A couple recent articles caught my eye regarding radiologist-physician interaction and clinical decision support. They address the value of radiologist and physician interaction/communication.
The first article (http://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=114208) relates to a study done that suggests improved outcomes from radiologist-physician communication on the study ordered, versus total reliance on clinical decision support tools. The premise is that the interchange between the radiologist and physician can be valuable in deciding on the proper exam.
The second article, a blog (http://www.calgaryscientific.com/blog/face-to-face-communication-between-radiologists-and-referring-physicians-improves-patient-care) addresses the advantages of face-to-face contact between a radiologist and referring physician in terms of results review and the improvement of patient care.
While I subscribe to the message in both pieces, I am tempered by the realities of the day-to-day pressures on both radiologists and referring physicians in terms of their time utilization. As discussed in the first article from a presentation at the ACR 2016 (American College of Radiology annual meeting), the presenter discusses the value of proactive discussion between the radiologist and referring physician to assure the best study is ordered. They found that fourteen percent of proposed orders fell into a category of “alternative suggested,” and that ninety percent of the time the alternative order was accepted by the referring physician.
My issue in this case is not with the effectiveness of radiologist-physician communication, but with the communication capabilities between clinicians. If the only means for communication is via telephone, the likelihood is that it may be difficult and unproductive for the clinicians to actually speak!
In the second article, reference is made to a study involving the “results of rounds held between an acute care surgery team and abdominal radiologists. In 43 percent of these in-person meetings the acute care physicians changed their diagnosis, making significant changes in their surgical plans for the patients.” Again, the study relates to actual face time between clinicians. While I am not disputing the benefit of such face time, it as above places demands on the radiologist’s time.
In an environment where there is an overabundance of radiologists, such personal interactions would be a good thing. In an environment such as today where there are shortages and demands placed by managed care, clinician time is at a premium.
What to do? This is where emerging technology can be a boon to all. Collaboration tools utilizing clinical workstations, tablets, and smart phones can enable clinicians to meet without a physical presence, and over greater distances. My own healthcare provider utilizes a remote “doc in the box” approach to radiology in some of their facilities, meaning actual face time is even more difficult. By using collaborative tools, radiologists can address both study order and results discussions more productively.
Other technologies might also help. While not as good as face-to-face, tools such as instant messaging might be utilized as first steps that might lead to either face-to-face or collaborative interactions. It will be important to build these tools into PACS (Picture Archive and Communications) and EMR (Electronic Medical Record) systems to simplify and standardize their use. In the case of clinical decision support, perhaps a clinician using such a tool might get an alert that initiates either an instant message or a video chat for situations where the clinical decision support application suggests an alternative study. This will require a degree of standardization for such tools, which could easily be done by providing such applications in the Android or Apple Stores.
Again, not to pick on my healthcare provider, but they are already surveying patients regarding the use of electronic consultation tools to enable broader and more productive clinician coverage! They are exploring such concepts as interactive video chat with a physician for minor illnesses, as opposed to the patient visiting a clinic or wellness facility. And finally, they are considering enabling patients access to images, along with consultation with a clinician. Not only is this a convenience to the patient, but it may be a productivity improvement for the physician and support staff.
In summary, the first wave of technology for radiology made it easier for radiologist access to images (via digital images). The second wave of technology needs to address radiologist, clinician and patient interoperability via integrated collaboration tools for improved order selection and results communication.