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Tang CC, Nagesh S, Fussell DA, Glavis-Bloom J, Mishra N, Li C, Cortes G, Hill R, Zhao J, Gordon A, Wright J, Troutt H, Tarrago R, Chow DS. Generating colloquial radiology reports with large language models. J Am Med Inform Assoc 2024:ocae223. [PMID: 39178375 DOI: 10.1093/jamia/ocae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 08/25/2024] Open
Abstract
OBJECTIVES Patients are increasingly being given direct access to their medical records. However, radiology reports are written for clinicians and typically contain medical jargon, which can be confusing. One solution is for radiologists to provide a "colloquial" version that is accessible to the layperson. Because manually generating these colloquial translations would represent a significant burden for radiologists, a way to automatically produce accurate, accessible patient-facing reports is desired. We propose a novel method to produce colloquial translations of radiology reports by providing specialized prompts to a large language model (LLM). MATERIALS AND METHODS Our method automatically extracts and defines medical terms and includes their definitions in the LLM prompt. Using our method and a naive strategy, translations were generated at 4 different reading levels for 100 de-identified neuroradiology reports from an academic medical center. Translations were evaluated by a panel of radiologists for accuracy, likability, harm potential, and readability. RESULTS Our approach translated the Findings and Impression sections at the 8th-grade level with accuracies of 88% and 93%, respectively. Across all grade levels, our approach was 20% more accurate than the baseline method. Overall, translations were more readable than the original reports, as evaluated using standard readability indices. CONCLUSION We find that our translations at the eighth-grade level strike an optimal balance between accuracy and readability. Notably, this corresponds to nationally recognized recommendations for patient-facing health communication. We believe that using this approach to draft patient-accessible reports will benefit patients without significantly increasing the burden on radiologists.
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Affiliation(s)
- Cynthia Crystal Tang
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Supriya Nagesh
- Amazon Web Services, East Palo Alto, CA 94303, United States
| | - David A Fussell
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Justin Glavis-Bloom
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Nina Mishra
- Amazon Web Services, East Palo Alto, CA 94303, United States
| | - Charles Li
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Gillean Cortes
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Robert Hill
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Jasmine Zhao
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Angellica Gordon
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Joshua Wright
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Hayden Troutt
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
| | - Rod Tarrago
- Amazon Web Services, Seattle, WA 98121, United States
| | - Daniel S Chow
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA 92868, United States
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Berigan K, Short R, Reisman D, McCray L, Skelly J, Jones K, Befera NT, Ali N. The Impact of Large Language Model-Generated Radiology Report Summaries on Patient Comprehension: A Randomized Controlled Trial. J Am Coll Radiol 2024:S1546-1440(24)00595-7. [PMID: 38964446 DOI: 10.1016/j.jacr.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Kayla Berigan
- Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin.
| | - Ryan Short
- Mallinckrodt Institute of Radiology, St Louis, Missouri, and Scanslated, Inc, Tampa, Florida
| | - David Reisman
- Department of Family Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont; Co-Division Chief Patient Centered Medical Home University of Vermont Health Network; Site Leader Family Medicine South Burlington, University of Vermont Medical Center
| | - Laura McCray
- Department of Family Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont; Interim Chair, Network Department of Family Medicine, University of Vermont Health Network
| | - Joan Skelly
- Department of Biomedical Statistics, University of Vermont, Burlington, Vermont
| | - Kimberly Jones
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Nicholas T Befera
- Department of Radiology, Duke University Health System, Durham, North Carolina, and Scanslated, Inc, Tampa, Florida; ACR Patient and Family Centered Care Council-Patient Engagement Committee
| | - Naiim Ali
- Department of Radiology, Larner College of Medicine at the University of Vermont, Burlington, Vermont; ACR Delegate to the American Medical Association House of Delegates; Division Chief Ultrasound Imaging, Director of CM, Associate Program Director Diagnostic Radiology Residency. https://twitter.com/NaiimAli
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3
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Pollock JR, Petty SAB, Schmitz JJ, Varner J, Metcalfe AM, Tan N. Patient Access of Their Radiology Reports Before and After Implementation of 21st Century Cures Act Information-Blocking Provisions at a Large Multicampus Health System. AJR Am J Roentgenol 2024; 222:e2330343. [PMID: 38534191 DOI: 10.2214/ajr.23.30343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND. To implement provisions of the 21st Century Cures Act that address information blocking, federal regulations mandated that health systems provide patients with immediate access to elements of their electronic health information, including imaging results. OBJECTIVE. The purpose of this study was to compare patient access of radiology reports before and after implementation of the information-blocking provisions of the 21st Century Cures Act. METHODS. This retrospective study included patients who underwent outpatient imaging examinations from January 1, 2021, through December 31, 2022, at three campuses within a large health system. The system implemented policies to comply with the Cures Act information-blocking provisions on January 1, 2022. Imaging results were released in patient portals after a 36-hour embargo period before implementation versus being released immediately after report finalization after implementation. Data regarding patient report access in the portal and report acknowledgment by the ordering provider in the EMR were extracted and compared between periods. RESULTS. The study included reports for 1,188,692 examinations in 388,921 patients (mean age, 58.5 ± 16.6 [SD] years; 209,589 women, 179,290 men, eight nonbinary individuals, and 34 individuals for whom sex information was missing). A total of 77.5% of reports were accessed by the patient before implementation versus 80.4% after implementation. The median time from report finalization to report release in the patient portal was 36.0 hours before implementation versus 0.4 hours after implementation. The median time from report release to first patient access of the report in the portal was 8.7 hours before implementation versus 3.0 hours after implementation. The median time from report finalization to first patient access was 45.0 hours before implementation versus 5.5 hours after implementation. Before implementation, a total of 18.5% of reports were first accessed by the patient before being accessed by the ordering provider versus 44.0% after implementation. After implementation, the median time from report release to first patient access was 1.8 hours for patients with age younger than 60 years old versus 4.3 hours for patients 60 years old or older. CONCLUSION. After implementation of institutional policies to comply with 21st Century Cures Act information-blocking provisions, the length of time until patients accessed imaging results decreased, and the proportion of patients who accessed their reports before the ordering provider increased. CLINICAL IMPACT. Radiologists should consider mechanisms to ensure timely and appropriate communication of important findings to ordering providers.
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Affiliation(s)
- Jordan R Pollock
- Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Phoenix, AZ 85259
| | | | | | - Jacob Varner
- Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Phoenix, AZ 85259
| | | | - Nelly Tan
- Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Phoenix, AZ 85259
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Dutruel SP, Hentel KD, Hecht EM, Kadom N. Patient-Centered Radiology Communications: Engaging Patients as Partners. J Am Coll Radiol 2024; 21:7-18. [PMID: 37863150 DOI: 10.1016/j.jacr.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
Patient-centered care is a model in which, by bringing the patient's perspective to the design and delivery of health care, we can better meet patients' needs, enhancing the quality of care. Patient-centered care requires finding ways to communicate effectively with a diverse patient population that has various levels of health literacy, cultural backgrounds, and unique needs and preferences. Moreover, multimedia resources have the potential to inform and educate patients promoting greater independence. In this review, we discuss the fundamentals of communication with the different modes used in radiology and the key elements of effective communication. Then, we highlight five opportunities along the continuum of care in the radiology practice in which we can improve communications to empower our patients and families and strengthen this partnership. Lastly, we discuss the importance on communication training of the workforce, optimizing and seamlessly integrating technology solutions into our workflows, and the need for patient feedback in the design and delivery of care.
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Affiliation(s)
- Silvina P Dutruel
- Department of Radiology, Weill Cornell Medical Center, New York, New York.
| | - Keith D Hentel
- Professor, Clinical Radiology, Executive Vice Chairman, Department of Radiology; Vice President, Weill Cornell Imaging at New York-Presbyterian, New York, New York
| | - Elizabeth M Hecht
- Vice Chair for Academic Affairs, Department of Radiology, Weill Cornell Medical Center, New York, New York. https://twitter.com/ehecht_md
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Director of Quality, Department of Radiology, Children's Healthcare of Atlanta, Georgia; Interim Director of Quality, Department of Radiology, Emory Healthcare, Atlanta, Georgia; Chair, Practice and Performance Improvement Committee, ARRS; and Chair, Metrics Committee, ACR
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McFarland JA, Huang J, Li Y, Gunn AJ, Morgan DE. Patient Engagement with Online Portals and Online Radiology Results. Curr Probl Diagn Radiol 2023; 52:106-109. [PMID: 36030140 DOI: 10.1067/j.cpradiol.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to examine patient portal enrollment and the usage with a specific focus on the utilization of on-line radiology reports by patients. Oracle SQL (Austin, TX, USA) queries were used to extract portal enrollment data over a 13-month period from March 1, 2017 through March 31, 2018 from the hospital system's EMR. Patient enrollment was collected as was patient information including basic demographics and utilization patterns. For enrolled patients, interaction within the portal with the "Radiology" work tab (RADTAB) was used as a surrogate for review of radiology results. As a comparator, interaction within the portal with the "Laboratory" work tab (LABTAB) was used as a surrogate for review of laboratory results. Statistical analysis on the data was performed using Chi-squared, Student's t-test, Logistic regression and multivariate analysis where appropriate. The population for analysis included 424,422 patients. Overall, 138,783 patients (32.7%) were enrolled in the portal. Patients enrolled in the portal were older (P < 0.0001), female (P < 0.0001) and Caucasian (P < 0.0001). Patients enrolled in the portal had higher levels of educational attainment (p < 0.0001), higher annual household income (P < 0.0001), and more outpatient clinic visits (P < 0.0001). The proportion of enrolled patients that interacted with the LABTAB (47.2%) was significantly higher than those that interacted with the RADTAB (27.1%) (P < 0.0001; Table 2). Patients that utilize the portal are more likely to utilize the Laboratory tab than the Radiology tab, and demographic differences do not account for this difference in usage. Further investigation is needed to better understand the reasons for the differing usage trends of Laboratory and Radiology tabs.
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Affiliation(s)
- J Alex McFarland
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
| | - Junjian Huang
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL.
| | - Yufeng Li
- Preventive Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Andrew J Gunn
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
| | - Desiree E Morgan
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL
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6
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Vincoff NS, Barish MA, Grimaldi G. The patient-friendly radiology report: history, evolution, challenges and opportunities. Clin Imaging 2022; 89:128-135. [DOI: 10.1016/j.clinimag.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/08/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
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7
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Verosky A, Leonard LD, Quinn C, Vemuru S, Warncke E, Himelhoch B, Huynh V, Wolverton D, Jaiswal K, Ahrendt G, Sams S, Lin CT, Cumbler E, Schulick R, Tevis SE. Patient comprehension of breast pathology report terminology: The need for patient-centered resources. Surgery 2022; 172:831-837. [PMID: 35715235 DOI: 10.1016/j.surg.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As health care continues to evolve toward information transparency, an increasing number of patients have access to their medical records, including result reports that were not originally designed to be patient-facing. Previous studies have demonstrated that patients have poor understanding of medical terminology. However, patient comprehension of terminology specific to breast pathology reports has not been well studied. We assessed patient understanding of common medical terms found in breast pathology reports. METHODS A survey was administered electronically to patients scheduled for a screening mammogram within a multisite health care system. Participants were asked to objectively define and interpret 8 medical terms common to breast biopsy pathology reports. Patient perception of the utility of various educational tools was also assessed. Demographic information including health literacy, education level, previous cancer diagnosis, and primary language was collected. RESULTS In total, 527 patients completed the survey. Terms including "malignant" and "benign" were the most correctly defined at 80% and 73%, respectively, whereas only 1% correctly defined "high grade." Factors including race/ethnicity and education level were correlated with more correct scores. Patients preferred educational tools that were specific to their diagnosis and available at the time they were reviewing their results. CONCLUSION Patient comprehension of common medical terminology is poor. Potential assumptions of understanding based on patient factors including education, past medical history, and occupation are misinformed. With the newly mandated immediate release of information to patients, there is a pressing need to develop and integrate educational tools to support patients through all aspects of their care.
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Affiliation(s)
- Alexandra Verosky
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/veroskyalex
| | | | | | - Sudheer Vemuru
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/sudheervemuru
| | - Emily Warncke
- Department of Radiology, University of Colorado, Denver, CO
| | - Ben Himelhoch
- Department of Radiology, University of Colorado, Denver, CO. https://twitter.com/BHimelhoch
| | - Victoria Huynh
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/THuynhMD
| | | | - Kshama Jaiswal
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/KshamaRJaiswal
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/ahrendt50
| | - Sharon Sams
- Department of Pathology, University of Colorado, Denver, CO
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/CTLin1
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Denver, CO; Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/ECumbler
| | - Richard Schulick
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/RichSchulickMD
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/SarahTevisMD
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8
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Talking Points: Enhancing Communication Between Radiologists and Patients. Acad Radiol 2022; 29:888-896. [PMID: 33846062 DOI: 10.1016/j.acra.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
Abstract
Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.
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Choi HH, Kotsenas AL, Chen JV, Bronsky C, Roth CJ, Kohli MD. Multi-institutional Experience with Patient Image Access Through Electronic Health Record Patient Portals. J Digit Imaging 2022; 35:320-326. [PMID: 35022926 PMCID: PMC8921401 DOI: 10.1007/s10278-021-00565-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022] Open
Abstract
The objective is to determine patients' utilization rate of radiology image viewing through an online patient portal and to understand its impact on radiologists. IRB approval was waived. In this two-part, multi-institutional study, patients' image viewing rate was retrospectively assessed, and radiologists were anonymously surveyed for the impact of patient imaging access on their workflow. Patient access to web-based image viewing via electronic patient portals was enabled at 3 institutions (all had open radiology reports) within the past 5 years. The number of exams viewed online was compared against the total number of viewable imaging studies. An anonymized survey was distributed to radiologists at the 3 institutions, and responses were collected over 2 months. Patients viewed 14.2% of available exams - monthly open rate varied from 7.3 to 41.0%. A total of 254 radiologists responded to the survey (response rate 32.8%); 204 were aware that patients could view images. The majority (155/204; 76.0%) felt no impact on their role as radiologists; 11.8% felt negative and 9.3% positive. The majority (63.8%) were never approached by patients. Of the 86 who were contacted, 46.5% were contacted once or twice, 46.5% 3-4 times a year, and 4.7% 3-4 times a month. Free text comments included support for healthcare transparency (71), concern for patient confusion and anxiety (45), and need for attention to radiology reports and image annotations (15). A small proportion of patients viewed their radiology images. Overall, patients' image viewing had minimal impact on radiologists. Radiologists were seldom contacted by patients. While many radiologists feel supportive, some are concerned about causing patient confusion and suggest minor workflow modifications.
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Affiliation(s)
- Hailey H Choi
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA.
| | - Amy L Kotsenas
- Mayo Clinic Rochester, 200 1st St. SW, Rochester, 55905, MN, USA
| | - Joshua Vic Chen
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA
| | - Christina Bronsky
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA
| | | | - Marc D Kohli
- University of California San Francisco, 505 Parnassus Ave., CA, San Francisco, 94143, USA
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Zhang Z, Kmoth L, Luo X, He Z. User-Centered System Design for Communicating Clinical Laboratory Test Results: Design and Evaluation Study. JMIR Hum Factors 2021; 8:e26017. [PMID: 34842529 PMCID: PMC8723791 DOI: 10.2196/26017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/19/2021] [Accepted: 09/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Personal clinical data, such as laboratory test results, are increasingly being made available to patients via patient portals. However, laboratory test results are presented in a way that is difficult for patients to interpret and use. Furthermore, the indications of laboratory test results may vary among patients with different characteristics and from different medical contexts. To date, little is known about how to design patient-centered technology to facilitate the interpretation of laboratory test results. Objective The aim of this study is to explore design considerations for supporting patient-centered communication and comprehension of laboratory test results, as well as discussions between patients and health care providers. Methods We conducted a user-centered, multicomponent design research consisting of user studies, an iterative prototype design, and pilot user evaluations, to explore design concepts and considerations that are useful for supporting patients in not only viewing but also interpreting and acting upon laboratory test results. Results The user study results informed the iterative design of a system prototype, which had several interactive features: using graphical representations and clear takeaway messages to convey the concerning nature of the results; enabling users to annotate laboratory test reports; clarifying medical jargon using nontechnical verbiage and allowing users to interact with the medical terms (eg, saving, favoriting, or sorting); and providing pertinent and reliable information to help patients comprehend test results within their medical context. The results of a pilot user evaluation with 8 patients showed that the new patient-facing system was perceived as useful in not only presenting laboratory test results to patients in a meaningful way but also facilitating in situ patient-provider interactions. Conclusions We draw on our findings to discuss design implications for supporting patient-centered communication of laboratory test results and how to make technology support informative, trustworthy, and empathetic.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Lukas Kmoth
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Xiao Luo
- School of Engineering & Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Zhe He
- School of Information, Florida State University, Tallahasse, FL, United States
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11
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Barrett SK, Patrie J, Kitts AB, Hanley M, Swanson CM, Vitzthum von Eckstaedt H, Krishnaraj A. Patient-centered Reporting in Radiology: A Single-site Survey Study of Lung Cancer Screening Results. J Thorac Imaging 2021; 36:367-372. [PMID: 34029279 DOI: 10.1097/rti.0000000000000591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess whether patients preferred traditional or patient-friendly radiology reports and, secondarily, whether one reporting style led to a subjective improvement in patients' understanding of their imaging results and next steps in their clinical care. MATERIALS AND METHODS This randomized study included patients who had previously enrolled in an institutional comprehensive lung cancer screening program. Three hundred patients were randomly selected from the program database to receive both traditional and patient-centered radiology reports. Randomization also occurred at both the risk level of the fictitious test results (low, intermediate, or high) and the order in which the reports were read by each participant. Participants completed a survey providing demographic information and indicating which report style was preferred and which report style led to a better understanding of screening results and future options. In addition, each report style was rated (from 1 to 5) for clarity, understandability, attractiveness, and helpfulness. RESULTS A total of 46 responses for report preference data and 41 responses for attribute rating data were obtained. Overall, participants demonstrate a preference for patient-friendly reports (65.2%) over traditional reports (21.7%). On a 5-point scale, average ratings for patient-friendly reports were higher than traditional reports by 1.2 (P<0.001) for clarity, 1.5 (P<0.001) for understandability, 1.5 (P<0.001) for attractiveness, and 1.0 (P<0.001) for helpfulness. CONCLUSION Data suggest that patients prefer patient-friendly reports over traditional reports and find them to be clearer, more comprehensible, more attractive, and more helpful.
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Affiliation(s)
- Spencer K Barrett
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | - James Patrie
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Michael Hanley
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | - Christina M Swanson
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
| | | | - Arun Krishnaraj
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA
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Patient and Provider Feedback for Radiology Reports: Implementation of a Quality Improvement Project in a Multi-Institutional Setting. J Am Coll Radiol 2021; 18:1430-1438. [PMID: 34171227 DOI: 10.1016/j.jacr.2021.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/10/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Radiology does not routinely solicit feedback on radiology reports. The aim of the study is to report the feasibility and initial results of a multi-institutional quality improvement project implementing patient and provider feedback for radiology reports. METHODS A HIPAA-compliant, institutional review board-waived quality improvement effort at two institutions obtaining patient and provider feedback for radiology reports was implemented from January 2018 to May 2020. INTERVENTION A two-question survey (quantitative review and open text box feedback) was embedded into the electronic health records for patients and providers. Text-based feedback was evaluated, and patterns of feedback were categorized: thoroughness of reports, error in reports, timeliness of reports, access to reports, desire for patient summary, and desire for key images. We performed the χ2 test for categorical variables. P < .05 was considered significant. RESULTS Of 367 responses, patients provided 219 of 367 (60%), and providers provided 148 of 367 (40%) of the feedback. A higher proportion of patients reported satisfaction with reports (76% versus 65%, P = .023) and provided more feedback compared with providers (71% versus 50%, P < .0001). Both patients and providers commented on the thoroughness of reports (12% of patients versus 9% of providers) and errors in reports (8% of patients and 9% of providers). Patients disproportionately commented on timeliness of reports (11%) and access to the reports (6%) compared with providers (3% each). In addition, 7% of patients expressed a desire for patient summaries. CONCLUSION Report-specific patient and provider feedback demonstrate the feasibility of embedding surveys into electronic medical records. Up to 9% of the feedback addressed an error in reports.
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13
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Mezrich JL, Jin G, Lye C, Yousman L, Forman HP. Patient Electronic Access to Final Radiology Reports: What Is the Current Standard of Practice, and Is an Embargo Period Appropriate? Radiology 2021; 300:187-189. [PMID: 33944630 DOI: 10.1148/radiol.2021204382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients have a right to their medical records, and it has become commonplace for institutions to set up online portals through which patients can access their electronic health information, including radiology reports. However, institutional approaches vary on how and when such access is provided. Many institutions have advocated built-in "embargo" periods, during which radiology reports are not immediately released to patients, to give ordering clinicians the opportunity to first receive, review, and discuss the radiology report with their patients. To understand current practices, a telephone survey was conducted of 83 hospitals identified in the 2019-2020 U.S. News & World Report Best Hospitals Rankings. Of 70 respondents, 91% (64 of 70) offered online portal access. Forty-two percent of those with online access (27 of 64 respondents) reported a delay of 4 days or longer, and 52% (33 of 64 respondents) indicated that they first send reports for review by the referring clinician before releasing to the patient. This demonstrates a lack of standardized practice in prompt patient access to health records, which may soon be mandated under the final rule of the 21st Century Cures Act. This article discusses considerations and potential benefits of early access for patients, radiologists, and primary care physicians in communicating health information and providing patient-centered care. © RSNA, 2021.
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Affiliation(s)
- Jonathan L Mezrich
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Grace Jin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Carolyn Lye
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Laurie Yousman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Howard P Forman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
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Computed Tomography for Abdominal Pain: Do Radiology Reports Answer the Clinical Question? Acad Radiol 2021; 28:671-675. [PMID: 32423766 DOI: 10.1016/j.acra.2020.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/15/2020] [Accepted: 03/18/2020] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES To assess whether abdominopelvic computed tomography (CT) radiology reports directly address a cause for pain when pain is included in the scan indication. MATERIALS AND METHODS Four hundred and ninety-five random abdominopelvic CT reports containing "pain" in the indication were retrospectively reviewed. The position of pain descriptors within the indication, the presence of an oncology-related indication in addition to pain and whether a cause for pain was addressed in the impression were recorded. Linguistic analysis of indication and impression sections was performed. Comparisons between reports that addressed pain and those that did not were conducted using Chi-square, Fisher exact, and two-tailed t-tests. RESULTS A cause for pain was addressed in 454 of 495 (91.7%) report impressions. Indications with both oncology-related and pain-related descriptors were less likely to have pain directly addressed (χ2 (1, N = 495) = 16.4, p < .001). There was no significant association between where pain appeared within the indication and whether pain was addressed (χ2 (1, N = 495) = 3.2, p = .07). Whether an impression conveyed a normal result did not influence if pain was addressed (p = .49). Impression word count and complexity were higher in the addressed group compared to the not addressed group (word count 66.6 vs. 51.9, p= .02, Composite grade level 30.1 vs. 25.3, p= .02). CONCLUSION Radiologists at our institution consistently addressed a cause for pain on abdominopelvic CTs when pain was in the indication. However, oncology patients who also had an indication of pain were less likely to have a cause for pain addressed. Impression complexity was high for all reports, though higher in those where pain was addressed.
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15
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Holder J, Tocino I, Facchini D, Nardecchia N, Staib L, Crawley D, Pahade JK. Current state of radiology report release in electronic patient portals. Clin Imaging 2021; 74:22-26. [PMID: 33429142 DOI: 10.1016/j.clinimag.2020.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of our study is to evaluate the current practice patterns of radiology report release into electronic patient portals. METHODS A survey to assess details of radiology report release was distributed to members of The Association of Administrators in Academic Radiology across the United States. Numerical analysis was used to calculate the frequencies and percentages for the clinical site, frequency and pattern of patient portal use were calculated. Statistical analysis determined the percentages and frequencies for the clinical site, frequency and pattern of patient portal use, as well as statistical differences. RESULTS A total of 31 (response rate = 28%, 31/108) at least partially completed surveys were received. Most (29/31, 94%) sites reported having a patient portal available with 80% (12/15) reporting < 50% patient utilization. There were no significant (p > 0.05) geographical differences noted in percentage utilization. Seventy-eight percent (21/27) of sites reported some form of automatic radiology report release into their portal. Mean delay was 4 days (range 0-7) from report completion to portal release. No correlation (r = 2) was seen between percentage of patient utilization of portals and timing of radiology report release. CONCLUSION Most academic centers across the country have patient portals, however, most of these centers report less than 50% utilization of the portals by patients. While variability in radiology report release in patient portals was noted, the majority (78%) of academic medical centers have some form of automatic report release with average delay of 4 days between report completion to portal release.
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Affiliation(s)
- Justin Holder
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America.
| | - Irena Tocino
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America
| | - David Facchini
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America
| | - Nicole Nardecchia
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America
| | - Lawrence Staib
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America
| | - Dan Crawley
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America
| | - Jay K Pahade
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, 333 Cedar Street, PO Box 208042, New Haven, CT, United States of America
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16
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Morgan MB, Mates JL. Applications of Artificial Intelligence in Breast Imaging. Radiol Clin North Am 2021; 59:139-148. [DOI: 10.1016/j.rcl.2020.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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17
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Abstract
Medicine is slowly transitioning toward a more patient-centered approach, with patients taking a more central role in their own care. A key part of this movement has involved giving patients increased access to their medical record and imaging results via electronic health portals. However, most patients lack the knowledge to fully understand medical documents, which are generally written above their comprehension level. Radiology reports, in particular, utilize complex terminology due to radiologists' historic function as consultants to other physicians, with little direct communication to patients. As a result, typical radiology reports lack standardized formatting, and they are often inscrutable to patients. Numerous studies examining patient preference also point to a trend for more accessible radiology reports geared toward patients. Reports designed with an infographic format, combining simple pictures and standardized text, may be an ideal format that radiologists can pursue to provide patient-centered care. Our team, through feedback from patient advisory groups, developed a patient-friendly low-dose computed tomography lung cancer screening report with an infographic format that is both visually attractive and comprehensible to the average patient. The report is designed with sections including a description of low-dose computed tomography, a section on individualized patient results, the meaning of the results, and a list of the next steps in their care. We believe that this form of the report has the potential to serve as a bridge between radiologists and patients, allowing for a better patient understanding of their health and empowering patients to participate in their health and health care.
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18
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Zhang Z, Citardi D, Xing A, Luo X, Lu Y, He Z. Patient Challenges and Needs in Comprehending Laboratory Test Results: Mixed Methods Study. J Med Internet Res 2020; 22:e18725. [PMID: 33284117 PMCID: PMC7752528 DOI: 10.2196/18725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background Patients are increasingly able to access their laboratory test results via patient portals. However, merely providing access does not guarantee comprehension. Patients could experience confusion when reviewing their test results. Objective The aim of this study is to examine the challenges and needs of patients when comprehending laboratory test results. Methods We conducted a web-based survey with 203 participants and a set of semistructured interviews with 13 participants. We assessed patients’ perceived challenges and needs (both informational and technological needs) when they attempted to comprehend test results, factors associated with patients’ perceptions, and strategies for improving the design of patient portals to communicate laboratory test results more effectively. Descriptive and correlation analysis and thematic analysis were used to analyze the survey and interview data, respectively. Results Patients face a variety of challenges and confusion when reviewing laboratory test results. To better comprehend laboratory results, patients need different types of information, which are grouped into 2 categories—generic information (eg, reference range) and personalized or contextual information (eg, treatment options, prognosis, what to do or ask next). We also found that several intrinsic factors (eg, laboratory result normality, health literacy, and technology proficiency) significantly impact people’s perceptions of using portals to view and interpret laboratory results. The desired enhancements of patient portals include providing timely explanations and educational resources (eg, a health encyclopedia), increasing usability and accessibility, and incorporating artificial intelligence–based technology to provide personalized recommendations. Conclusions Patients face significant challenges in interpreting the meaning of laboratory test results. Designers and developers of patient portals should employ user-centered approaches to improve the design of patient portals to present information in a more meaningful way.
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Affiliation(s)
- Zhan Zhang
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Daniel Citardi
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Aiwen Xing
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Xiao Luo
- School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Yu Lu
- School of Computer Science and Information Systems, Pace University, New York, NY, United States
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States
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El-Toukhy S, Méndez A, Collins S, Pérez-Stable EJ. Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey. J Am Board Fam Med 2020; 33:953-968. [PMID: 33219074 PMCID: PMC7849369 DOI: 10.3122/jabfm.2020.06.190402] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patient access to their medical records through patient portals (PPs) facilitates information exchange and provision of quality health care. Understanding factors that characterize patients with limited access to and use of PPs is needed. METHODS Data were from the 2017-2018 Health Information National Trends Survey 5, Cycles 1 and 2, a nationally representative survey of US adults ≥ 18 years old (n = 6789). Weighted multivariate logistic regressions modeled the associations between patient characteristics and access to, facilitators of use, and use of PPs and their functions. RESULTS Individuals without (vs with) a regular doctor (adjusted odds ratio [aOR], 0.4; CI, 0.3-0.5) or health insurance (aOR, 0.4; CI, 0.2-0.7), those with high school (aOR 0.4; CI, 0.3-0.5) or with vocational/some college (aOR, 0.5; CI, 04.-0.7) education (vs college/postgraduate), or those with limited English proficiency (vs those who speak English very well) (aOR, 0.7; CI, 0.5-0.9) were less likely to report accessing their personal medical records. Women (vs men) were more likely to report accessing their medical records (aOR, 1.5; CI, 1.2-1.8). Similar patterns were found for PPs access and facilitators of use. Less consistent associations emerged between patient characteristics and use of PP functionalities. CONCLUSIONS PP access and use are low. Having a primary care clinician, patient's educational attainment, and being a woman were factors associated with PP access and use, but not race/ethnicity. Once access was achieved, use of PP functionalities was generally uniform across demographic segments. Facilitating PP access and use among all patient populations is warranted.
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Affiliation(s)
- Sherine El-Toukhy
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS).
| | - Alejandra Méndez
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
| | - Shavonne Collins
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
| | - Eliseo J Pérez-Stable
- From the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD (SET); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (SET, AM); School of Medicine, Indiana University, Indianapolis (AM); School of Medicine, Emory University, Atlanta, GA (SC); Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (EJPS); Office of the Director, National Institute on Minority Health and Health Disparities, Bethesda, MD (EJPS)
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Garry K, Blecker S, Saag H, Szerencsy A, Jones SA, Testa P, Kang SK. Patient Experience With Notification of Radiology Results: A Comparison of Direct Communication and Patient Portal Use. J Am Coll Radiol 2020; 17:1130-1138. [DOI: 10.1016/j.jacr.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 11/16/2022]
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21
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Immediate Interpretation and Results Communication Decreases Patient Anxiety: Experience in a Private Practice Community Hospital. AJR Am J Roentgenol 2020; 214:1311-1315. [DOI: 10.2214/ajr.19.22264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Phillips AW, Landon RA, Stacy GS, Dixon L, Magee AL, Thomas SD, Dai X, Straus C. Optimizing the Radiology Experience through Radiologist-Patient Interaction. Cureus 2020; 12:e8172. [PMID: 32550085 PMCID: PMC7296885 DOI: 10.7759/cureus.8172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The goal of this survey-based study is to explore patients’ knowledge of and expectations for radiologists in the outpatient setting. Materials and Methods A comprehensive survey was distributed to adult patients undergoing knee magnetic resonance imaging (MRI) over a one-year period from September 2015 through August 2016 at an urban, quaternary care academic medical center. Results The survey results demonstrate that only a subset of patients undergoing knee MRI at the institution during the survey period are aware of the role of the radiologist, which is a well-documented fact described in the literature. Approximately one-third of patients expected to meet the radiologist during their visit to the department of radiology to undergo a knee MRI. The vast majority of patients surveyed wanted to be able to contact the person who read their exam, but only one patient actually contacted the radiologist during the study period. Conclusion While the vast majority of surveyed patients wanted to be able to contact the person who read their knee MRI, only one patient actually did reach out to the radiologist to discuss findings. However, six of 36 follow-up respondents reported that they had contacted the person “who interpreted/read your exam:” two in person, one by email, three by phone, and one by other. Survey results demonstrated that only a subset of patients correctly understood the role of the radiologist (46% in the 1st survey and 63% in the 2nd survey, which does not represent a statistically significant difference), which suggests that perhaps the patients did have a conversation with a member of the radiology department staff whom they believed was actually the radiologist. The fact that patients expressed a desire to communicate with the person reading their reports, but then did not take advantage of the opportunity to contact the radiologist, suggests that the issue is more complicated than just a lack of a pathway for communication between patients and radiologists. Perhaps the lack of a clear understanding of the role of the radiologist hinders patients from contacting radiologists, as they feel uncertain as to whom they are actually attempting to reach. Or perhaps patients are sufficiently reassured by having a means through which they could contact the radiologist and do not require the actual communication in order to feel comfortable. There remains a significant amount of work to be done in understanding the barriers in patient-radiologist communications.
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Affiliation(s)
| | - Rebecca A Landon
- Emergency Medicine, University of North Carolina, Chapel Hill, USA
| | | | - Larry Dixon
- Radiology, The University of Chicago Medicine, Chicago, USA
| | - Andrea L Magee
- Radiology, The University of Chicago Medicine, Chicago, USA
| | | | - Xi Dai
- Radiology, The University of Chicago Medicine, Chicago, USA
| | - Christopher Straus
- Nuclear Medicine, Thoracic Imaging, The University of Chicago Medicine, Chicago, USA.,Radiology, The University of Chicago Medicine, Chicago, USA
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Use of an Online Crowdsourcing Platform to Assess Patient Comprehension of Radiology Reports and Colloquialisms. AJR Am J Roentgenol 2020; 214:1316-1320. [PMID: 32208006 DOI: 10.2214/ajr.19.22202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE. The purpose of this study was to use an online crowdsourcing platform to assess patient comprehension of five radiology reporting templates and radiology colloquialisms. MATERIALS AND METHODS. In this cross-sectional study, participants were surveyed as patient surrogates using a crowdsourcing platform. Two tasks were completed within two 48-hour time periods. For the first crowdsourcing task, each participant was randomly assigned a set of radiology reports in a constructed reporting template and subsequently tested for comprehension. For the second crowdsourcing task, each participant was randomly assigned a radiology colloquialism and asked to indicate whether the phrase indicated a normal, abnormal, or ambivalent finding. RESULTS. A total of 203 participants enrolled for the first task and 1166 for the second within 48 hours of task publication. The payment totaled $31.96. Of 812 radiology reports read, 384 (47%) were correctly interpreted by the patient surrogates. Patient surrogates had higher rates of comprehension of reports written in the patient summary (57%, p < 0.001) and traditional unstructured in combination with patient summary (51%, p = 0.004) formats than in the traditional unstructured format (40%). Most of the patient surrogates (114/203 [56%]) expressed a preference for receiving a full radiology report via an electronic patient portal. Several radiology colloquialisms with modifiers such as "low," "underdistended," and "decompressed" had low rates of comprehension. CONCLUSION. Use of the crowdsourcing platform is an expeditious, cost-effective, and customizable tool for surveying laypeople in sentiment- or task-based research. Patient summaries can help increase patient comprehension of radiology reports. Radiology colloquialisms are likely to be misunderstood by patients.
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Cox J, Graham Y. Radiology and patient communication: if not now, then when? Eur Radiol 2019; 30:501-503. [PMID: 31359123 DOI: 10.1007/s00330-019-06349-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/10/2019] [Accepted: 06/28/2019] [Indexed: 11/24/2022]
Abstract
KEY POINTS • Communication with patients in radiology is, in general, indirect using the referrer as a conduit. • Direct patient communication may be beneficial for radiology departments and radiologists to improve patient awareness about the nature of our role and also to provide correct and measured information about the nature and frequency of discrepancies in radiology.
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Affiliation(s)
- Julie Cox
- Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Kayll Road, Sunderland, Tyne and Wear, SR4 7TP, UK. .,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sciences Complex, Sunderland, Tyne and Wear, SR1 3SD, UK.
| | - Yitka Graham
- Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Kayll Road, Sunderland, Tyne and Wear, SR4 7TP, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sciences Complex, Sunderland, Tyne and Wear, SR1 3SD, UK
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Arjunan A, Ben-Shachar R, Kostialik J, Johansen Taber K, Lazarin GA, Denne E, Muzzey D, Haverty C. Technology-Driven Noninvasive Prenatal Screening Results Disclosure and Management. Telemed J E Health 2019; 26:8-17. [PMID: 30807262 PMCID: PMC6948005 DOI: 10.1089/tmj.2018.0253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Noninvasive prenatal screening (NIPS) utilization has grown dramatically and is increasingly offered to the general population by nongenetic specialists. Web-based technologies and telegenetic services offer potential solutions for efficient results delivery and genetic counseling. Introduction: All major guidelines recommend patients with both negative and positive results be counseled. The main objective of this study was to quantify patient utilization, motivation for posttest counseling, and satisfaction of a technology platform designed for large-scale dissemination of NIPS results. Methods: The technology platform provided general education videos to patients, results delivery through a secure portal, and access to telegenetic counseling through phone. Automatic results delivery to patients was sent only to patients with screen-negative results. For patients with screen-positive results, either the ordering provider or a board-certified genetic counselor contacted the patient directly through phone to communicate the test results and provide counseling. Results: Over a 39-month period, 67,122 NIPS results were issued through the platform, and 4,673 patients elected genetic counseling consultations; 95.2% (n = 4,450) of consultations were for patients receiving negative results. More than 70% (n = 3,370) of consultations were on-demand rather than scheduled. A positive screen, advanced maternal age, family history, previous history of a pregnancy with a chromosomal abnormality, and other high-risk pregnancy were associated with the greatest odds of electing genetic counseling. By combining web education, automated notifications, and telegenetic counseling, we implemented a service that facilitates results disclosure for ordering providers. Discussion: This automated results delivery platform illustrates the use of technology in managing large-scale disclosure of NIPS results. Further studies should address effectiveness and satisfaction among patients and providers in greater detail. Conclusions: These data demonstrate the capability to deliver NIPS results, education, and counseling-congruent with professional society management guidelines-to a large population.
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Affiliation(s)
- Aishwarya Arjunan
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Rotem Ben-Shachar
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Jamie Kostialik
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | | | - Gabriel A Lazarin
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Elizabeth Denne
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Dale Muzzey
- Division of Medical Affairs, Counsyl, South San Francisco, California
| | - Carrie Haverty
- Division of Medical Affairs, Counsyl, South San Francisco, California
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Arenson RL. Building a Better Online Portal for Patients to Obtain Radiologic Results. Radiology 2019; 290:144-145. [DOI: 10.1148/radiol.2018182218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ronald L. Arenson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M391, San Francisco, CA 94143-0628
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Ravn Jakobsen P, Hermann AP, Søndergaard J, Wiil UK, Clemensen J. Help at hand: Women's experiences of using a mobile health application upon diagnosis of asymptomatic osteoporosis. SAGE Open Med 2018; 6:2050312118807617. [PMID: 30397471 PMCID: PMC6207955 DOI: 10.1177/2050312118807617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/24/2018] [Indexed: 01/12/2023] Open
Abstract
Objectives This study aims to test a mobile health application (mHealth app) developed to meet the needs of women newly diagnosed with asymptomatic osteoporosis. We investigate how the women experience using an mHealth app upon diagnosis of osteoporosis and whether the app can help them to be prepared for treatment decision-making and support them in osteoporosis self-management. We also tested the usability of the app, to find out whether any adjustments were necessary prior to implementation. Methods A test was conducted at a Danish university hospital with 18 women aged 50-65, newly diagnosed with asymptomatic osteoporosis. On presenting for a bone density scan at the hospital, they were provided with the app, which was named 'My Osteoporosis Journey'. Data were collected through semi-structured interviews. Giorgi's descriptive phenomenological method guided the data analysis in four steps. Findings In total, 17 women succeeded in downloading the app, thereby accessing information on asymptomatic osteoporosis, their bone density scan results and treatment recommendations prior to visiting their general practitioner. Three overall themes were identified. Women experienced that the app (1) gave a feeling of confidence and reassurance, (2) prepared the women on treatment decision-making in the general practitioner visit and (3) provided help at hand in self-management of osteoporosis. Conclusion Our findings show that the mHealth app helps women to feel confident and reassured upon diagnosis of asymptomatic osteoporosis. The women felt that the app promoted an equal dialogue in the osteoporosis consultation since they felt prepared for visiting their general practitioner and were able to articulate their individual needs regarding treatment. After diagnosis, the women felt that the app provided support in self-management, right at their fingertips.
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Affiliation(s)
- Pernille Ravn Jakobsen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,University College South Denmark, Haderslev, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Uffe Kock Wiil
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Woolen SA, Kazerooni EA, Steenburg SD, Nan B, Ma T, Wall A, Linna NB, Gayed MJ, Kushdilian MV, Parent K, Cahalan S, Alameddine M, Ladd LM, Davenport MS. Optimizing Electronic Release of Imaging Results through an Online Patient Portal. Radiology 2018; 290:136-143. [PMID: 30398436 DOI: 10.1148/radiol.2018180883] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine an optimal embargo period preceding release of radiologic test results to an online patient portal. Materials and Methods This prospective discrete choice conjoint survey with modified orthogonal design was administered to patients by trained interviewers at four outpatient sites and two institutions from December 2016 to February 2018. Three preferences for receiving imaging results associated with a possible or known cancer diagnosis were evaluated: delay in receipt of results (1, 3, or 14 days), method of receipt (online portal, physician's office, or phone), and condition of receipt (before, at the same time as, or after health care provider). Preferences (hereafter, referred to as utilities) were derived from parameter estimates (β) of multinomial regression stratified according to study participant and choice set. Results Among 464 screened participants, the response and completion rates were 90.5% (420 of 464) and 99.5% (418 of 420), respectively. Participants preferred faster receipt of results (P < .001) from their physician (P < .001) over the telephone (P < .001). Each day of delay decreased preference by 13 percentage points. Participants preferred immediate receipt of results through an online portal (utility, -.57) if made to wait more than 6 days to get results in the office and more than 11 days to get results by telephone. Compared with receiving results in their physician's office on day 7 (utility, -.60), participants preferred immediate release through the online portal without physician involvement if followed by a telephone call within 6 days (utility, -0.49) or an office visit within 2 days (utility, -.53). Older participants preferred physician-directed communication (P < .001). Conclusion The optimal embargo period preceding release of results through an online portal depends on the timing of traditional telephone- and office-based styles of communication. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Arenson et al in this issue.
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Affiliation(s)
- Sean A Woolen
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Ella A Kazerooni
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Scott D Steenburg
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Bin Nan
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Tianwen Ma
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Amber Wall
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Nathaniel B Linna
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Matthew J Gayed
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Michael V Kushdilian
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Kelly Parent
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Shannon Cahalan
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Mitchell Alameddine
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Lauren M Ladd
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Matthew S Davenport
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
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Schultz CL, Alderfer MA. Are on-line patient portals meeting test result preferences of caregivers of children with cancer? A qualitative exploration. Pediatr Blood Cancer 2018; 65:e27306. [PMID: 30007016 DOI: 10.1002/pbc.27306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Management of pediatric cancer entails frequent laboratory and radiology testing to monitor response to treatment, side effects, and possible relapse of disease. Little is known about how caregivers of children with cancer would like to receive results of these tests and whether on-line patient portals may meet those preferences. PROCEDURES One-on-one semistructured interviews were conducted with 19 caregivers of children with cancer purposively sampled for breadth on demographic characteristics. Inductive qualitative content coding/analysis was utilized to distill caregiver's preferred methods for test result acquisition and their views of using an on-line patient portal to do so. RESULTS The relative prioritization of speed of information and mode of communication (i.e., "in person," by phone, etc.) revealed three preference styles. Factors including type of testing, type of result, and the time course within their child's care modified these preferences, and the desire to reduce anxiety played a central role. Caregivers recognized advantages of portal use including getting results "fast," being able to visualize trends in results, "keeping a record," and not interfering with clinic flow. Perceived disadvantages included the results being "complicated" or easily misunderstood, and learning results prior to disclosure by care team. CONCLUSION This study provides insight into the importance of understanding of how caregivers want test results and how they utilize the portal. Preferences for result acquisition vary on many factors and include the desire to decrease anxiety. As portal use increases, we have a duty to integrate this technology responsibly.
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Affiliation(s)
- Corinna L Schultz
- Nemours Center for Cancer and Blood Disorders, Wilmington, Delaware.,Nemours/AI duPont Hospital for Children & Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Melissa A Alderfer
- Nemours/AI duPont Hospital for Children & Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.,Center for Healthcare Delivery Sciences, Wilmington, Delaware
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Communication errors in radiology – Pitfalls and how to avoid them. Clin Imaging 2018; 51:266-272. [DOI: 10.1016/j.clinimag.2018.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 05/11/2018] [Accepted: 05/31/2018] [Indexed: 12/21/2022]
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Vijayasarathi A, Kharkar R, Salamon N. Strategies for Patient-Centered Communication in the Digital Age. Curr Probl Diagn Radiol 2018; 48:210-215. [PMID: 30075879 DOI: 10.1067/j.cpradiol.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 01/08/2023]
Abstract
Recently, the major professional societies in Radiology have embarked upon a campaign to increase the patient-centeredness of Radiology. At the foundation of this initiative is direct communication between radiologist and patient, an area that has long been a deficiency for the field. Historically, there have been a number of barriers to effective radiologist-patient communication including logistical challenges, a negative impact on efficiency, and uncertainty of the role of the radiologist in discussing results with patients. The ubiquity of the internet and the wealth of applications that allow the safe transmission of robust information provide a number of opportunities for the radiologist. The purpose of this article is to review key web-based platforms that can improve communication, highlight unique initiatives being employed by thought leaders, and emphasize why radiologist-patient communication is paramount to the patient centered imaging experience.
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Affiliation(s)
- Arvind Vijayasarathi
- UCLA Department of Radiology, Neuroradiology Section, 757 Westwood Plaza, Room 1621D, Los Angeles, CA 90095.
| | - Renuka Kharkar
- Carl T Hayden Veterans Affairs Medical Center, Department of Psychiatry 650 E. Indian School Road, Phoenix AZ 85012-1892
| | - Noriko Salamon
- UCLA Department of Radiology, Neuroradiology Section, 757 Westwood Plaza, Room 1621D, Los Angeles, CA 90095
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Affiliation(s)
- Michael Shoffeitt
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
| | - Holly Lanham
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Patient-Centered Radiology Reporting: Using Online Crowdsourcing to Assess the Effectiveness of a Web-Based Interactive Radiology Report. J Am Coll Radiol 2018; 14:1489-1497. [PMID: 29101973 DOI: 10.1016/j.jacr.2017.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/21/2017] [Accepted: 07/25/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of a patient-centered web-based interactive mammography report. METHODS A survey was distributed on Amazon Mechanical Turk, an online crowdsourcing platform. One hundred ninety-three US women ≥18 years of age were surveyed and then randomized to one of three simulated BI-RADS® 0 report formats: standard report, Mammography Quality Standards Act-modeled patient letter, or web-based interactive report. Survey questions assessed participants' report comprehension, satisfaction with and perception of the interpreting radiologist, and experience with the presented report. Two-tailed t tests and χ2 tests were used to evaluate differences among groups. RESULTS Participants in the interactive web-based group spent more than double the time viewing the report than the standard report group (160.0 versus 64.2 seconds, P < .001). Report comprehension scores were significantly higher for the interactive web-based and patient letter groups than the standard report group (P < .05). Scores of satisfaction with the interpreting radiologist were significantly higher for the web-based interactive report and patient letter groups than the standard report group (P < .01). There were no significant differences between the patient letter and web-based interactive report groups. CONCLUSIONS Radiology report format likely influences communication effectiveness. For result communication to a non-medical patient audience, patient-centric report formats, such as a Mammography Quality Standards Act-modeled patient letter or web-based interactive report, may offer advantages over the standard radiology report. Future work is needed to determine if these findings are reproducible in patient care settings and to determine how best to optimize radiology result communication to patients.
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Giardina TD, Baldwin J, Nystrom DT, Sittig DF, Singh H. Patient perceptions of receiving test results via online portals: a mixed-methods study. J Am Med Inform Assoc 2018; 25:440-446. [PMID: 29240899 PMCID: PMC5885801 DOI: 10.1093/jamia/ocx140] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/14/2017] [Indexed: 02/05/2023] Open
Abstract
Objective Online portals provide patients with access to their test results, but it is unknown how patients use these tools to manage results and what information is available to promote understanding. We conducted a mixed-methods study to explore patients' experiences and preferences when accessing their test results via portals. Materials and Methods We conducted 95 interviews (13 semistructured and 82 structured) with adults who viewed a test result in their portal between April 2015 and September 2016 at 4 large outpatient clinics in Houston, Texas. Semistructured interviews were coded using content analysis and transformed into quantitative data and integrated with the structured interview data. Descriptive statistics were used to summarize the structured data. Results Nearly two-thirds (63%) did not receive any explanatory information or test result interpretation at the time they received the result, and 46% conducted online searches for further information about their result. Patients who received an abnormal result were more likely to experience negative emotions (56% vs 21%; P = .003) and more likely to call their physician (44% vs 15%; P = .002) compared with those who received normal results. Discussion Study findings suggest that online portals are not currently designed to present test results to patients in a meaningful way. Patients experienced negative emotions often with abnormal results, but sometimes even with normal results. Simply providing access via portals is insufficient; additional strategies are needed to help patients interpret and manage their online test results. Conclusion Given the absence of national guidance, our findings could help strengthen policy and practice in this area and inform innovations that promote patient understanding of test results.
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Affiliation(s)
- Traber D Giardina
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jessica Baldwin
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel T Nystrom
- Department of Biomedical Informatics, University of Utah, and VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Dean F Sittig
- Center for Healthcare Quality and Safety, School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Alpert JM, Morris BB, Thomson MD, Matin K, Brown RF. Implications of Patient Portal Transparency in Oncology: Qualitative Interview Study on the Experiences of Patients, Oncologists, and Medical Informaticists. JMIR Cancer 2018; 4:e5. [PMID: 29581090 PMCID: PMC5891668 DOI: 10.2196/cancer.8993] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/04/2017] [Accepted: 12/23/2017] [Indexed: 12/16/2022] Open
Abstract
Background Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledge. However, little is known about how patient portals are used in oncology. Objective The aim of this study was to understand attitudes of the portal’s adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. Methods In-depth semistructured interviews were conducted with 60 participants: 35 patients, 13 oncologists, and 12 medical informaticists. Interviews were recorded, transcribed, and thematically analyzed to identify critical incidents and general attitudes encountered by participants. Results Two primary themes were discovered: (1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists’ involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; (2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another’s culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. Conclusions The majority of patients (54%, 19/35) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure but still preferred face-to-face or telephone communication. Findings from this study indicate that portal education is needed for both patients and oncologists, especially when portals are implemented across entire health systems since highly specialized areas of medicine may have unique needs and uses. Patient portals in oncology can potentially alter the way diagnoses are delivered and how patients and oncologists communicate. Therefore, communication about the portal should be established during initial consultations so patients can decide whether they want to be informed in such a manner.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Bonny B Morris
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Khalid Matin
- Division of Hematology and Oncology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
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The Current State and Path Forward For Enterprise Image Viewing: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2018; 29:567-73. [PMID: 27473474 PMCID: PMC5023528 DOI: 10.1007/s10278-016-9887-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Clinical specialties have widely varied needs for diagnostic image interpretation, and clinical image and video image consumption. Enterprise viewers are being deployed as part of electronic health record implementations to present the broad spectrum of clinical imaging and multimedia content created in routine medical practice today. This white paper will describe the enterprise viewer use cases, drivers of recent growth, technical considerations, functionality differences between enterprise and specialty viewers, and likely future states. This white paper is aimed at CMIOs and CIOs interested in optimizing the image-enablement of their electronic health record or those who may be struggling with the many clinical image viewers their enterprises may employ today.
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Abstract
To empower patients to participate in their medical care and decision-making, effective communication is critical. In radiology, the clinical report is the primary medium of communication. Although radiologists historically have authored reports with the referring provider as the intended reader, patients increasingly access the reports through portals to electronic health record systems. We developed a system named PORTER (Patient-Oriented Radiology Reporter) to augment radiology reports with lay-language definitions. Our IRB-approved, HIPAA-compliant study protocol analyzed 100 knee MRI reports from an academic medical center to identify the most commonly utilized terms. A glossary of 313 terms was constructed to include definitions of the terms and, where available, links to reference sources and public-domain images. Flesch-Kincaid readability scores were computed to assure that definitions were readable at or below 10th-grade reading level. The system provided an interactive web site to view outpatient knee MRI exams. After logging in with their exam ID number and date of birth, patients viewed their report annotated with definitions from the glossary. Applicable images were displayed when the user's mouse hovered over a glossary term. This patient-oriented system can help empower patients to better understand their radiology results.
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Woolen S, Kazerooni EA, Wall A, Parent K, Cahalan S, Alameddine M, Davenport MS. Waiting for Radiology Test Results: Patient Expectations and Emotional Disutility. J Am Coll Radiol 2018; 15:274-281. [DOI: 10.1016/j.jacr.2017.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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Dy GW, Gore JL, Muncey WW, Ellison JS, Merguerian PA. Comparative effectiveness of a pilot patient-centered ultrasound report in the management of hydronephrosis. J Pediatr Urol 2018; 14:57.e1-57.e7. [PMID: 29054388 DOI: 10.1016/j.jpurol.2017.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/25/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Hydronephrosis is a common pediatric abnormality and can be associated with substantial parental anxiety, especially in the prenatal period. Radiology reports contain complex content that can be difficult for lay audiences to comprehend, potentially contributing to parental distress. MATERIALS AND METHODS We developed and piloted a patient-centered radiology report (PCRR) for renal ultrasounds (US) in children with hydronephrosis (Figure). We obtained consensus from a multidisciplinary panel of experts regarding critical US report components. A parent focus group provided input regarding syntax and formatting of a PCRR, incorporating elements deemed valuable by the expert panel. We prospectively recruited parents of children who underwent US for hydronephrosis and randomized parents to receive either the PCRR + standard report (SR) or SR alone. Web-based surveys assessed self-efficacy and knowledge of US elements. RESULTS Our pilot study included 20 SR patients and 24 PCRR patients, with no difference in demographic or disease characteristics between groups. Self-efficacy scores were uniformly high in both groups (p = 0.79). PCRR parents trended towards increased accuracy in identifying presence of severity (88% vs. 70%; p = 0.15) and bilaterality (67% vs. 45%; p = 0.15), with minimal difference in identifying parenchymal pathology (75% vs. 70%; p = 0.71) and bladder abnormalities (88% vs. 85%; p = 0.81). Parents were more confident in their ability to understand the PCRR (92% vs. 60%; p = 0.01). CONCLUSIONS A PCRR was associated with significantly higher confidence in US report interpretation, but was underpowered to demonstrate increased accuracy in identifying US findings. These findings justify future studies of PCRRs for hydronephrosis care.
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Affiliation(s)
- Geolani W Dy
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Wade W Muncey
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan S Ellison
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA; Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA
| | - Paul A Merguerian
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA; Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA.
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Automatic Release of Radiology Reports via an Online Patient Portal. J Am Coll Radiol 2017; 14:1219-1221. [DOI: 10.1016/j.jacr.2017.04.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/22/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
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Lee CI, Langlotz CP, Elmore JG. Implications of Direct Patient Online Access to Radiology Reports Through Patient Web Portals. J Am Coll Radiol 2017; 13:1608-1614. [PMID: 27888949 DOI: 10.1016/j.jacr.2016.09.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
In an era of increasing health information transparency and informed decision making, more patients are being provided with direct online access to their medical records, including radiology reports, via web-based portals. Although radiologists' narrative reports have previously been the purview of referring physicians, patients are now reading these on their own. Many potential benefits may result from patients reviewing their radiology reports, including improvements in patients' own understanding of their health, promotion of shared decision making and patient-physician communication, and, ultimately, improvements in patient outcomes. However, there may also be negative consequences, including confusion and anxiety among patients and longer patient-physician interactions. The rapid adoption of this new technology has led to major questions regarding ethics and professionalism for radiologists, including the following: Who is the intended audience of radiology reports? How should content be presented or worded? How will open access influence radiologists' relationships with patients and referring physicians? What legal ramifications may arise from increased patient access? The authors describe the current practices and research findings associated with patient online access to medical records, including radiology reports, and discuss several implications of this growing trend for the radiology profession.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Curtis P Langlotz
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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Jensen JD, Allen L, Blasko R, Nagy P. Using Quality Improvement Methods to Improve Patient Experience. J Am Coll Radiol 2017; 13:1550-1554. [PMID: 27888940 DOI: 10.1016/j.jacr.2016.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
Patient experience is an important component of the overall medical encounter. This paper explores how patient experience is measured and its role in radiology, including its impact on clinical outcomes and reimbursement. Although typically applied to safety and clinical outcomes, quality improvement methodology can also be used to drive improvement efforts centered on patient experience. Applying an established framework for patient-centered care to radiology, this paper provides a number of examples of projects that are likely to yield significant improvement in patient satisfaction measures.
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Affiliation(s)
- Jeff D Jensen
- Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
| | - Lisa Allen
- Johns Hopkins Health System, Baltimore, Maryland
| | | | - Paul Nagy
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hong MK, Feustel C, Agnihotri M, Silverman M, Simoneaux SF, Wilcox L. Supporting Families in Reviewing and Communicating about Radiology Imaging Studies. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2017; 2017:5245-5256. [PMID: 28920107 DOI: 10.1145/3025453.3025754] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Diagnostic radiology reports are increasingly being made available to patients and their family members. However, these reports are not typically comprehensible to lay recipients, impeding effective communication about report findings. In this paper, we present three studies informing the design of a prototype to foster patient-clinician communication about radiology report content. First, analysis of questions posted in online health forums helped us identify patients' information needs. Findings from an elicitation study with seven radiologists provided necessary domain knowledge to guide prototype design. Finally, a clinical field study with 14 pediatric patients, their parents and clinicians, revealed positive responses of each stakeholder when using the prototype to interact with and discuss the patient's current CT or MRI report and allowed us to distill three use cases: co-located communication, preparing for the consultation, and reviewing radiology data. We draw on our findings to discuss design considerations for supporting each of these use cases.
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Affiliation(s)
- Matthew K Hong
- School of Interactive Computing, Georgia Institute of Technology
| | - Clayton Feustel
- School of Interactive Computing, Georgia Institute of Technology
| | - Meeshu Agnihotri
- School of Interactive Computing, Georgia Institute of Technology
| | - Max Silverman
- School of Interactive Computing, Georgia Institute of Technology
| | | | - Lauren Wilcox
- School of Interactive Computing, Georgia Institute of Technology
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Johnson EJ, Doshi AM, Rosenkrantz AB. Strengths and Deficiencies in the Content of US Radiology Private Practices’ Websites. J Am Coll Radiol 2017; 14:431-435. [PMID: 27815055 DOI: 10.1016/j.jacr.2016.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 07/21/2016] [Accepted: 08/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Evan J Johnson
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York.
| | - Ankur M Doshi
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York
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Patel BN, Lopez JM, Jiang BG, Roth CJ, Nelson RC. Image-Rich Radiology Reports: A Value-Based Model to Improve Clinical Workflow. J Am Coll Radiol 2017; 14:57-64. [DOI: 10.1016/j.jacr.2016.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 12/16/2022]
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Pakpoor J. Should Radiologists Adapt to a New Audience? Acad Radiol 2017; 24:116. [PMID: 27765599 DOI: 10.1016/j.acra.2016.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Jina Pakpoor
- Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287
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Mervak BM, Davenport MS, Flynt KA, Kazerooni EA, Weadock WJ. What the Patient Wants: An Analysis of Radiology-Related Inquiries From a Web-Based Patient Portal. J Am Coll Radiol 2016; 13:1311-1318. [DOI: 10.1016/j.jacr.2016.05.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/20/2016] [Accepted: 05/27/2016] [Indexed: 11/26/2022]
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