Virtual consults please rads as well as referrers, but workflow disruption may hinder widespread adoption

A “virtual consult” system based on instant messaging and real-time image sharing between radiologists and referrers has been tried and found worthwhile on both ends at a large teaching hospital. However, the rads weren’t entirely thrilled by the disruptions to their normal workflows.

Reporting their results April 12 in the Journal of the American College of Radiology, Andrew Rosenkrantz, MD, and colleagues at NYU Langone Medical Center in Manhattan describe their system connecting 74 referrers and 47 radiologists in 110 virtual consultation (VC) sessions.

During the test period, the referrers accessed the VC through the EMR while the rads tapped in with their PACS.

Upon reviewing clinical exam reports, the referrers could click a VC link. This would initiate an instant-messaging session with the appropriate subspecialist radiologist, who received an alert and a link to the report and its associated images.

The two then discussed the case in the instant-message field, and either one could control an optional real-time screen share of the radiologist’s PACS display.

Perhaps not surprisingly, ED physicians were the most eager users of the system (27.3 percent of the cohort). The authors note that this was likely so because the ED docs could use the system to “solicit rapid interpretations of recently completed examinations before official report dictation and thereby expedite ED management decisions.”

Internal medicine specialists were next (13.6 percent), and radiologists’ most common subspecialties were abdominal (33.6 percent) and thoracic (16.4 percent) imaging.

Screen-shares lasted, on average, 12 ± 16 minutes (range, 2 to 45 minutes; median, 5 minutes).

In a follow-up survey, 27 percent of the referring physicians (20 of 74) responded, and most gave the system high marks.

Using a five-point scale, the vast majority agreed that the VC was easy to use (90 percent), the VC improved their understanding of the radiology report (80 percent), the VC affected patient management (85 percent), access to a subspecialized radiologist was helpful (85 percent) and the VC enhanced the integration of the radiologist into the clinical care team (85 percent).

Among the referrers who participated in screen shares and responded to the survey, 70 percent said the sharing function was helpful.

As for the radiologists, 48.9 percent (23 of 47) responded to the survey.

They tended to agree that the VC was easy to use (69 percent), participation in the VC contributed positively to patient care (60.9 percent) and the VC enhanced the integration of the radiologist into the clinical care team (73.9 percent).

A similarly sized majority of the rads, 60.9 percent, felt the VC was disruptive to normal workflow.

This concern “will ultimately need to be addressed to achieve radiologists’ buy-in and long-term success of the tool,” the authors write.

Still, the overall satisfaction with NYU-Langone’s virtual-consultation system on both ends reinforces the consensus that the radiologist’s role “does not end with the completion of the report but fundamentally entails participation in subsequent patient care activities, including follow-up communications with the referring physician to ensure that the report is properly understood and acted upon,” write Rosenkrantz and team.

“By helping ensure that examination interpretations are properly understood and acted upon by referring physicians,” they conclude, “the VC promotes the Imaging 3.0 initiative for radiologists to engage in added-value activities beyond image interpretation.”