Structured reporting: Aid or distraction?

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Image courtesy of Agfa

If change is constant, so, too, is resistance to it. The form of the interpretative report for radiology imaging evaluation has remained relatively little changed since the specialty’s debut in clinical medicine. The introduction of structured reporting systems—the use of a defined format, organization and nomenclature for diagnostic interpretation—offers the potential to improve clinical communication, aid in evidence-based data collection and improve the quality of patient care.

The adoption of structured reporting systems also requires a sea change in the manner in which most radiologists conduct their diagnostic image interpretation. As such, deployment of the technology will initially be disruptive to the productivity of the majority of practices, given current workflow structures.

David L. Weiss, MD, and Curtis P. Langlotz, MD, PhD, took on the most common pros and cons of structured reporting systems in an effort to explore the arguments for and against utilization of this technology. Their work, published in this month’s Radiology, offers compelling reading for proponents and detractors of structured reporting systems.

The duo agreed that some elements of structured reporting systems are desirable for radiologists. However, based on their familiarity with other highly-touted information systems that became disenabling technologies in practice, they offered an experienced skepticism of magic-bullet applications.

“Will these new systems result in improved workflow or are these reports merely administrative agitprop designed to convince radiologists to adopt one more reporting system that may ultimately have negative consequences for the user?”

According to Langlotz, who took the proposition in the paper, structured reporting systems offer beneficial features, such as enabling the capture of radiology report information so it later can be retrieved and reused. In addition, he cited the preference of referring physicians to receive reports utilizing a consistent organizational format; allowing them to access specific information more easily than in a narrative report.

The utilization of standard language for results interpretation is perhaps the most compelling reason to adopt structured reporting systems.

“When defined terms from a standard lexicon are associated with imaging reports, the information in the report becomes more accessible and reusable,” Langlotz wrote.

Mammography reporting has become the first area of radiology to adopt standard terms, which is mandated by U.S. law. Langlotz noted that the use of non-standard language degrades the quality of the radiologist’s communications to referring clinicians.

“For example, radiologists and referring physicians cannot agree on the meaning of many common words and phrases used to represent uncertainty, both in radiology reports and in other medical narrative,” he noted.

Weiss, arguing the con position, agreed that the formatting and organizational aspects of structured reporting systems were desirable features for radiologists.

“The report should contain a precise diagnosis and recommendations,” he wrote. “There is no argument here that this type of structured report is not only desirable but necessary for effective and efficient communication.”

The main issue in contention for Weiss is that the interface to structured reporting systems requires a keyboard stroke or mouse click to input standardized nomenclature from the application’s lexicon. This action takes the radiologist’s attention away from image interpretation, which could affect diagnostic accuracy. In addition, navigating a PACS efficiently generally requires a two-handed approach, leaving the interpreting clinician one hand short for the structured reporting application.

“In fact, if biologic evolution could match the speed of software development, the three-handed radiologist might eventually prevail through natural selection,” Weiss noted. “Requiring radiologists to now use one or both of these scarce resources for creation of a structured report seems wasteful and illogical.”

The authors agreed that structured reporting has the potential to improve patient care; and they also concurred that dropping the technology onto current radiology workflows could compromise radiologist productivity, and possibly, accuracy.

“It will be interesting to see whether newer structured reporting software can offer the workflow improvements necessary to achieve widespread