Structured Reports in Radiology

“Promise, Potential, and Problems”

Matt Hawkins, MDAssistant Professor – Emory University SOM

• History/context of structured reports

• Variations of structured reports

• Data

• Change management

OUTLINE

• History/context of structured reports

• Variations of structured reports

• Data

• Change management

OUTLINE

• Structured reports first introduced by Preston M. Hickey, MD• 1922

• “The ARRS should recommend a standardized nomenclature to be used in writing roentgenological reports.”

HISTORY

• Structured reports first introduced by Preston M. Hickey, MD• 1922

• “The ARRS should recommend a standardized nomenclature to be used in writing roentgenological reports.”

HISTORY

• RADLEX introduced in 2006

HISTORY

• Keys to radiology report

CONTEXT

CLARITY

CORRECTNESSCONFIDENCE

CONCISE

COMPLETENESS

CONSISTENCY

Reiner et al. JACR 2007; 4:313-319.

• Keys to radiology report

CONTEXT

COMMUNICATION

CONSULTATION

Reiner et al. JACR 2007; 4:313-319.

• Strengths of Structure

• Eliminates ambiguity• Creates mineable data• Auto-population of data• Standardized follow-up• Billing/compliance

CONTEXT

Reiner et al. JACR 2007; 4:313-319.

CONTEXT

CONTEXT

• What do we prefer?

CONTEXT

Naik et al. AJR 2001; 176:591-598.

• What do we prefer?

CONTEXT

86% of referring clinicians preferred detailed structure

Naik et al. AJR 2001; 176:591-598.

• What do we prefer?

CONTEXT

56% of radiologists preferred detailed structure

Naik et al. AJR 2001; 176:591-598.

• History/context of structured reports

• Variations of structured reports

• Data

• Change management

OUTLINE

• “Structured” has different meanings

• Pure structure• Structured template; no structured

content• Structured “normals”• Hybrid

VARIATIONS

• “Structured” has different meanings

• Purely structured reports have been ridiculed• Johnson et al – free-text reports had

greater clarity approx. 80% of the time

VARIATIONS

Johnson et al. JACR 2010;7:501-506.

• “Structured” has different meanings

VARIATIONS

VARIATIONS

• History/context of structured reports

• Variations of structured reports

• Data

• Change management

OUTLINE

• Structure is great, but does it fix everything?

DATA on STRUCTURE

DATA on STRUCTURE

60% of reports have errors (1.73 errors per report)

DATA on STRUCTURE

36% of reports have non-grammatical errors

DATA on STRUCTURE

0.02 errors per dictated word

DATA on STRUCTURE

Missense errors = 12% of all errors (0.21 per report)

DATA on STRUCTURE

Omission errors = 10.1% of all errors

DATA on STRUCTUREOmission errors that change the meaning of a sentence =

1.2% of all errors

DATA on STRUCTURE

DATA on STRUCTURE

26% of reports contained non-grammatical errors (p=0.024)

DATA on STRUCTURE

Missense omission errors: 3.5% 1.2% (p=0.0175)

DATA on STRUCTURE

Comission errors: 3.9% 0.8% (p=0.0007)

DATA on STRUCTURE

37% of reports STILL had errors

• History/context of structured reports

• Variations of structured reports

• Data

• Change management

OUTLINE

Change Management

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early

Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informatics team early

Change Management

Matt Hawkins, MD@MattHawkinsMD

matt.hawkins@emory.edu