Structured reporting in radiology has its detractors, but few would argue against the proposition that the days are numbered for traditional free-text narrative reports. The latter vary too much in language, length and style to consistently aid referring physicians making care decisions—a potentially serious demerit in the “prove your value” care era—while structured reporting offers a way to improve on not only consistency and actionability but also profession-wide quality.
In so many words, that’s the summary conclusion of a task force on structured reporting convened by the Association of University Radiologists and its Radiology Research Alliance.
The task force’s report, published online Oct. 10 in Academic Radiology, acknowledges that structured reporting is a work in progress while suggesting ways for rad practices to overcome its challenges and successfully leverage its strengths.
Along the way, lead author Dhakshinamoorthy Ganeshan, MD, of the University of Texas, senior author Isaac Francis, MD, of the University of Michigan and colleagues itemize eight upsides to implementing structured radiology reporting, along with five difficulties to reckon with.
Here are their lists.
- Disease-specific report templates can improve report clarity and quality, and ensure consistent use of terminology across practices.
- Checklist style reports can reduce diagnostic errors (such as failing to report incidental renal cell carcinoma in a magnetic resonance spine performed for back pain).
- Structured reporting can reduce grammatical and nongrammatical digital speech recognition errors;
- ensures completeness of radiology report documentation and thereby improves radiology reimbursement;
- may be financially rewarding under the new Medicare Merit-based Incentive Payment System;
- positively impacts research in radiology by facilitating data mining;
- provides opportunities for quality improvement; and
- can help promote evidence-based medicine by integrating clinical decision support tools with radiology reports.
Limitations and challenges:
- Radiologists may be resistant to change.
- Learning curve associated with new reporting style may negatively impact radiology workflow and productivity.
- Potentially increased error rates if used improperly (e.g., failing to remove the prepopulated phrase of “normal gallbladder” in a patient who is post-cholecystectomy).
- Interruption of visual search pattern may increase reporting time.
- Including unnecessary or irrelevant information in a template report may negatively impact the coherence of the report and its subsequent comprehension by referring physicians.
“Use of structured radiology reports is important in our pursuit for practicing precision medicine,” the task force concludes. “By using standardized terminology, structured reports enhance clarity and improve communication of radiological findings.”
Moreover, the authors add, the ease with which data can be mined from structured reports can lead to better research and more finely tuned QA projects.
“Although structured radiology reporting faces challenges such as depersonalization of radiology reports and workflow and productivity issues, these problems can be overcome with concerted effort from the radiology community,” Ganeshan et al. write. “Promoting further research evaluating the impact of structured radiology reporting on patient outcomes may help increase its use across radiological practices worldwide.”