Can enhancing radiology reports with web-based multimedia presentation prove to be clinically significant for radiologists? Researchers believe so. Indeed, a few researchers are beginning to look at the potential role that multimedia-enhanced radiology reporting, or MERR, might play in radiological studies that might enhance the clinical interactions between radiologists and referring physicians, and even better help patients to understand the results of their diagnostic imaging procedures.
Last year (2014), a group of researchers came together under the aegis of the Harvey Neiman Health Policy Institute, a research division created in late 2012 by the American College of Radiology (ACR), the governing specialty society for radiologists in the U.S., to study just that question.
Richard Duszak, Jr., M.D., the vice chair of Health Policy and Practice in the Department of Radiology at Emory University (Atlanta), and the chief medical officer at the Harvey Neiman Health Policy Institute, helped to lead and coordinate the study, which was presented as a poster session at the 2014 RSNA Conference, sponsored by the Radiological Society of North America and held Nov. 30-Dec. 4 at Chicago’s McCormick Place Convention Center.
Richard Duszak, Jr., M.D.
The title of the RSNA poster session was “Traditional Text vs. Image and Interactive Data Embedded Multimedia Enhanced Radiology Reporting: Referring Physicians Perceptions about Value,” and was produced by a team of researchers led by Gelareh Sadigh, M.D., and which included Dr. Duszak. As the authors noted in their presentation, “over a two-week period in 2014, medical oncologists, radiation oncologists, neurosurgeons and pulmonologists practicing in the United States were contacted via email and asked to complete a 22-quesiton online survey with embedded images describing and illustrating MERR. The survey included questions about physician satisfaction with current text-based radiology reporting, and their perceptions about the value of enhanced reporting.”
As the authors noted, “194 responding physicians met inclusion criteria… Although 78 percent were satisfied with the current format of received radiology reports, 79 percent believed MERR would represent an improvement. The most commonly reported advantages of MERR were ‘improved understanding of radiology findings by correlating images to text reports’ (68 percent) and ‘easier access to images while monitoring progression of a disease/condition’ (60 percent).” The authors ultimately concluded that “Most specialist referring physicians believe that MERR represents an improvement over current text-based radiology reporting. Most would preferentially refer patients and peers to facilities offering enhanced reporting.
The actual creation of MERR-based solutions is only beginning to emerge. One vendor, the Rochester, N.Y.-based Carestream Health, announced in November a new “Clinical Collaboration Platform” that, according to a Nov. 12 company press release, “can facilitate teleconsultancy with remote specialists who can access multimedia reports containing embedded hyperlinks to key findings within the image data on their mobile devices using a zero-footprint viewer.” Industry observers expect other vendor companies to pursue this type of a solution soon as well.
Dr. Duszak, who makes it clear that he has no financial relationship with Carestream, hopes that multiple vendors will emerge that will provide some type of MERR-based solution to enhance radiology reporting and information-sharing among physicians. He spoke in November with HCI Editor-in-Chief Mark Hagland regarding the topic of MERR-based radiology reporting. Below are excerpts from that interview.
Could you explain a bit more about the concept of multimedia-enhanced radiology reporting?
What it contrasts to is traditional, text-only reporting. That’s the standard of care for how reports go out there. Before EMRs really took off, radiologists’ job was to put toner on white paper, I would joke! It was text on white paper, and not interactive. That has now evolved from paper-based, which got faxed or mailed, to electronic sharing. Both referring physicians and patients are still receiving basically text-only reports, but now in electronic form. We asked folks about a new world: if this were commercially available, what would you do? Now we’re at the point where the technology is available. So how MERR would be consumed, based on how we’d survey people is, rather than a blank text coming up on your screen, where you’re reading a Word document, the platform would be a web-page presentation. And it would be more interactive. We showed people a couple of specific pieces, such as, if you see the language “3-centimeter liver lesion,” you would get a hyperlink that would take you to a web page showing that image. So my report is supplemented by real-time information that’s web-based.
Second, we looked at referring physicians ordering follow-up imaging, particularly for cancer. So the lesion has decreased from 3 centimeters to 2 centimeters to 1, for example. So when there’s a comment on size, you could click those measurements, and it would graph it out. Kind of like what Fitbit does. So that graphic visualization helps people consume information better. So those were the two graphic enhancements we thought of.
You yourself are a radiologist, correct?
By fellowship training, I’m an interventional radiologist, but practice mostly general radiology. I finished my training in 1995; currently, my work is only 20-percent clinical—one day a week in clinical practice, plus nights and weekends. Thirty percent of my time is administrative/faculty. And half of my time is spent as chief medical officer of the Harvey Neiman Health Policy Institute at the ACR, where we just celebrated our second anniversary.
What are the main areas of focus at the Institute?
Our mission statement is that we were founded to study the role and value of radiology and radiologists in evolving healthcare delivery and payment systems. The bulk of our work has actually been in imaging utilization and imaging economics. And part of that is by the design of our team. I’m half of an FTE and we have 4.5 FTEs. Our director of research is a PhD economist. So a lot of our work has been looking at the economics of medical imaging. We’ve been spending a lot of our time and interest on the dollar side, the utilization side.
What was your conclusion about MERR?
The RSNA poster session was intended as a kind of “teaser.” The gold standard is the peer-reviewed article. That article has been submitted and accepted by the Journal of the American College of Radiology for publication sometime in 2015.
Per the overall conclusions, can you give me your interpretation of them?
Yes, we explicitly went to 50 specialists in four different specialties—pulmonary medicine, radiation oncology, medical oncology, and neurosurgery—specialists who might make use of this. We asked
We asked them a variety of questions pertaining to their satisfaction with text-only reporting, paper or electronic. And by and large about 80 percent of them were satisfied with the current methods of reporting. After they answered those questions, we showed them some examples of what MERR could do. And it’s kind of like what happened with the iPhone—people had been satisfied with flip phones before that. And we showed them what MERR could do, and overall, physicians said they would be happier with the content; and more importantly, they said they would more likely share that information with their patients. They might show the patient their liver lesion while they were together.
And we sort of knew that would be the expectation there. But we asked referring physicians, if this technology were implemented at another institution or practice in their community, what would be the likelihood that you would preferentially refer your patients to places that had this technology? And it was about 80 percent. I was shocked that they were so wowed by that. In other words, they said they would effectively fire their existing radiology group to get this. So when you look at the value proposition of imaging, what’s important is not so much whether we ourselves think we’re doing a good job, but what our customers think. And it brings up a quote that had been attributed to Henry Ford, where he said, if I had asked people what they wanted when I started up, they would have said, faster horses. So we want to anticipate the needs of our customers, and we as radiologists need to anticipate those needs rather than waiting for the market to tell us what they want and to have to catch up.
Now that a few vendors are offering this, what will the trajectory of adoption be like?
Some of this gets back to how expensive, complicated technology is being adopted. The iPhone 6 is out now. And my contract with Verizon was up this summer. I waited a bit and became an early adopter of the iPhone 6. While those things are not cheap, they’re relatively low-ticket items. When you get into hospital-based integrated technology, it’s much more complicated. So the window from initial commercial offering is very long. A zillion stakeholders have to approve an addition, and you have to order and implement the technology. Because of the technological platforms that have to be implemented to enable this, I think we’re talking a couple of years for early adopters and several years for lagging adopters. This is really good stuff; we need more vendors to offer this.
What should our audience be thinking about with regard to this?
I interact with informaticists quite a bit. I tend to look at sort of two groups of people in the informatics space—the IT-oriented folks, and then the people focused on the processes. And those peope focusing on the processes and the end-deliverables, those folks will “get it” much more quickly. The former group may question this at first. My message to those folks would be, get your fingers off your keyboards and eyes off your monitors, and look at what the physicians and patients need.
So you believe this will improve patient care?
Yes, I do. Now, quantifying that is going to be difficult. How does one measure better understanding on the part of the patient? Or the value of the oncologist prescribing a course of chemotherapy, that this is the right therapy, as opposed to just a good one? Measuring and quantifying it will be challenging as a health services researcher, but yes, I do believe it will improve care.