structured reporting - potential, promise, and problems
TRANSCRIPT
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
