UVA Health transforms plain text radiology reports into multimedia, gaining clinical ROI
Back in 2018, Healthcare IT news reported on how the University of Virginia (UVA) Health System, based in Charlottesville, completed the implementation of new reporting technology that allows radiologists to create next-generation reports with rich features.
Catching up with UVA
Radiology reporting was and still is behind. Plain text is the industry standard format.
UVA Health has added the ability to enhance reports, just like you see with every news article on the Internet these days. It added text formatting, key images, tables, figures and hypertext that connects key findings in the report to annotated images in the PACS. A signature photo of the radiologist was also added to increase professional visibility.
“In 2018 we faced two major issues,” said Dr. Cree Gaskin, associate chief medical information officer, vice president of informatics and operations, and division director of musculoskeletal imaging. “The first was technical. While we were successful in creating interactive multimedia reports, sharing them downstream in an ideal format was another problem.
“We relied on the PDF format to pass the rich content of our reporting application into our EHR,” he continued. “To view the advanced report content, providers had to use a third-party PDF viewer integrated into the EHR. The solution worked, but had room for improvement. We wanted to make the content more quickly and directly visible within the EHR, just like regular text reports.”
The second problem was adoption. UVA Health wanted to increase how often the technology was used. The aim was to increase the number of advanced reports by radiologists and increase the awareness of these reports among referring healthcare providers and patients.
PROPOSAL
Creating rich digital content is so ubiquitous today that it can be difficult to understand how report formatting was and continues to be a barrier in radiology.
“As a very early adopter of interactive multimedia reporting, we were faced with challenges due to the lack of industry standards, and we asked our suppliers to do more than before,” said Gaskin. “Nearly every facility and radiology practice still uses plain text for radiology reporting because the content is better supported and easily shared with providers.
“I believe we were successful as an early adopter because our reporting application was integrated with our PACS viewer.”
Dr. Cree Gaskin, UVA Health System
“While PDF was a working solution for our advanced reports, it was slower and required the use of a third-party viewer, rather than serving dynamic content directly within the EHR itself,” he continued. “We worked with the R&D teams of both our reporting and EHR vendors to reach an agreement on how we can share and display the reporting content.”
The staff decided to use the RTF format to create, share, and display RTF radiology reports.
“Each vendor completed a small development, and then we all worked together on the final implementation,” Gaskin recalls. “Initially, there were display issues for some advanced report elements created in one vendor’s reporting application and displayed in another vendor’s EHR. Overall, we were able to resolve these formatting issues by aligning the configuration.
“For the second issue, that of increasing adoption, we’ve taken a few different steps,” he continued. “Because it is important that radiologists understand the benefits of and are fluent in creating advanced reports, we have increased visibility in the department through dedicated conferences and sharing of electronic manuals.”
Staff highlighted how the advanced reports benefit patients, caregivers and radiologists through greater clarity and significantly reduced review time. Additionally, while some were concerned that it would take extra time to create advanced reports, employees emphasized how many of the tools can actually speed up the report creation workflow while reducing reporting errors.
“We also worked with our EHR vendor to ensure that the advanced reporting elements would be visible and functional to our patients through the EHR patient portal, and not just available to our vendors in the main EHR,” Gaskin said. “That required a little development from the supplier, but the result is that patients also see this content.
“Putting interactive multimedia reports into the EHR for healthcare providers, radiologists and patients significantly increases the use of the features,” he noted. “It almost goes without saying that the advanced elements are not used if they are not seen.
“So it is important that they are easily accessible,” he added. “The visibility increases adoption. Radiologists are more likely to create advanced reports if they are used by our consumers.”
RESULTS
UVA Health collected data on how often radiologists create reports with interactive elements.
“We have solid adoption within the department, although we are seeing interactive elements being placed more frequently in MRI, CT and PET-CT reports,” he said. “For example, 66-78% of our abdominal CTs, chest MRIs and PET CTs have interactive links to key findings.
“This is a really high acceptance rate, especially when you consider that some studies are negative and do not warrant link creation at all,” he continued. “This is a very compelling argument that our radiologists find this tool useful.”
Staff has begun a preliminary investigation into how often these links are used downstream by consumers once they are created. For now, the links are activated approximately twice in the EHR for each report created with hyperlinks. So the staff knows that healthcare providers and patients often click on the links.
“I don’t have any hard data on radiologists’ use of the links after they’re created, but anecdotally I can tell you it’s strong,” Gaskin said. “From my own experience, I find it disappointing when I come across previous reports without interactive elements, because it takes longer for me to find what the previous radiologist was talking about in the report.
“When reviewing comparative studies, it is much faster and more reliable to just click on a link and see it immediately,” he added. “Once you get used to advanced reporting, it can be difficult to go without it. Radiologists who have left UVA have told me how they miss effortlessly passing information from the viewer (the PACS) into the report in a integrated system like we have.”
It’s faster and there’s no chance of transcription errors compared to doing it manually, Gaskin said.
“Finally, plain text reports are just that: they are clear,” he noted. “The advanced reports look better and are more attractive. It can be more fun and satisfying to create a better product.”
ADVICE FOR OTHERS
The report is the primary work product of the diagnostic radiologist.
“It seems very natural to move forward in a direction that improves the quality of the report,” Gaskin advised. ‘It’s clearly an improvement to move beyond plain text if you can. In addition to my own opinion, several other opinions have appeared in the literature in recent decades that all agree with each other.
“But that’s easier said than done,” he continued. “Some past attempts have failed due to the cumbersome workflow. Radiologists will not adopt it until it is simple enough to use. It is very important to consider radiologists’ workflow when considering products and implementation.”
Moreover, radiologists may not be interested in the hassle of adoption if their clients don’t ask for it, he added. Because plain text reports are so ubiquitous, referring providers often don’t even know they can insist on these types of reports. Because it is so new, some leadership is needed to overcome the inertia and change, he said.
“Ultimately, I believe we were successful as an early adopter because our reporting application was integrated with our PACS viewer,” he said. “We chose this path because we believed it was a privileged position for efficient interactive multimedia reporting.
“Many practices have reporting applications that are separate from their PACS viewer, which presents additional technical and workflow challenges,” he concluded.
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