More money, better care hinge on wider use of images

April 7, 2010

Radiologists express their diagnostic findings in words, their exam reports typically containing not a single image. They would be better served politically, and their referring physicians and patients clinically, if they shared their images as well as their conclusions.

Radiologists express their diagnostic findings in words, their exam reports typically containing not a single image. They would be better served politically, and their referring physicians and patients clinically, if they shared their images as well as their conclusions.

While text-only reports get the job done, images may enable the referring physician to put together treatment plans for the patient more rapidly and with increased confidence, according to Veena Iyer, a research fellow at Massachusetts General Hospital. Iyer documented the benefits of images embedded in radiology reports during a study she conducted at MGH and published in the March issue of the Journal of the American College of Radiology.

“Providing referring clinicians with a selected subsample of relevant images attached to the report improves the radiologist’s communication with them,” she said. “Such a report has the ability to save the clinician’s time and possibly improve patient management.”

The Medical Imaging and Technology Alliance is onboard with that. In a just-released white paper, MITA argues that medical images are critically important to the diagnostic process and need to be part of electronic health records. Yet imaging has been excluded until 2015 from the interim final rule that defines “meaningful use” of EHRs. When the final rule is cast, possibly later this year, providers will have to meet the criteria of meaningful use in order to gain access to the tens of billions of dollars in federal payments available under the American Recovery and Reinvestment Act of 2009 to providers for using healthcare information technologies.

Ironically, the paper notes, imaging data are already an integral part of the EHR, which “conglomerates data but is not always the owner of the data.” Standards and data interchanges among healthcare information systems have paved the way, allowing access through web-enabled viewers to the thousands of images in an MR diffusion-weighted study, for instance, and multiple gigabytes of a digital bilateral mammogram, with the heavy lifting done by an already installed and operating PACS. The value of these data, however, is not politically recognized.

It’s hard to overestimate the importance of such recognition. In a survey by the Healthcare Information and Management Systems Society, 49% of respondents who said their budgets for healthcare IT would increase this year said that meaningful use would be the driver.

At a time of shrinking reimbursements and languishing equipment purchases, radiology cannot afford to be left out of one of the few bright spots in the U.S. economy. The definition of meaningful use is still evolving. A full court press by radiology might yet bring imaging into the stimulus-governed fold before the final criteria are set in stone later this year.

But, as important as money is, much more is at stake. And providers know it. When asked about the area of patient care where they believed IT could have the most impact, more than a third of HIMSS study respondents said it could improve clinical and quality outcomes. Another quarter said the biggest impact would be in reducing medical errors and improving patient safety.

Here Iyer’s research at MGH comes into play, bolstering radiology’s case for inclusion. It is an argument that needs making in the political wrangling over EHRs and in the writing-and illustrating-of radiology reports.