EMR paves the way to radiology consulting role

The advent of the electronic medical record is redefining the radiologist's place in the healthcare chain by transforming traditional morphological descriptions into radiological consultations, according to researchers at the University of Texas M.D. Anderson Cancer Center.

There is a current trend to integrate radiology workstations with clinical information systems, said Dr. Kevin W. McEnery, associate head of informatics at M.D. Anderson. Information system integration provided radiologists a bounty of clinical information, so it was important to discover what was the most valuable type of information for the radiologists.

To that end, McEnery and colleagues analyzed August 2003 audit files from the center's homegrown EMR, ClinicStation and its integrated PACS workstation, RadStation. Both information systems recorded over 20 million events, which the researchers analyzed to see how radiologists and nonradiologists were using information ranging from radiology reports, pathology reports, laboratory results, and transcribed documents.

"Radiologists were looking at radiology reports almost 50% of the time," McEnery said at the recent SCAR conference.

This meant that the radiologists were accessing ancillary clinical information not related to radiology the other 50% of the time. Prior images and incomplete patient histories represent missing pieces of the patient puzzle, and by accessing the entire database made available by the EMR, radiologists can go beyond just providing morphology reports. They can provide expert diagnostic consultations, which McEnery said was a transition that was necessary for radiologists to stay clinically relevant.

The audit reports indicate that radiologists are already making use of the extra information available.

"Anecdotally, clinicians are telling me that we radiologists all seem a lot smarter then we used to be," McEnery said.

There are some problems with presentation of the ancillary data, for instance pathology reports that make perfect sense to pathologists as presented, may require more effort for the radiologists. This problem could be solved by using more structured documents enterprise wide, according to McEnery.

The audit logs indicate that radiologists are active data users, McEnery said, and radiologists should be active participants in the development of future electronic medical records.