Structured reporting fails to provide advantage over narrative format

Free text or structured reports are equally efficient and accurate in transmitting case-specific interpretive content, according to researchers at the University of Florida School of Medicine.

"A lot of people are making the assertion that structured reporting almost by definition is better, that because it's computerized it must be," said Dr. Christopher Lee Sistrom, an assistant professor of radiology at the university.

Sistrom's study found no difference in information transfer efficiency between free text (narrative style) and structured (itemized) reports having the same content (AJR 2005;185(3):804-812).

While it may be true that overall structured reporting is better, before this study there were little or no empirical data that examined the accuracy and speed with which readers extract case-specific information from free text or structured reports. The study is the first experimental evaluation of radiology reports whose primary outcomes are quantitative measures of information transfer to readers, Sistrom said.

Sistrom and colleagues designed a Web-based testing mechanism that was used to present radiology reports to 16 senior medical students and record their answers to multiple choice questions about specific medical content for each of 12 cases.

The study was delicate enough to detect even small differences in three outcomes: time to read each case, correct score, and efficiency.

"I could have detected very small differences, and the differences I found were even smaller than that," he said.

Sistrom said that the researchers had expected structured reporting to be speedier and more efficient, and to have a slightly lower accuracy. However, they found no significant differences for any of the three measures

The results were somewhat surprising, Sistrom said. Physicians may need to be a little more careful before shifting all documentation and communication from narrative structures to more strictly codified formats.

Human beings organize their work around complex tasks using narrative and normal texts and should be careful about dropping that approach, he said.

"We don't know what parts of that linguistic and semantic combination really provide synergy with the way we think," Sistrom said.

Still, even though they performed no better with structured versions, Sistrom said his subjects reported that they clearly preferred structured to free text format.