Creating value with better communication

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 - Doctor Communciation

Hailing a taxi used to be a low-tech process. You’d walk out to the street and raise your hand, sometimes whistle, and a nearby cab would see you and take you on your way.

Then came Uber.

Of course, you can still hail cabs the old fashioned way, but Uber’s app-based design simplified the process of getting and paying for ground transport at the push of a button using your smartphone. Is there a lesson here for radiology?

Po-Hao Chen, MD, MBA, chief resident in radiology at the Hospital of the University of Pennsylvania, thinks so. Chen, who is interested in the study of informatics and has blogged for the Society of Imaging Informatics in Medicine, sees parallels in the way Uber upended the traditional chain of communication for hailing a cab with the changes that are happening in medicine.

“The biggest lesson with Uber is that it simply proves that better communication alone creates massive value,” says Chen.

Uber’s big innovation is creating a system of communication that didn’t exist previously, one that creates value by improving on the inefficiencies of the past.

Drilling way down to basics, Chen explains that communication requires two to tango. He points to an article published in the American Journal of Roentgenology by David Larson, MD, of the department of radiology at Stanford University School of Medicine, and colleagues, which delves into the media synchronicity theory. This theory states that communication must feature both conveyance and convergence, essentially sending and receiving a message.

In healthcare generally, and radiology specifically, these concepts are easily illustrated. If a radiologist picks up a phone and calls a referring provider, the conveyance and convergence is happening at the same time. Since this isn’t practical at all times, asynchronous communication has been a major focus area in communication between physicians—namely the automated emails and texts that can be generated during an interpretation and sent to referrers to read at their convenience.

The lesson for radiologists from Uber is that it’s important to know the balance between synchronous and asynchronous communication.

“It’s important to have communication available to [clinicians] when they’re most available rather than a predetermined time, but at the same time, we can’t get so drowned in the expediency of asynchronous communication that we forget some information is best communicated face-to-face or on the telephone,” says Chen.

In addition to the asynchronous communication leveraged by Uber to hail a cab at the push of a button, the app makes it easy to also call or text drivers, in cases where direct—or synchronous—communication is more helpful.

This balance between synchronous and asynchronous communication is more important that emphasizing one or the other, says Chen. He add that as communication in radiology continues to be refined, that there is a focus on the ability to triage communication. Messages between physicians can escalate from an email or tweet to a text to a phone call, depending on the urgency of the matter, with automated systems helping to coordinate.

Boosting value

Aside from balancing the synchronicity, Chen sees other areas where communication in radiology could be improved.

Radiologists and referring providers need to understand what each means by the terms they use, or else they risk talking past each other. For example, says Chen, a radiologist could mention a consolidation in the lungs that is really just a white spot signaling pneumonia, cancer or a number of other things, whereas the referrer might assume it to be pneumonia in the absence of more detail from the radiologist.

“Radiologists using a specific lexicon is more precise, but the problem is clinicians don’t always know the clinical applicability of those comments,” says Chen.

The other area of potential innovation could come on the front end of an imaging order, in the way that an indication is relayed. Chen notes that referrers don’t always have the time or space needed to fully communicate important information on why a study was requested, often defaulting to a drop-down list of limited options.

“[Indications are] kind of like a Magic Eight Ball,” quips Chen. “You only get the answer you’re looking for if you asked the right question.”

To help physicians ask more thorough questions with indications, Chen says additional options should be available besides a drop-down menu of common indications or a small text box. One