![7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language
https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 4/9
JACR presents Konski’s argument as a counterpoint to a piece in the same issue tled “Let Pa ents Decide How to Get
Their Radiologists’ Reports.” Its author is Andrea Borondy Ki s, MPH, MS, a Connec cut-based pa ent advocate who
lost her husband to lung cancer and blogs at JACRblog.org.
“I propose that pa ents be able to select their desired methods of receiving both images and radiologists’ reports at
the me their tests are ordered,” Borondy Ki s writes. “As we transi on to pa ent- and family-centered care in
radiology, it is important to provide op ons for pa ents to receive the main product provided by radiologists: their
expert opinions on what the pictures show and what these mean for the pa ents.”
Reports in context
Radiology reports don’t exist in a vacuum. As U.S. healthcare con nues adop ng value-based payment models using
use pa ent engagement and sa sfac on as key metrics, radiologists are exploring new ways to add value.
“‘Value’ is not just a new corporate buzzword [but rather] a fundamental goal of the new healthcare, which seeks to
improve the pa ent experience while maximizing outcomes and minimizing costs,” Gunn and colleagues write in a
2015 study published in the American Journal of Roentgenology.](https://image.slidesharecdn.com/httpswww-180710063531/85/The-pleasures-and-pitfalls-of-rendering-interpretations-in-layperson-s-language-4-320.jpg)
![7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language
https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 5/9
The authors describe how they created a pa ent-centered radiology prac ce by establishing a diagnos c radiology
consulta on clinic at Massachuse s General Hospital. Lead author Mark Mangano, MD, and colleagues surveyed
pa ents who’d had one of three types of imaging and then were given an opportunity to discuss their results with a
radiologist. Some 88 percent opted to have the radiology consults, and as a group they rated the session as “very
helpful” (mean, 4.8 on 1–5 scale). All par cipants who took the consult said they’d do it again. What’s more, all were
able to correctly iden fy the radiologist as a physician who interprets medical images.
Among their ideas for growth in this area, the authors name reviewing specific report terminology with pa ents “to
clarify and poten ally reduce pa ent anxiety while suppor ng referring physicians.”
Well and good, but are radiologists on board? Some are, some aren’t, Gunn suggests. To those who see pa ents
reading radiology reports as a thing to avoid as long as possible, he offers a reality check: The sooner you accept the
inevitable, the sooner you’ll be giving yourself a compe ve edge.
“You would an cipate that, as we transi on to value-based care, prac ces and radiologists who invested in this early
on would be ahead of the game,” Gunn says. “The ques on is, how do we demonstrate value?” The answer has less
to do with cranking out as many reads as possible, he adds, than with supplying expert clinical guidance.
It pays to go face to face
The me radiologists spend discussing radiology reports with pa ents is not reimbursable. But that shouldn’t be a
disincen ve to have the conversa ons, as the me commitment is modest, according to the authors of a study
posted online in JACR this past January, “Radiologists’ Experience with Pa ent Interac ons in the Era of Open Access
of Pa ents to Radiology Reports.”
Led by Jieming Fang, MD, a radiologist with Boston’s Beth Israel Deaconess Medical Center, the researchers surveyed
94 radiologists working at that medical center about their pa ent interac ons. They found fewer than one-fi h of
respondents had interac ons requiring more than 15 minutes, and they cite prior studies showing the average
discussion mes ranging from 7 to 10 minutes.
“[M]ost radiologists at our ins tu on would welcome more direct interac ons with their pa ents,” they write,
adding that “the vast majority of these radiologists do not subjec vely perceive these interac ons to be detrimental
to their normal workflow.”
Asked about the me commitment needed for going face-to-face with pa ents, Gunn emphasizes that today’s
radiologists face plenty of compe on. “Why will the referring physician send pa ents to your group versus another
group?” he says. “What service do you provide in addi on to that read?” He posits that the return on investment is
likely to take the form of loyalty from both pa ents and referring physicians.
Mark Raden, MD, a radiologist with Northwell Health and Staten Island University Hospital, agrees. Time spent
discussing images with pa ents is a good business investment and fosters loyalty, he points out. “We let them know
that we exist—‘I am Dr. So-and-So and I’m specially trained,’” he says. “They’re not just ge ng an MRI of the spine
and then seeing a bill with some guy’s name on it.”](https://image.slidesharecdn.com/httpswww-180710063531/85/The-pleasures-and-pitfalls-of-rendering-interpretations-in-layperson-s-language-5-320.jpg)
The pleasures and pitfalls of rendering interpretations in layperson’s language
- 1. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 1/9 June 28, 2018 | Milly Dawson | Imaging Informa cs When it comes to monitoring their own health, many of today’s pa ents expect fast access to all their info. Why wouldn’t they? Wearables record how many steps they walk each day. Smartphone apps tell them how much sleep they’re ge ng each night. If they have a chronic condi on, chances are there’s a specialized app for it. And on top of all that, according to the Na onal Coordinator for Health Informa on Technology, nearly three-quarters of U.S. hospitals now offer EMR-linked pa ent portals with view, download and transmit capabili es. To pa ents who embrace these opportuni es, craving the data and even applying the results to their lifestyle choices, medical images and reports register as being of a piece with all the rest of mHealth. Few would argue that they’re wrong to see things this way. The pleasures and pitfalls of rendering interpretations in layperson’s language
- 2. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 2/9 “Pa ents seeing their medical records and their images and reading their radiology reports—on the whole, I think it’s a good thing,” says David Hackney, MD, a radiologist a Boston’s Beth Israel Deaconess Medical Center and professor of radiology at Harvard Medical School. “It’s about them. They have the right to see every bit of it.” Of course, images are one thing. Most pa ents like to look even though they don’t know what to look for. Radiology reports, however, invite word-by-word scru ny. Hackney acknowledges that the language of radiology can be daun ng and some mes frightening even for highly educated, sophis cated pa ents with Google at their finger ps. “Last week I read a scan and men oned some incidental, insignificant thing that was there,” he explains, adding that the untroublesome finding was a pineal cyst. The pa ent researched the term online and became alarmed. “I spent a lot of me trying to tell this pa ent that the finding is completely insignificant, that it didn’t ma er for their life,” says Hackney. “Then I tried, with less success, to explain what it actually was.” Despite the occasional cases of misplaced anxiety, Beth Israel has long given pa ents ready access to all their medical records, including radiology images and reports. And Hackney is confident that the advantages of such clinical transparency outweigh any drawbacks. He’s not alone. Numerous surveys and studies have shown high pa ent interest in radiology reports. And, as far back as 2011, approximately 90 percent of radiologists were incen vized by CMS to improve access to health data— including via radiology reports (reference: Lee et al., “Implica ons of Direct Pa ent Online Access to Radiology Reports Through Pa ent Web Portals,” JACR, December 2016). The momentum is clearly in favor of greater direct-to-pa ent radiology repor ng. However, the consensus among experts and observers seems to be that radiologists need to think like a layperson on the receiving end. In most cases this means checking for clarity over ambiguity, an cipa ng poten al trip-ups and generally taking care to minimize the risk of stressing pa ents out rather than filling them in.
- 3. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 3/9 Several schools of thought When pa ents see their radiology images and reports, they o en have ques ons and concerns that no clinician is be er qualified to address than a radiologist. So asserts Andrew “AJ” Gunn, MD, an interven onal radiologist and assistant professor at the University of Alabama at Birmingham (UAB). “I don’t think we can rely on primary-care doctors or non-imaging experts to be able to explain the subtle detail of the wording used in the report,” he says. “Si ng down with the pa ent to explain can be really helpful.” Doing so is surely easier for interven onalists and breast specialists than for other diagnos c rads. Either way, a slightly different take gets an airing in the October 2017 edi on of JACR. In an opinion piece tled “Pa ents Should Not Have Unchaperoned Access to Radiology Reports,” Andre Konski, MD, MBA, professor of clinical radia on oncology at Penn Medicine, makes the case that pa ent access and review of radiology reports should take place only when a qualified care professional—not necessarily a radiologist—is available to serve as an informa on chaperon. “I am not arguing pa ents should not have access to their EHR,” Konski writes, “but they should have access to them with their physicians, who are able to explain the findings on the report in a way the pa ent can understand and in the context of the pa ent’s disease course. Only then can unintended consequences of pa ent distress be averted.”
- 4. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 4/9 JACR presents Konski’s argument as a counterpoint to a piece in the same issue tled “Let Pa ents Decide How to Get Their Radiologists’ Reports.” Its author is Andrea Borondy Ki s, MPH, MS, a Connec cut-based pa ent advocate who lost her husband to lung cancer and blogs at JACRblog.org. “I propose that pa ents be able to select their desired methods of receiving both images and radiologists’ reports at the me their tests are ordered,” Borondy Ki s writes. “As we transi on to pa ent- and family-centered care in radiology, it is important to provide op ons for pa ents to receive the main product provided by radiologists: their expert opinions on what the pictures show and what these mean for the pa ents.” Reports in context Radiology reports don’t exist in a vacuum. As U.S. healthcare con nues adop ng value-based payment models using use pa ent engagement and sa sfac on as key metrics, radiologists are exploring new ways to add value. “‘Value’ is not just a new corporate buzzword [but rather] a fundamental goal of the new healthcare, which seeks to improve the pa ent experience while maximizing outcomes and minimizing costs,” Gunn and colleagues write in a 2015 study published in the American Journal of Roentgenology.
- 5. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 5/9 The authors describe how they created a pa ent-centered radiology prac ce by establishing a diagnos c radiology consulta on clinic at Massachuse s General Hospital. Lead author Mark Mangano, MD, and colleagues surveyed pa ents who’d had one of three types of imaging and then were given an opportunity to discuss their results with a radiologist. Some 88 percent opted to have the radiology consults, and as a group they rated the session as “very helpful” (mean, 4.8 on 1–5 scale). All par cipants who took the consult said they’d do it again. What’s more, all were able to correctly iden fy the radiologist as a physician who interprets medical images. Among their ideas for growth in this area, the authors name reviewing specific report terminology with pa ents “to clarify and poten ally reduce pa ent anxiety while suppor ng referring physicians.” Well and good, but are radiologists on board? Some are, some aren’t, Gunn suggests. To those who see pa ents reading radiology reports as a thing to avoid as long as possible, he offers a reality check: The sooner you accept the inevitable, the sooner you’ll be giving yourself a compe ve edge. “You would an cipate that, as we transi on to value-based care, prac ces and radiologists who invested in this early on would be ahead of the game,” Gunn says. “The ques on is, how do we demonstrate value?” The answer has less to do with cranking out as many reads as possible, he adds, than with supplying expert clinical guidance. It pays to go face to face The me radiologists spend discussing radiology reports with pa ents is not reimbursable. But that shouldn’t be a disincen ve to have the conversa ons, as the me commitment is modest, according to the authors of a study posted online in JACR this past January, “Radiologists’ Experience with Pa ent Interac ons in the Era of Open Access of Pa ents to Radiology Reports.” Led by Jieming Fang, MD, a radiologist with Boston’s Beth Israel Deaconess Medical Center, the researchers surveyed 94 radiologists working at that medical center about their pa ent interac ons. They found fewer than one-fi h of respondents had interac ons requiring more than 15 minutes, and they cite prior studies showing the average discussion mes ranging from 7 to 10 minutes. “[M]ost radiologists at our ins tu on would welcome more direct interac ons with their pa ents,” they write, adding that “the vast majority of these radiologists do not subjec vely perceive these interac ons to be detrimental to their normal workflow.” Asked about the me commitment needed for going face-to-face with pa ents, Gunn emphasizes that today’s radiologists face plenty of compe on. “Why will the referring physician send pa ents to your group versus another group?” he says. “What service do you provide in addi on to that read?” He posits that the return on investment is likely to take the form of loyalty from both pa ents and referring physicians. Mark Raden, MD, a radiologist with Northwell Health and Staten Island University Hospital, agrees. Time spent discussing images with pa ents is a good business investment and fosters loyalty, he points out. “We let them know that we exist—‘I am Dr. So-and-So and I’m specially trained,’” he says. “They’re not just ge ng an MRI of the spine and then seeing a bill with some guy’s name on it.”
- 6. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 6/9 A er talking with their radiologist, Raden adds, pa ents are likely u er some varia on on a statement every physician wants to hear: “Next me I need this service, I’m coming back to you.” Words that work for pa ents How best to provide pa ent-friendly radiology reports? Research into that ques on is ongoing. In a survey-based study published in in the November 2017 edi on of JACR, Ryan Short, MD, of Duke and colleagues looked at the use of crowdsourcing to assess the effec veness of an in-terac ve radiology report available to pa ents online. They found the format of the report, including not only terminology but also display components—hover-over text op ons, popup nota ons and so on—likely influences the effec veness of the end aim of pa ent access to radiology reports: communica on. “Pa ent-centered reports, such as a simple-language pa ent le er or a web-based interac ve radiology report, may offer advantages in pa ent communica on over the standard radiology report, including improvements in pa ent engagement, report comprehension and sa sfac on with radiologists,” Short and co-authors write. Whatever methods of report access go on to become best prac ces, Gunn believes the healthcare market probably won’t be kind to those who take a wait-and-see approach. “Do you want to be involved in a prac ce that is si ng s ll and not moving forward?” he asks, rhetorically. “If you hunker down in hopes that this trend is going away, you will be le behind.”
- 7. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 7/9 More in Imaging Informa cs Informa cs approach improves workflow, pa ent care in IVC filter Implemen ng a tracking system helps improve IVC filter retrieval rate AHRA survey: Many imaging providers have not started CDS implementa on Modified TI-RADS standardizes thyroid cancer repor ng among radiologists What’s the decision on decision support? Real- me loca on systems streamline workflow, improve pa ent sa sfac on Produc vity metrics reports improve efficiency in radiology departments Why the FHIR interoperability standard is great for radiology Res ng state fMRI fails less than standard fMRI for cogni ve analysis Convolu onal neural network reveals 'choices'—and why they were made—in classifying re nal images
- 8. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 8/9
- 9. 7/10/2018 The pleasures and pitfalls of rendering interpretations in layperson’s language https://www.radiologybusiness.com/topics/imaging-informatics/pleasures-and-pitfalls-rendering-interpretations-laypersons-language 9/9