Automating Radiologist Workflow Part 1: The Digital Consultation

Quality Improvement Report: Design and Implementation of a Radiology E-Consult Service

Electronic consultations (e-consults) mediated through an electronic health record system or web-based platform allow synchronous or asynchronous physician-to-physician communication. E-consults have been explored in various clinical specialties, but relatively few instances in the literature describe e-consults to connect health care providers directly with radiologists.The authors outline how a radiology department can implement an e-consult service and review the development of such a service in a large academic health system. They describe the logistics, workflow, turnaround time expectations, stakeholder management, and pilot implementation and highlight challenges and lessons learned.

Difficulties and possibilities in communication between referring clinicians and radiologists: perspective of clinicians

Purpose

To investigate modes and quality of interprofessional communication between clinicians and radiologists, and to identify difficulties and possibilities in this context, as experienced by referring clinicians.

Patients and methods

Focus group interviews with 22 clinicians from different specialties were carried out. The leading question was: "How do you experience communication, verbal and nonverbal, between referring clinicians and radiologists?" Content analysis was used for interpretation of data.

Results

Overall, referring clinicians expressed satisfaction with their interprofessional communication with radiologists, and digital access to image data was highly appreciated. However, increased reliance on digital communication has led to reduced face-to-face contacts between clinicians and radiologists. This seems to constitute a potential threat to bilateral feedback, joint educational opportunities, and interprofessional development. Cumbersome medical information software systems, time constraints, shortage of staff, reliance on teleradiology, and lack of uniform format of radiology reports were mentioned as problematic. Further implementation of structured reporting was considered beneficial.

Conclusion

Deepened face-to-face contacts between clinicians and radiologists were considered prerequisites for mutual understanding, deepened competence and mutual trust; a key factor in interprofessional communication. Clinicians and radiologists should come together in order to secure bilateral feedback and obtain deepened knowledge of the specific needs of subspecialized clinicians.

An evaluation of the impact of clinically embedded reading rooms on radiologist-referring clinician communication

The aim of this study was to investigate whether locating reading rooms in clinical areas at a large tertiary care, academic hospital in the United States corresponds with increased rates of direct communication between radiologists and clinicians. Data recorded included the frequency, form, duration, and general purpose of communications. Two-tailed Fisher's exact tests were used to determine the statistical significance of differences between the frequencies of communication methods for the reading rooms included in the study. During the observation period, there were a total of 175 episodes of communication between radiologists and referring providers in the 4 study reading rooms. There was a highly significant difference (P < .0001) in the percentage of visits and critical test result management messages sent between embedded and nonembedded reading rooms, while the differences in the proportion of calls both to and from referring providers was not significant (P = .4468). Although the purpose of this study was to assess the impact of reading room location on radiologists' communications with referring providers, several alternative hypotheses could also explain the results. The value of this study emerges from the documentation of the high degree of variability among institutions in communication practices among different kinds of radiologists and referring physicians. The extent of these different practices among the 4 reading rooms has important implications for future studies of communication patterns between radiologists and referring providers as well as for designing effective interventions to enhance the role of radiologists as consultants.

A web-based flexible communication system in radiology

A web-based system for rapid multidirectional communication has been created in the Radiology department at San Francisco General Hospital. The system allows messaging among radiology attendings, residents, and technologists, as well as other members of the hospital community, such as Emergency Department physicians and nurses. Instead of being tied to a particular workflow, this system provides a flexible communication infrastructure which can be easily adapted for different functions and user roles. The system has so far been configured to successfully support the standard “wet reading” workflow, to support marking and tracking of critical results, as well as multiple educational and quality improvement workflows. In the 19 months of operation, the system has gained over 1,800 users (virtually all providers at our institution), it has been accessed by radiologists over 39,000 times and by non-radiologists over 34,000 times. It has become an integral part of the radiology department operations and non-radiology clinical workflows. Unlike most existing softwares, our system is not a task-specific application, but a multipurpose communication system. It is able to effectively accommodate multiple workflows and user roles through configuration (without additional programming). This flexibility has helped this system to be rapidly and widely adopted within our enterprise. The extended reach of the system enables improved monitoring and documentation of workflows, helping with management decision making, and quality assurance. We report a successful radiology communication system based on the principles of flexibility and inclusiveness of users inside and outside the radiology department.