V. Katherine Gray, PhD

The Recovery Act (2009) mandates record keeping changes to provide incentive payments for the adoption and use of Electronic Health Records (EHR) provided that such systems support “meaningful use.”

Radiology has not been as included in the meaningful use program for Stage 1 and 2 (2013 deadline) as it should have been. Radiologists need to make sure that they are specifically included in Stage 3 (2016 deadline).

Currently, the only part of meaningful use that has included radiology is the requirement that computerized physician order-entry (CPOE) software include "at least one medication, and one lab or radiology order for 60 percent of unique patients who have at least one such order.”

What is clear, though, is that the usual EHR approach won’t suffice in the future.

For example, in Stage 3, 80 percent of all orders from both providers and hospitals will have to come through CPOE. They need a way to transfer order information to radiologists electronically. However, typical CPOE as part of an EHR system doesn’t usually let users send orders from office practices to all the possible hospital EHRs or free-standing facility EHRs for outpatient imaging.

Furthermore, Stage 3 MU requires that radiologists provide patients with an electronic copy of their records in 90 percent of the cases when requested by the patient. This particular requirement gets specific in saying that patient should be able to get their “diagnostic test results” or standard radiology reports. And you have to contact the patient in the manner they prefer.

Finally, the most significant change to radiology reporting will be due to the Stage 3 MU requirement to: “make the information relevant to the patient encounter” available in four days (for follow-up testing) in a summary form. In order to make the testing results relevant, the radiology reporting approach must change-at least to some degree. At present, many reports would not be interpretable by patients as radiology reports provide data and information, but not clinical understanding. Although the referring physician has an important role in assisting the patient with understanding the report, the radiology report itself will seem inadequate without changes to make the findings interpretable.

Start changing your reporting style now; can you add a summary that makes the findings clear? Start talking to your hospital(s) and key referrers about their plans to get you orders electronically. And start thinking about how you’ll make records available to requesting patients.

V. Katherine Gray, Ph.D., is President, Sage Health Management Solutions, Inc.

Articles

The usual EHR approach won’t suffice in the future. You need to be able to get orders electronically and be more responsible to patients with your reporting.

Meaningful Use Outcomes will Change Reporting

 - is an important issue in radiology malpractice lawsuits. Communication issues were ranked as the fourth largest cause of 

, and it is the second highest average indemnification or compensation. Furthermore, it contributes to 80 percent of malpractice lawsuits as a causative factor. 

However, in the past, radiologists have not been the primary communicators of imaging reports with patients, as that has been the responsibility of the referring physician. That is about to change.

The direct disclosure of findings by radiologists is believed by some experts as being an improvement that outweighs the risks. For example, one of the foremost experts on radiology malpractice, Dr. Leonard Berlin, explains that “a patient who has expectations of being promptly informed of imaging results, only to be disappointed in that regard, will grow frustrated and then angry - not toward the referring physician, but toward the radiologist prompting a call to a malpractice attorney.”

By the radiologist communicating directly, the radiologist might actually solve the errors in communication.

Recent malpractice judicial decisions point to clear expectations of direct communication with patients. At both state and federal appellate levels, several cases have found against the radiologist when abnormal findings were not directly communicated. These decisions focus on the “duty of care” that any physician has of warning a patient of abnormal findings when the physician is aware of the results, regardless of the reason for the testing or what another physician may be responsible for, so the patient can seek proper treatment.

Legislative action in 2010 also suggests that the expectation of reporting radiology results directly to patients is growing. Last year, Pennsylvania was the first state to introduce legislation that requires a summary of imaging findings to be sent to patients within 10 days of the full report being sent to the ordering physician. The concern by some radiologists is that the radiology report is too technical for patients to understand or interpret properly, and that will cause confusion. Another concern is the increased time for radiologists to meet such a requirement.

Also in 2010, California legislation required radiology facilities to alert patients if any unusual radiation dosages had been administered. This issue of radiation exposure is relatively new in radiology malpractice. This increased awareness was based upon sensational cases about damage from imaging radiation exposure due to malfunctioning equipment, improper procedures, and poorly performing staff.

With this new awareness, patients have also become more concerned with the accumulated dosages over time from repeated 

. Patients are expecting information about the dosage - including the expected amount of radiation exposure, the amount received by a patient, and the accumulation. This suggests a need for radiation exposure reporting directly to patients.

These malpractice factors are pushing for direct communication to patients about findings and radiation exposure. Such transparency and work flow will be a major change in radiology reporting.

Coming up next in the series: Meaningful Use Outcomes will Change Reporting

Radiology Reports in the Age of Smartphones

V. Katherine Gray, PhD, is president of Sage Health Management Solutions, Inc. Gray’s healthcare management experience includes managed care, self-insured employers, long-term care, hospital systems, Medicaid and Medicare, and specialty care. She founded Sage Health Management Solutions, Inc. in 1997 with a vision to develop Web-based technology to improve the diagnostic process using evidence-based clinical decision support. 

Communication - or failure to communicate - is an important issue in radiology malpractice lawsuits. However, in the past, radiologists have not been the primary communicators of imaging reports with patients, as that has been the responsibility of the referring physician. That is about to change.

Malpractice Movement Calls for Reporting Directly to Patients, Part 2 in a Series

Just as healthcare professionals were getting comfortable with e-health, there is a new wave coming to our electronic world - mobile. Now there are m-payments, m-banking, and m-wallets. Globally there are 

5.3 billion mobile subscribers or 77 percent of the total population

, including Africa and other developing countries. The smartphone growth from 2009 to 2010 was up 74 percent. All of this means that our communications will increasingly go through mobile devices and mobile broadband.

In particular in healthcare, both providers and patients will increasingly rely on 

 for accessing medical information. This means that security issues and privacy concerns will need to be met for confidential and secure exchange of healthcare data. It is projected that m-health will be a key driver in the future for new mobile apps.

In radiology this presages the American College of Radiology (ACR) 

standard of diagnostic reporting of interpretations

 will certainly change in the age of smartphones. This will impact the regular dissemination of final reports, but more importantly will affect the non-routine communications even more. The desire to send the communication via mobile devices will become the expectation when a finding is urgent, different from previous reports, or when an intervention in treatment is believed to be warranted even if not requiring immediate attention. The speed of connecting and the ability to reach the specific individual desired through mobile devices only makes sense when over 94 percent of the population in the U.S. has mobile devices.

When transmitting diagnostic imaging information using mobile devices, a receipt of communication by the referring physician or patient will be required. As the ACR states, “Therefore, in these instances, the interpreting physician may consider initiating a system that explicitly requests confirmation of receipt of the report by the clinician. If confirmation or other response is not received within a time appropriate to the diagnosis after the initial communication, a staff person should notify the clinician to document follow-up. Regardless of the method selected, it must be in compliance with state and federal law.”

In the near future, expect to see the development of m-health reporting apps that will handle the issues of security, privacy, and documentation of the receipt of the information. In fact, a recent Pew study “found that a full 9 percent of American mobile phone users said they have mobile health apps on their phones that enable them to ‘track’ or ‘manage’ their health.” Others are predicting that by 2015 more than one-third of the smartphone users will be running an m-health app. It is expected that many 

 will be used for tracking chronic conditions and for identification and monitoring patients. However, don’t be surprised if they are also used for reporting results and communicating about treatment options.

Next in the series: Movement in Malpractice Calling for Reporting Directly to Patients

V. Katherine Gray, PhD, is president of Sage Health Management Solutions, Inc. Gray’s healthcare management experience includes managed care, self-insured employers, long-term care, hospital systems, Medicaid and Medicare, and specialty care. She founded Sage Health Management Solutions, Inc. in 1997 with a vision to develop Web-based technology to improve the diagnostic process using evidence-based clinical decision support. 

In the near future, expect to see the development of m-health reporting apps that will handle the issues of security, privacy, and documentation of the receipt of the information. It is expected that many m-health apps will be used for tracking chronic conditions and for identification and monitoring patients. However, don’t be surprised if they are also used for reporting results and communicating about treatment options.

V. Katherine Gray, PhD

Articles

Meaningful Use Outcomes will Change Reporting

Malpractice Movement Calls for Reporting Directly to Patients, Part 2 in a Series

Radiology Reports in the Age of Smartphones, Part 1 in a Series