Electronic Health Records

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Will Health IT Systems Improve Radiology Reporting?

By Vera Gruessner

- Within the healthcare industry, there are a wide variety of different professionals who participate in managing patient care including treatment and diagnosis. Health IT systems and EHR technology play a role in every medical providers’ workflow, but does not always assist in streamlining healthcare services. With regard to diagnostics, radiologists are often inconsistent in how they recommend additional imaging or follow-up for incidental findings. It may be difficult to locate and use the complex published guidelines available.

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However, Nuance Communications has assisted the radiology field by developing the PowerScribe 360® Reporting version 3.0, which offers useful reporting information to radiologists during the clinical documentation process, according to a company press release.

Dr. Lincoln Berland, the Chair of the Body Imaging Commission at the American College of Radiology, spoke with EHRIntelligence.com and shared his insights on the radiology field and the technologies including health IT systems that affect it.

When discussing the latest version of the PowerScribe 360 Reporting solution, Berland stated, “I’ve been involved with the development and refinement of this new system and what it’s designed to do is to assist the radiologist at the point of interpretation for making recommendations and describing findings. The way it works is that, while a radiologist is dictating a report, he/she may come upon a finding – for example, an adrenal nodule, that they will report. The system will recognize that it’s an adrenal nodule and highlight with a flag in the corner that there is a guidance rule for managing that.”

“A radiologist clicks on that and a box pops up into which the radiologist fills in the blanks,” Berland explains. “For example, it could be a two centimeter adrenal nodule. There may be two to five different features that you fill in, such as density and texture. At that point, text appears that the system can insert regarding how the findings and recommendation would appear in the report. If the radiologist finds it acceptable, he/she clicks to accept and it automatically pops into the correct locations in the report.”

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“This is revolutionary in the sense that nothing like this has ever been available before,” exclaimed Dr. Berland. “The reason it’s so important is that medicine has become so complex and algorithms for managing different kinds of findings – and particularly incidental findings – have become so confusing that to really make sure the right one is chosen every time, radiologists have to look it up, find an article, read through an algorithm, and follow a chart. This bypasses all of that.”

“In practical reality, the way it worked before this system, is that the radiologist most of the time doesn’t look it up. If they’re a specialist in the area, they’ll remember most of the findings and recommendations, but they won’t do it with complete accuracy. If you’re not a specialist, you may not know where to look it up or that even such a guidance rule exists and you might not get it right,” mentioned the Chair of Body Imaging Commission at the American College of Radiology. “What this provides is efficiency, accuracy, consistency, and the right recommendation every time because it’s appearing right on the screen and all of the potential recommendations have been reviewed before you get to the report.”

When asked what some common challenges in the radiology field are specifically with regard to digital technologies and health IT systems, Berland answered, “One of the main challenges that we deal with is the correlation of information. Radiology requests often have a very rudimentary amount of clinical information that come with them and the EHR has voluminous amounts of information.”

“It’s often in a separate system and radiologists have to open that separate system to review the data, going through reams of pages to find the particular piece of information that’s relevant to the examination that you’re reporting,” he continued. “That is a tremendous challenge. Gathering the right information is one of the most difficult parts about making the correct interpretation, particularly for the increasingly complex radiology procedures that we perform.”

“Another problem is dealing with access to all of the relevant information from patients that are in multiple sites,” he explained. “Nuance now has a system called PowerShare [the Nuance PowerShare Network] so that people can share information and images from other sites very quickly. With something like PowerShare, that information can be shared through the cloud before the patient even arrives at the tertiary care center.”

As a final thought on the challenges within the radiology field, Berland stated, “The complexity of information that’s available now and accessing the right information at the right time is very difficult. Automating that through a system at the point of interpretation is going to be a game changer in how we manage radiology reporting.”

When asked about some of the benefits and difficulties of implementing the PowerScribe 360 reporting program, Berland answered, “From the standpoint of having worked on the system to try to develop it, the challenges that we’ve had in trying to make sure that all of the answers are correct is that the logic is complex because of the algorithms that follow down multiple different paths that depend on multiple different conditions.”

“One of the advantages of the system is that using the PowerShare method, whenever there’s an update that comes along with a newer algorithm that can be downloaded through the cloud to all the sites that are used in the system so that there isn’t a significant delay between the issuance of the new guideline and everyone having access to it,” he explained.

Dr. Berland also discussed the most vital quality check tools that radiologists need to conduct their work.

“The Incidental Findings Committee has devised rules for particular organ systems where incidental findings are discovered. Now we have six papers that cover 11 organ systems. What Nuance and Mass General have done is take five of those rules and one additional guideline from another source and translated them into this computerized system. Specifically, they have a rule for managing renal, liver, adrenal and pulmonary nodules, thyroid, and ovarian cysts incidental findings,” Berland answered.

When asked whether the cloud platform is preferable for storing radiology reports, Berland explained, “I don’t think [the cloud] is a prevalent way of managing information right now. We’re a unified healthcare system with a single computerized system that goes covers all of our various physical sites. We manage our data locally with backup.”

“The advantage of the cloud that we see is access to data in other health systems either in our state of Alabama or elsewhere in the region wherever a patient has been seen. The problem is that we don’t currently have standards that are well established enough – patients don’t have a single identifier – so we can’t easily have a unified system over multiple sites. There always has to be some reconciliation locally. I think the cloud will increase in utility because people are now being seen in a broader array of institutions and sites, which is going to require the interconnectivity of data,” Berland concluded.




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