Dhruv Chopra, MBA, Collaborative Imaging Chief Executive Officer

From the detection of a bulging blood vessel to a blocked artery to a suspicious mass, the advancements in modern medical imaging save lives. However, there are many times when medical imaging tests are being performed for one reason, and the radiologist detects an unexpected anomaly that is completely unrelated. In those cases, the radiologist usually recommends additional imaging.

Unfortunately, the number of the recommendations that actually translate into additional imaging (RAIs) tests being performed is low. This non-compliance can cause poor outcomes for patients, and it could have negative downstream effects for a practice, as well. In some cases, a patient could file a malpractice lawsuit, resulting in the radiology practice or department being found legally liable for some of a patient's damages.

New Research Indicates Adherence to Recommendations for Additional Imaging is Low

New research gathered during a six-month study shows that whether the follow-up exams a radiologist recommends are performed depends greatly on the type of provider who receives the recommendation and the care setting in which that provider treats the patient.

The Goal of This Study: Determining Why RAI Adherence is Low

The only way to increase the number of providers adhering to the recommendations for additional imaging is to discover the factors affecting adherence rates.

Factors Affecting Adherence to Recommendations for Additional Imaging of Incidental Findings in Radiology Reports

. Conducted by doctors at the University of California’s Davis Medical Center, this study focused on the reasons why providers disregard RAIs. To answer this question, researchers reviewed 539 reports of computed axial tomography scans that, due to incidental findings, had recommendations for additional imaging. Since these reports were studied retrospectively, the researchers used the patients’ medical charts to determine if providers adhered to the RAIs.

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Study results indicate that outpatient sites and primary care providers (PCP) were most likely to follow additional imaging recommendations. However, according to study researcher Shan S. Hansra, M.D., from the Sacramento, California, institution, it is the referring physician who is usually responsible for managing radiology report recommendations.

Nevertheless, if the referring physician neglects to follow-up on the incidental findings, the consequences are likely to trickle down, detrimentally affecting the radiology practice or department.

Factors Affecting Recommendations for Additional Imaging Adherence Rates

Ascertaining adherence rates and, then, recognizing the factors that affect these rates can help determine the reasons that RAIs are not being addressed.

Overall, the recommendations for additional imaging were performed in 39.1 percent of the 539 cases. However, when the patient’s primary care provider was at the institution where the CT scan was performed, the compliance rate increased substantially to 56.8 percent.

Adherence Rates Based on the Type of Patient Being Treated When the PCP is at the Same Location

The adherence rate when the patient is seen as:

A patient in the emergency department, 46 percent.

Adherence rates based on the part of the body that requires additional imaging tests:

At 3.5 percent, chest imaging had the highest rate of adherence. After chest imaging, providers adhered to 3.1 percent of the RAIs for the neck, abdomen and pelvis.

The lowest adherence rates involved an extremity (0.3 percent), the spine (0.8 percent), the head (0.1 percent) and the face (0.1 percent).

For outpatients, the specialty of the provider ordering the CT scan made a difference in the percentage of providers following up, as well:

PCPs adhered to the recommendations 67 percent of the time.

Surgeons followed up 37.7 percent of the time.

Internal medicine subspecialists adhered to the RAIs 50 percent of the time.

Noncompliance to RAIs is Mainly Due to a Lapse in Communication

According to the authors of this study, lapses in communication serve as the main reason for the failure to follow-up on RAIs. While documenting the need for follow-up imaging in the discharge summary does boost adherence rates, these details are often absent from the patient's discharge summary. In addition, many times, the patient only receives the test results once they are released.

There are numerous gaps that must be addressed to make sure that there is a good line of communication between the radiologist, the ordering physician, the PCP, and the patient.

Neglecting to follow-up on a recommendation for additional imaging can result in diagnosis and treatment delays, which may lead to poor patient outcomes. Poor patient outcomes due to this negligence can lead to a malpractice lawsuit, resulting in the practice’s or department’s legal liability. 

Numerous examples demonstrate where incidental findings go unnoticed due to a gap in communication and lack of patient tracking – these mishaps can lead to patient fatalities and lawsuits. A recent settlement in Illinois makes it clear how important good communication is.

In November 2017, Mark James had a CT scan for potential venous stenosis in one of his kidneys. This scan was performed on James' pelvis and abdomen. While the radiologist was reading the scan, he found a mass on James’ lung. The radiologist gave a recommendation for additional imaging; however, this information was not shared with James.

In May 2019, James began experiencing inflammation and pain in his chest and shoulder. He had another CT scan – it revealed that the mass found in 2017, which he was never informed about, had metastasized. James passed away in July of 2019.

Due to the delayed cancer diagnosis, James’ family received a $7.5 million settlement from the University of Illinois Hospital.

Patients who miss their follow-up appointments or choose another provider for their care are vulnerable. Often, incidental findings and recommendations are altogether missed by the referring provider. It is essential that patient contact information and preferences on how to be contacted are captured accurately to ensure the continuity of care. Otherwise, the patient may never know there is a recommendation for additional imaging. Consider implementing the practice of informing the patient how important his or her follow-up visit is. Doing so may increase the likelihood that the patient keeps this appointment.

Texas Radiology Associates, a group of 150 radiologists based in Plano, Texas, also has a unique solution to combat the lack of follow-ups through technological advancements.

John Kim, M.D., managing partner of Texas Radiology Associates explains how technology has helped them better communicate.

“We have deployed technology that identifies studies that require follow-ups based on the patient’s case. This technology can also ensure the same information has been relayed and received by the referring physician, and creates an alerting mechanism to take action should the particular patient not have the recommended study, such as following up with the patient, or the referring physician to inform them of a recommendation not being adhered to,” he said. “This has resulted into a significant decrease in missed recommendations.” 

Texas Radiology Associates also allows patients to have access to their radiology reports, thereby allowing them to play a critical role in their continuity of care. In the healthcare space, innovative technology can address several gaps and is ever-growing and evolving.

The American College of Radiology is Addressing Gaps in Care

Currently, a consensus for guiding classification of the incidental findings discovered on imaging tests is nonexistent. However, the American College of Radiology (ACR) is in the process of creating a quality measure for addressing these potentially dangerous gaps in care.

Recently, the ACR received a grant in the amount of $341,000 for work that was previously done with a large group of radiologists. Now, the researchers are requesting that physicians give questionnaires to patients and their families with the goal of attaining additional information related to incidental findings. Furthermore, the American College of Emergency Physicians is working in conjunction with the ACR to create guidance related to following up on anomalies found during emergency situations.

Once a coordinated process is implemented to prevent gaps in care, patient morbidity and mortality rates should drop. Consequently, the likelihood of litigation due to poor communication related to CT scans and other imaging test results will drop.

Articles

Collaborative Imaging’s Dhruv Chopra, MBA, takes a deeper look into how many follow-up recommendations are ignored and what can be done to reverse the trend, leading to better patient care.

Communication Critical to Providers Adhering to Follow-Up Recommendations

Continued digitization has brought tremendous benefits to healthcare, making the industry more connected and efficient than ever. However, with an overwhelming number of data and patient records located on interconnected networks, the importance of actively protecting it all cannot be overstated. Hackers have continually evolved and adapted with technology. They are always seeking new sectors to attack, including in the healthcare space.

For radiology departments, the risks of experiencing cyber-attacks has increased over the past several years with widespread industry consolidation and the profession becoming a mainly digital practice. With many radiologists now working remotely due to COVID-19, hackers are more likely than ever to jump at the opportunity to breach private data with employees working on less secure mobile devices and wireless networks.

Practices must begin to invest in and strengthen their cybersecurity immediately to prevent the possibility of an attack. As our industry transitions to a more virtual environment, taking immediate action may save the future of your practice and, more importantly, the future of your patients’ health information.

Understanding Cyber-Attacks on Healthcare Practices

The incredible growth of industry technology has enhanced the medical profession, making data and information instantaneously accessible. However, this immediate access to private data also creates opportunities for hackers to invade organizations’ systems, majorly affecting the entire industry.

Cyber-crimes cost the healthcare industry around 

, with organizations individually losing an average of $3.7 million. There are also many other costs organizations could face with cyber-crimes, including post-breach costs, potential fines from HIPAA and even lawsuits. What’s more, employees can be major contributors to potential network breaches, as well. According to a 2016 report from BakerHostetler, 24 percent of healthcare data breaches were the fault of employee errors.

 Avoiding Hacked DICOM Images – What Can You Do?

Organizations are not the only ones affected by cyber-attacks, however. Their patients suffer just as much, and in some cases, even more so. In 2019 alone, 

 were affected by healthcare data breaches, doubling the amount recorded in 2018. This trend is expected to increase as more data and protected healthcare information (PHI) becomes digitized on network servers across the industry.

It’s hard to predict where hackers will attack next and how they will do so. Cyber-crimes can stretch from breaching systems for patients’ PHI, infecting networks in malware attacks, or deliberately tampering with images and scans in ransomware attacks. This uncertainty can make securing data and preparing systems for attacks a challenging process.

While there is uncertainty in exactly how hackers will attack, they have been pretty consistent in targeting small- and medium-sized medical practices. This is because many of these specific practices do not have the manpower nor financial resources to field a full cybersecurity team, making their data less secure and easier to breach.

Hackers have also become interested in targeting healthcare networks consisting of consolidated practices. With imaging, patient information and other data streamlined across multiple networks and facilities, there are more opportunities for hackers to breach, steal, and manipulate private data.

Figuring Out How Practices Can Prevent Cyber-Attacks

Practices can take many different avenues to bolster their cybersecurity efforts. One of the most important steps is implementing proper security systems, such as artificial intelligence (AI) solutions. These systems are designed to constantly understand patterns and protect data automatically while anticipating and identifying any nefarious activity. In a time where hackers can attack systems in various forms at various times, AI solutions will intuitively protect your network and patient data.

Another step, especially in this remote era of healthcare, is to have added protection for any mobile devices used by employees. While the amount of mobile devices at our disposal is helpful to radiologists and their practices, they also pose a great threat to network privacy and security. With the pandemic forcing many radiologists and physicians to work remotely, they have relied on their mobile devices and wireless networks at home to accomplish their work. These devices and networks are much less secure than those at their practices or hospitals, increasing the vulnerability for hacking. 

To decrease the possibility of hackings or any unauthorized access, all used mobile devices must be equipped with stronger authentication and access control settings. Regularly changed passwords, further authentication steps and even limiting the amount of mobile devices used are a few ways to increase protection when utilizing mobile devices. Implementing these settings can be a major step in keeping all data and private information secure as remote work could be the future of the industry, at least for the rest of this pandemic, and maybe even beyond.

Network breaches can be detrimental to practices and their patients in numerous ways. It is important that practices improve, and maybe even overhaul, their cybersecurity efforts. The expansion and evolution of industry technology only increases the chances of network hackings and practices losing invaluable data and information. As many practices struggle to survive during these turbulent times, one network hacking could be the ultimate kiss of death for an organization and affected patients.

Anticipating where hackers might strike and determining how to prevent attacks can be critical.

The Importance of Cybersecurity in This Era of Radiology

The business of radiology continues to evolve, including the interactions between practices and their patients. Patients are now seeking tighter control of their own healthcare and are becoming more educated with the pervasiveness of technology and information they get at their fingertips.

As patients continue to evolve, radiology practices have had to adjust their patient interaction methods to become more sensitive and empathetic to their individual situations – something patients yearn for in their physicians and radiologists. According to a 2016 study done by the Massachusetts General Hospital department of orthopedic surgery, 65 percent of patient satisfaction was directly correlated with physician empathy, highlighting the importance of professionals’ behaviors when interacting with their patients.

While many practices have created suitable programs to be understanding of and responsive to their patients’ wishes, there’s still more to be done to be on par with the patient-centric trend we’re seeing throughout health care. With that, here are three ways radiology practices can become more patient-friendly.

Much of the relationship between a radiologist or referring physician and their patient consists of the radiologist giving consultation to the patient on the best possible treatment options. While this part of the process will not and should not change, we often forget about where the patient’s perspective lies in this.

It’s a best practice to empower patients by letting them share input and what they feel is right for them, along with guidance from their radiologist or physician. After all, it is the patient’s right to make his or her own decisions and that should never be interfered with. It’s important to make patients feel comfortable at all times and to encourage them to share any vital specifics about their medical history, as it could have a major impact on image diagnosing accuracy and the subsequent treatments.

Allowing patients this opportunity will give them more confidence to initiate conversations with their physician or radiologist, which can build a stronger relationship between both sides moving forward.

Maintaining a Fluid Line of Communication with Patients

Maintaining constant and informatory communication with patients is paramount throughout the diagnosing and treatment process when radiologists are called to interact with patients. No matter the news – good or bad – patients deserve to be readily updated on their scans and what those scans mean in terms of treatment from their physicians. Keeping patients regularly updated can calm any fears they may have while going through the process, no matter if it’s from their referring physician or radiologist.

Keep in mind you must do your best to explain everything in layman’s terms for patients, as some patients may be new to radiology and what it all entails. Using complex industry terminology could cause confusion and misinterpretation, which can affect patients’ decisions and their understanding of treatment steps. Some patients may still not fully comprehend all the information, no matter how clear and concise it was presented to them. The next step would be to refer them to physical or digital resources that may explain their situation differently. Again, making patients feel comfortable and knowledgeable of what all is transpiring is paramount.

Practices can also enhance their patient communication methods by utilizing the vast capabilities of modern technology. Some groups, such as 

, have adopted and innovated technological solutions, such as instant messaging, image annotation, full directory of referring physicians and phone apps to consolidate patients’ appointment schedules.

These solutions allow the conversation between both parties to remain fluid and informatory. This technology has aided patients and radiologists during the COVID-19 pandemic, as many practices and facilities have moved toward remote work and telehealth visits. Implementing this technology can greatly improve the communication between your radiologists and patients in this virtual era of health care and beyond.

The third – and maybe most important step – practices can take to become more patient-friendly is to be as transparent as possible with patients at all times. Patients deserve clear and honest communication, no matter the nature of the dialogue. This builds trust between both sides, which can pay dividends in terms of patient loyalty and patient engagement. It also emphasizes your practice’s obligations to providing the best possible patient care and emulates the values the entire practice strives by which to operate.

Not being empathetic and transparent with your patients could have numerous ramifications that could affect the future of your business. Legal issues, loss of current and future patients, and damage to your practice’s brand are just the few of the complications that could occur if you are operating dishonestly with patients.

Interactions between patients and their referring physicians will continue to evolve as patients will look to have direct input and tighter control of their health care. Radiology practices need to embrace the changes in patient behavior and incorporate these three principles, along with others, to properly adapt in this new industry era. If not, patients will leave lagging practices behind for those who listen to them and attend to their wants and needs accordingly.

Three strategies to keep your patients at ease and satisfied with your performance.

How Practices Can Become More Patient-Friendly

While data and analytics reporting has grown immensely throughout other industries, it is still highly underutilized in radiology. Practices are often intimidated by transitioning into new data systems for fear of using them incorrectly. However, radiological analytics and reporting can be a major asset for any practice, especially in weathering the turbulent times of the coronavirus 2019 (COVID-19) pandemic.

Incorporating analytics and reporting into your practice can enhance clinical care and operations, fix billing errors and cut costs. This will not only improve your practice, but will also help it to stay afloat in the ever-evolving industry and for the remainder of this pandemic. Below, I dive deeper into three benefits of implementing analytics and reporting and how each can positively impact your practice.

The more radiological data becomes available, the more responsibility you have with managing it, especially across multiple platforms. Today’s radiologists often use multiple data systems – possibly one for each partnering hospital they work with – which could lead to massive operational headaches depending on how many partners these systems are spread across. If they are not streamlined consistently, errors, such as failing to visualize and predict trends, detect gaps, or draw accurate correlations, could arise.

Thankfully, advanced reporting tools that simultaneously manage multiple radiology systems and workstations can effectively handle information overload within practices. Leveraging these tools allows data to be aggregated and consolidated from various platforms into one common system. This converts the data into a more easily functional format that improves radiologists’ overall productivity.

In relevance to the COVID-19 pandemic, widespread implementation and utilization of these advanced tools can play a pivotal role in a practice’s pandemic response and beyond. Providing deep insights into COVID-19 symptoms and tracking for departments treating infected patients – along with managing high volumes of patients once business influx returns – could be an invaluable tool in navigating the complexity of the current industry.

Correct Billing Inaccuracies While Eliminating Waste

Revenue cycle management (RCM) processes have become increasingly complex over time, which can lead to severe complications if not maintained properly. Incomplete information, missing prior authorization or lack of documentation are just a few examples that can lead to significant subsequent issues if left unchecked in your RCM processes.

For example, let’s say a radiologist filed a claim for imaging services to their billing company. When the claim is submitted, the practice’s software accidentally attaches the imaging service to three other patient claims instead of just one. In this instance, the system shows the patients received additional imaging services that were never completed – causing a major quagmire in the revenue management cycle. An error like this could result in intensive, time-consuming billing nightmares that eventually delay reimbursement.

These errors in claims cost industry insurers billions of dollars annually. Furthermore, given the sheer volume of claims submitted each day, the price of capturing and reconciling billing discrepancies without the use of rich analytics systems is extremely ineffective and time-consuming.

Rich analytics systems identify poor data quality and fix mistakes automatically, resulting in more accurate claims and higher reimbursement rates while avoiding crucial errors that could lead to wasteful spending. In a time where many radiologists are working remotely due to recent federal regulations, implementing these systems in your practice can ease complex billing processes and avoid any possible billing complications.

Enhance Patient Care Through Detection and Prioritization

According to a 2018 report published in Nature Reviews Cancer on artificial intelligence (AI) in radiology, the massive rise in available radiological data and analytics has outgrown the number of industry professionals who are able to read and analyze them. To compensate for this disproportionate growth, healthcare providers have increased radiologist workload. Radiologist burnout is already extremely high, and increasing their workload can lead to increased human error.

Fortunately for referring providers and their radiologists, utilizing rich analytics in conjunction with AI offers the benefit of reading and interpreting multiple images at a more proficient pace. They also enforce deep learning models that are trained for specified image recognition tasks.

For example, a rich analytics system can recognize abnormalities in an image and place it higher in the order of images needed to be read. This allows radiologists to view images based on reading priority. Also, if images are accidentally sent to the incorrect physician, the data can be automatically re-routed to the appropriate referring physician, so an immediate plan of action can be determined for the sake of the patient’s health. Overall, this utilization of rich analytics and AI together drastically speeds up reporting and improves patient outcomes, lessening the overall workload for radiologists and enhancing the practice’s overall patient care.

Implementing analytics and reporting systems – such as those offered by Collaborative Imaging to its partners – can greatly improve your practice in the current digital age of radiology. Enhancing operational efficiency, fixing billing errors and improving patient care are just a few of the many benefits these systems can provide any practice looking to move forward in the industry. Radiology has always been extremely competitive, but in times like these, incorporating analytics and reporting systems may be what keeps your practice afloat for the remainder of the COVID-19 pandemic -- and what sets it apart once business returns.

While data and analytics reporting has grown immensely throughout other industries, it is still highly underutilized in radiology. 

Author | Dhruv Chopra, MBA, Collaborative Imaging Chief Executive Officer

Articles

Communication Critical to Providers Adhering to Follow-Up Recommendations

The Importance of Cybersecurity in This Era of Radiology

How Practices Can Become More Patient-Friendly

The Importance of Implementing Analytics and Reporting Into Your Radiology Practice