Productivity tools remain scarce in radiology

Adoption of productivity systems in radiology has been disappointingly slow, according to a recent study."A surprising number of radiologists still work without some basic supports," said Dr. Nikhil R. Nayak of the department of diagnostic radiology at Yale University School of Medicine.Nayak investigated what types of radiology practices are early adopters and what types are lagging adopters of operational technologies, including PACS, wet-reading telephone lines, speech recognition, standard report language templates, physician assistants, and film-hanging staff (AJR 2008;190:1445-1452)."We conceptualized operational technologies as being distinct from direct-care technologies, such as laparoscopic surgery, and as being more likely to affect efficiency, with relatively little effect on patient outcomes," Nayak said.

Nayak analyzed data collected in the American College of Radiology's 2003 survey of 1924 responding radiologists. Among his findings:

• In 2003, 47% of U.S. radiologists were in practices that had no PACS.
• Only 34% of U.S. radiology practices used PACS.
• 21% of U.S. radiologists were in practices that had neither PACS nor film-hanging staff.
• Only 18% of radiologists were in practices that used speech recognition.

Nayak believes the data are not altogether obsolete despite their age.

"Although the percentage of practices with a given technology may have changed in the five years since the survey, the kinds of practices likely to have a technology remain more or less stable over long periods," he said.The study concluded that solo practices and practices in nonmetropolitan areas have decreased odds of having PACS, while academic practices and medium-large practices of 11 to 14 radiologists have increased odds. "Practices in the West and those serving only hospitals are particularly likely to have radiologists hanging films themselves, although academic and medium-large practices are particularly unlikely to be in this situation," Nayak said.Based on the findings, Nayak concluded that scale economies and, even more, organizational culture seem to explain early adoption of new technology."Surprisingly, we did not find evidence of any effect from practices' finances," he said. "Determinants of being a serious laggard with respect to established technologies are less clear, but substantial size seems a deterrent."Although financial rewards have been most discussed as the way to encourage physician practices to adopt modern operational technologies, they may have less effect than expected, according to Nayak. "Conversely, efforts to change organizational culture and to get physicians into larger groups may be unexpectedly effective," he said.