The radiology report is the principle work product of the radiologist. Until recently, reports describing findings in imaging studies have been plain, text-only documents. Such reports are increasingly inadequate.
The problem
“Traditional radiology reports are limited to plain-text in order to simplify the transport of results across information systems,” said Dr. Cree Gaskin, associate chief medical information officer and vice-chair of informatics and operations, division director of musculoskeletal imaging, at the University of Virginia Health System in Keswick, Virginia. “One cost is that report consumers are often stuck reviewing blocks of bland text in one system, and comparing to the images themselves in another system.”
Because radiology reporting applications typically are separate from the applications used to view images, radiologists are hindered in their ability to create interactive reports that connect directly to imaging findings, he added. The University of Virginia Health System wanted to create AI-powered, interactive multimedia reports, believing that radiologists could communicate better through the use of enriched and interactive content.
Proposal
The University of Virginia Health System implemented interactive multimedia reporting via a hybridized viewing-reporting application. More specifically, it used AI-driven Vue Reporting embedded in Vue PACS by vendor Carestream Health.
“This hybridized viewing-reporting application supports the radiologist in transporting image-related information into the report, and in turn, for the report consumer, the report becomes interactive and connected back to the images,” Dr. Gaskin said. “Advanced reports support the use of rich content, like styled text, images, tables, graphs and hyperlinks, to improve communication around medical imaging findings. These enhancements can add speed and clarity to report and image review.”
Marketplace
There are many imaging and PACS technology vendors serving the healthcare marketplace. These vendors include AGFA Healthcare, Apollo Enterprise Imaging, GE Healthcare, Canon USA, Dicom Systems, FUJIFILM Medical Systems USA, Hyland Healthcare, Konica Minolta, Lumedx, Philips, Sectra, Siemens Healthineers and Singular Medical Technologies.
Meeting the challenge
Radiologists now view and report images from the same application, so it’s easier to create interactive multimedia reports. The technology is used by radiologists – residents, fellows and faculty. They all needed to learn to report from a new application and adopt new multimedia reporting habits. One reports a little differently when adding rich content rather than just plain-text.
“We can measure findings on the images, and have these measurements and image locations import automatically into the report without dictating them,” Dr. Gaskin explained. “We can mark key findings with arrows and add connectors into the report. Report consumers can click on hyperlinks within the report to launch the relevant annotated images.”
This saves them time in results review and improves the clarity of reports, he added.
“I’ve had referring doctors comment that they thought we were talking about one thing in our report, only to click a link and see that we were talking about a different finding on the images,” he said. “We can also place key images directly into the report. You know the old adage – a picture tells a thousand words. A radiologist could create a 3-D cinematic rendering of a CT scan showing fractures and add that special image directly into the report to visually sum the findings.”
It can be easier to digest AI-refined complex information visually than to read lengthy descriptions, he said. And patients will be more engaged by seeing images in their reports, he added.
"The use of formatted text allows us to make statements stand out in bold, underline or color for emphasis. It’s only natural for your eyes to be drawn to styled text against a background of plain black text."
Dr. Cree Gaskin, University of Virginia Health System
“They may not need to review the entire study – just a key image or two to better understand what’s going on,” he explained. “Also, the use of formatted text allows us to make statements stand out in bold, underline or color for emphasis. It’s only natural for your eyes to be drawn to styled text against a background of plain black text.”
The University of Virginia Health System uses the Epic electronic health record. To date, staff has been able to place interactive multimedia reports in the EHR in the form of PDFs. They also have links in the EHR that launch an image and multimedia report viewer – Vue Motion from Carestream Health.
“Thus, our clinicians are able to access a full imaging study and the interactive multimedia report when starting from the EHR,” Dr. Gaskin said. “We currently are working with Epic and Carestream to get the enriched content available in-line or more directly within the EHR itself. We are excited about this opportunity to further improve clinician access to our interactive multimedia reports. We currently are in a testing phase.”
Results
The University of Virginia Health System has had technical success in creating AI-powered, interactive multimedia reports and making them visible to referring providers and patients. It has examined the frequency that reports contain hyperlinks to imaging findings in the PACS.
“For our more complex reports like PET-CT, CT and MRI, we know that our radiologists very commonly are doing this,” Dr. Gaskin said. “This data has been accepted for publication in the Journal of the American College of Radiology. We believe that our adoption rates indicate that our radiologists find value in the technique, or they would not have bothered to make an elective change in their reporting habits.”
The University of Virginia Health System is interested in tracking how often patients and referring providers click on the interactive content within reports, but staff is just beginning to look at this.
“We know anecdotally that our radiologists commonly find convenience in clicking the links in previous reports when comparing to previous studies, but we have not yet quantified this impact,” he said.
Advice for others
“I support the transition into interactive multimedia reporting because I believe it improves the communication around imaging findings,” Dr. Gaskin said. “Very little media uses plain-text only to communicate complex information these days. It only makes sense for radiology reporting to evolve so that rich content is routine.”
It is a departure from conventional reporting practice, so it helps to have radiologists onboard with the decision to implement such technology on the front end, he added. However, if radiologists are not onboard, one can implement the technology and they may come to use it over time.
“Our application absolutely supports the old way of plain-text only reporting, so reluctant users can continue their old habits while others adopt the newer technique,” he explained. “It took a little training and months of availability for our radiologists to pick up the interactive multimedia reporting techniques. And some still don’t do it. It takes time to learn new habits.”
Creating interactive multimedia reports is not the same as disseminating them, he added. Organizations will need to consider integration of advanced reports into their existing or future information systems, he advised. One needs a mechanism to share the interactive multimedia content, he said. The University of Virginia Health System technology worked for them, he said, but the technology is continuing to improve.
Dr. Gaskin will be speaking on the subject of AI at HIMSS19 in a session titled “Enhancing Care with AI-Driven Interactive Multimedia Reports.” It’s scheduled for February 12 from 10:30 a.m. to 11:30 a.m. in room W311E.
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