Bringing Interaction Back
New York University Langone Medical Center's department of radiology leverages technology to give radiologists a more active role in patient care.
Before PACS technology, doctors had to visit the radiology reading room to see x-rays. When PACS made scans more accessible to clinicians, their interaction with radiologists waned.
"The positive effect, which was a more convenient way for physicians to view patient studies, had a negative impact on the role radiologists play in patient care," says Nancy R. Fefferman, MD, section chief of pediatric radiology and vice chair of education at NYU Langone Medical Center. "We had to enable clinicians to interact with radiologists without putting the onus on them to get to radiology."
A few years ago, as technological advances like teleradiology prompted questions about commoditization, Langone launched an initiative to revive the interactive role of radiologists.
Virtual Radiology Rounds
Michael P. Recht, MD, chair of the department of radiology at Langone, piloted this initiative in Langone's Neonatal Intensive Care Unit, which still saw high levels of face-to-face consultation between radiologists and NICU clinicians. The congenital cardiovascular care unit also participated in the pilot.
"We tried to recreate the environment of traditional rounds," says Fefferman. "There's more information exchanged when the radiologist interacts with the health care team."
Langone's virtual radiology rounds began two years ago, using web-based video conferencing software to enable real-time visual interaction. Every morning, the cardiovascular care unit initiates a video call with radiologists, who use screen-share capabilities to review scans while discussing recommendations. NICU virtual rounds follow.
"It's been a success," says Fefferman, citing several different diagnoses that radiologists made during rounds, that referring clinicians may have missed. "Physicians feel more comfortable having radiologists interpret studies, and it saves them time because they don't have to read reports." The report becomes a part of the patient's medical record for reference.
Multimedia Radiology Reports
Initially, radiologists worried that changes would make them busier. Recht assured them that solutions would be user-friendly because radiologists would be involved in the development. Ongoing collaboration was essential to integrating solutions into everyone's workflow.
"Radiologists and clinicians have to work together to maximize the capabilities of the imaging equipment we have," says Danny C. Kim, MD, director of quality and safety. "We need to understand the clinical impact of our services, so we asked clinicians, 'What information would be valuable when you make decisions? What would help you manage your patients?'"
The feedback prompted a redesign of Langone's radiology reports, adding annotated images, data tables, and other multi-media elements. It took 18 months perfecting the template to make reports streamlined for radiologists to use and clear for referring providers to read.
Recht wanted clinicians to be able to ask radiologists questions any time, not just during rounds. So, by clicking a button in the EMR, clinicians can instant-message subspecialty radiologists to initiate virtual consults. Radiologists take turns on-call.
Besides facilitating communication, Recht says another challenge was that "we weren't consistent in our recommendations, and the clinicians weren't following our recommendations consistently."
Kim collaborated with radiologists and clinicians to close the gap by standardizing recommendations for incidental findings like ovarian cysts.1
"Because the recommendations have been vetted by radiology and the appropriate specialty department," Kim says, "the referring clinicians feel more confident following them."
In partnership with a third-party vendor, Langone developed a system to track the outcomes of these joint recommendations. The system emails radiologists with the patient's pathology or operative reports, even matching relevant prior cases to provide feedback vital to the continuum of care.
"The most favorable change we've made, from the radiologist's view point, is giving them immediate feedback on their interpretations," Recht says. "Rarely do radiologists track results manually, but radiologists say the feedback has given them the insight to change their criteria for things like recommending biopsies. It's allowing us to be better radiologists."
1. Kim DC, et al. A multidisciplinary approach to improving appropriate follow-up imaging of ovarian cysts: a quality improvement initiative. JACR 2016;13(5):535–541.
By Brooke N. Bates, freelance writer for the ACR Bulletin