports more accessible to patients and their physicians appears to be underway. We reported recently on a study of the feasibility of video radiology reports, and the use of interactive multimedia reporting of radiologists' finding using interactive web page-style formats with diagrams and embedded plain language explanations of medical terms.
The Journal of Digital Imaging has just published a commentary on this movement by Dr. Dieter Enzmann, the well-known Chair of the Department of Radiology at the University of California Los Angeles. Dr. Enzmann refers to this movement as the “Smart New Deal." He proposes that radiologists revamp the efficiency and effectiveness of their main work product—the radiology report. The commentary sees a need to broaden the report's distribution to include patients. And, he says, it is necessary to more intelligently organize radiology reports and "minimize the cognitive distance between understanding its information and making decisions or taking actions." At the core of this disruption is the use of making reports available through smartphones with improved patient satisfaction and an elevation of the perceived value of the work of radiologists.
We have previously cited the information blocking provisions of the 21st Century Cures Act which has led a growing number of imaging centers and radiology departments to terminate report embargoes and to provide patients immediate access to their written radiology reports. This is a trigger to this discussion of how best to communicate directly with patients.
The smart new deal, according to Dr. Enzmann, envisions reports with interfaces that incorporate explanations of quantitation and annotation of key images, multimedia image presentations, and hyperlinks to other relevant information (clinical, genetic, etc.) or links to pertinent, up-to-date, scientific references. Dr. Enzmann foresees an end to the 8.5″ × 11″ paper radiology report format. Smartphone reporting, he writes, will accelerate redesign and stimulate reassessment of diagnostic radiologists reporting philosophy.
For now, I believe this movement will be additive and not a replacement for the traditional radiology report. Significant and important information is conveyed via the radiology report not only to physicians (and increasingly their patients) but also, and importantly, to radiology coders and to payors. Much detail needs to be incorporated into the report to assure that there is room to document all the work of radiologists so that reimbursement is accurate and appropriate. Additionally, it will be essential - should the traditional report be replaced - that a new generation of reporting provide a complete description of the radiologists' interpretive results—meeting the standard of care necessary to rebut allegations of negligence by plaintiffs' attorneys—including the reporting of incidental findings that are not currently incorporated into the new generation of patient-centered radiology reports.
Dr. Enzmann cites management philosopher Charles Handy's statement that “[t]he world keeps changing. It is one of the paradoxes of success that what got you where you are, won’t keep you where you are." He notes that the specialty of radiology has been successful in its high-volume, transactional report business, even without in-depth knowledge of its customer’s use of its report. But that model cannot be relied upon as a formula for success indefinitely.
By understanding that success is never final, Dr. Enzmann is describing a path to a new frontier of success for diagnostic radiologists, grounded in an era of increased patient engagement.