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Kim M, Lovett JT, Doshi AM, Prabhu V. Immediate Access to Radiology Reports: Perspectives on X Before and After the Cures Act Information Blocking Provision. J Am Coll Radiol 2024; 21:1130-1140. [PMID: 38147904 DOI: 10.1016/j.jacr.2023.12.015] [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: 09/03/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE The 21st Century Cures Act's information blocking provision mandates that patients have immediate access to their electronic health information, including radiology reports. We evaluated public opinions surrounding this policy on X, a microblogging platform with over 400 million users. METHODS We retrieved 27,522 posts related to radiology reports from October 5, 2020, through October 4, 2021. One reviewer performed initial screening for relevant posts. Two reviewers categorized user type and post theme(s) using a predefined coding system. Posts were grouped as "pre-Cures" (6 months before information blocking) and "post-Cures" (6 months after). Descriptive statistics and χ2 tests were performed. RESULTS Among 1,155 final posts, 1,028 unique users were identified (64% patients, 11% non-radiologist physicians, 4% radiologists). X activity increased, with 40% (n = 462) pre-Cures and 60% (n = 693) post-Cures. Early result notification before referring providers was the only theme that significantly increased post-Cures (+3%, P = .001). Common negative themes were frustration (33%), anxiety (27%), and delay (20%). Common positive themes were gratitude for radiologists (52%) and autonomy (21%). Of posts expressing opinions on early access, 84% favored and 16% opposed it, with decreased preference between study periods (P = .006). More patients than physicians preferred early access (92% versus 40%, P < .0001). DISCUSSION X activity increased after the information blocking provision, partly due to conversation about early notification. Despite negative experiences with reports, most users preferred early access. Although the Cures Act is a positive step toward open access, work remains to improve patients' engagement with their radiology results.
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Affiliation(s)
- Michelle Kim
- NYU Langone Health, Department of Radiology, New York, New York.
| | | | - Ankur M Doshi
- Associate Professor and Associate Clinical Director, Radiology Informatics, NYU Langone Health, Department of Radiology, New York, New York
| | - Vinay Prabhu
- Clinical Assistant Professor, Associate Program Director, and Body MRI Fellowship, NYU Langone Health, Department of Radiology, New York, New York
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de Haan J, Stoop M, van Zuijlen PPM, Pijpe A. Thermal Imaging for Burn Wound Depth Assessment: A Mixed-Methods Implementation Study. J Clin Med 2024; 13:2061. [PMID: 38610828 PMCID: PMC11012455 DOI: 10.3390/jcm13072061] [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: 02/10/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Implementing innovations emerging from clinical research can be challenging. Thermal imagers provide an accessible diagnostic tool to increase the accuracy of burn wound depth assessment. This mixed-methods implementation study aimed to assess the barriers and facilitators, design implementation strategies, and guide the implementation process of thermal imaging in the outpatient clinic of a burn centre. Methods: This study was conducted between September 2022 and February 2023 in Beverwijk, The Netherlands. Semi-structured interviews with burn physicians guided by the Consolidated Framework for Implementation Research (CFIR) were conducted to identify barriers and facilitators. Based on the barriers, implementation strategies were developed with the CFIR-ERIC Matching Tool, and disseminated to support the uptake of the thermal imager. Subsequently, thermal imaging was implemented in daily practice, and an iterative RE-AIM approach was used to evaluate the implementation process. Results: Common facilitators for the implementation of the thermal imager were the low complexity, the relative advantage above other diagnostic tools, and benefits for patients. Common barriers were physicians' attitude towards and perceived value of the intervention, the low compatibility with the current workflow, and a lack of knowledge about existing evidence. Six implementation strategies were developed: creating a formal implementation blueprint, promoting adaptability, developing educational materials, facilitation, conducting ongoing training, and identifying early adopters. These strategies resulted in the effective implementation of the thermal imager, reflected by a >70% reach among eligible patients, and >80% effectiveness and adoption. Throughout the implementation process, compatibility, and available resources remained barriers, resulting in low ratings on RE-AIM dimensions. Conclusions: This study developed implementation strategies based on the identified CFIR constructs that impacted the implementation of a thermal imager for burn wound assessment in our outpatient clinic. The experiences and findings of this study could be leveraged to guide the implementation of thermal imaging and other innovations in burn care.
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Affiliation(s)
- Jesse de Haan
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
| | - Matthea Stoop
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
- Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centers, 1941 AJ Beverwijk, The Netherlands
| | - Paul P. M. van Zuijlen
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
- Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Paediatric Surgical Center, Emma Children’s Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, 1081 HV Amsterdam, The Netherlands
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands; (J.d.H.); or (M.S.); or (P.P.M.v.Z.)
- Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Association of Dutch Burn Centers, 1941 AJ Beverwijk, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, 1081 HV Amsterdam, The Netherlands
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Deng J, Heybati K, Shammas-Toma M. When vision meets reality: Exploring the clinical applicability of GPT-4 with vision. Clin Imaging 2024; 108:110101. [PMID: 38341880 DOI: 10.1016/j.clinimag.2024.110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Affiliation(s)
- Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew Shammas-Toma
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Loftus JR, Kadom N, Baran TM, Hans K, Waldman D, Wandtke B. Impact of Early Direct Patient Notification on Follow-Up Completion for Nonurgent Actionable Incidental Radiologic Findings. J Am Coll Radiol 2024; 21:558-566. [PMID: 37820835 DOI: 10.1016/j.jacr.2023.07.026] [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: 05/29/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The aim of this study was to evaluate whether early direct patient notification in addition to an existing multistage recommendation-tracking system (Backstop) increases follow-up completion rates for actionable incidental findings (AIFs). Patient attitudes toward early notification were also assessed. METHODS This prospective, randomized controlled trial recruited patients with AIFs requiring follow-up being enrolled into the Backstop system. Patients were randomized into four groups: those receiving additional early direct notification in a mailed letter (group 1, similar to Pennsylvania Act 112), by phone (group 2), or in an electronic portal message (group 3) and a control group (group 4) without additional notifications added to the existing Backstop system. Differences in follow-up completion rates among these groups were determined using χ2 tests. Patients were surveyed on binary yes/no and Likert-type scale questions, and descriptive statistics are reported. RESULTS Data from 2,548 randomized patients were analyzed for the study, including 593 patients notified by letter, 637 notified by phone, 701 notified by portal, and 617 control patients. Group 3 demonstrated the lowest rate of follow-up completion within 1 month of the follow-up due date at 36.4%, compared with 58.7% for group 1, 60.4% for group 2, and 53.2% for group 4 (P < .0001 for all). Group 2 was the only group to have a significantly higher completion rate than group 4 (P = .014). Patients responded positively regarding early notification and preferred electronic portal communication. CONCLUSIONS Early direct notification had a mixed impact on follow-up completion rates on the basis of communication modality but was positively received by patients and may have health care benefits when implemented within a recommendation-tracking system.
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Affiliation(s)
- James Ryan Loftus
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York.
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory Healthcare, Atlanta, Georgia; Chair, ACR Metrics Committee; Interim Medical Director for Radiology Quality, Emory Healthcare, Atlanta, Georgia
| | - Timothy M Baran
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - Kristen Hans
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - David Waldman
- Chief Medical IT Development Officer and Associate Vice President, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
| | - Ben Wandtke
- Vice Chair of Quality and Safety, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York
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Petrovskaya O, Karpman A, Schilling J, Singh S, Wegren L, Caine V, Kusi-Appiah E, Geen W. Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review. J Med Internet Res 2023; 25:e43765. [PMID: 37856174 PMCID: PMC10623227 DOI: 10.2196/43765] [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: 10/24/2022] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.
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Affiliation(s)
| | - Albina Karpman
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | | | - Simran Singh
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Larissa Wegren
- South Health Campus, Women's Health, Calgary, AB, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Willow Geen
- School of Nursing, University of Victoria, Victoria, BC, Canada
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