Adding Structure: How to Boost Reporting Efficiency

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 - Reporting

Use of structured reports and quantitative data is growing as providers look to offer effective, personalized medicine. While these efforts are improving communication, they still require plenty of manual operations by the radiologist during interpretation. However, new technologies are offering a way to efficiently generate standardized reports and easily capture quantitative data.

The benefits are touted in literature, at conferences and around hospital hallways. Structured reporting can improve communication with clinicians, streamline radiology interpretations and reduce errors in coding, protecting reimbursement. The movement toward structured reporting has blossomed in tandem with a push to capture and incorporate standardized quantitative measurements and a common lexicon.

In the wake of the success of the American College of Radiology’s Breast Imaging-Reporting and Data System (BI-RADS), the college has developed terminologies and classification systems for hepatocellular carcinoma (HCC) imaging findings called LI-RADS, as well as PI-RADS for the prostate and HI-RADS for head injuries.

All this structure and standardization should be a boon to reporting practice, but radiologists must buy in, and the transition can slow down workflow. Even with the LI-RADS framework, for instance, reporting suspected HCC is challenging. Radiologists have to apply the LI-RADS flowchart to each lesion, and dictate findings into a specific reporting template that they have to select and bring into the dictation software interface.

LI-RADS might get everybody speaking the same language, but the workflow still has many steps in which human error can appear. Because of this, Toshimasa J. Clark, MD, and colleagues from the University of Washington in Seattle, developed a pair of software tools to improve consistency and timeliness of LI-RADS reporting, an innovation that could aid the institution’s large liver transplant center that serves five states.

“Almost all of our liver studies are reported in a structured manner despite the lack of a mandate, but most of these structured reports are painstakingly created by copying a template and editing each field by hand,” says Clark.

The first of the two complementary applications is a mobile app for iOS devices that allows for rapid characterization of hepatic observations in various situations, including during multidisciplinary conferences. This app is available through Apple’s iTunes App store.

The second application is desktop software written in Java that enables semi-automated, real-time application of the LI-RADS algorithm while also generating structured text that can be copied and pasted into reporting software.

Radiologists still have much to do, including identifying, measuring and characterizing lesions, so the software doesn’t fully automate the process. Still, generating the report text should make workflow more efficient. Even better, says Clark, would be a tool that is integrated with computer-aided detection and reporting software to directly report lesion characteristics with minimal user interaction.

“Closer integration with reporting software and PACS would certainly foster increased use,” he says. “Mandated structured reporting, as happened with the FDA and BI-RADS, also would encourage users to find workflow solutions that produced structured reports.”

Clark doesn’t believe vendors have done enough to this point to support the use of structured reporting by creating applications such as those from the University of Washington. These homemade solutions can be freely downloaded, with the open-source desktop software available at With the increased attention to structured reporting, however, the dearth of structured reporting tools could be remedied soon.

“Standardized reporting is part of the natural progression of radiology,” says Clark. “While some might resist it as part of the process of making radiology reports a commodity, from a patient care perspective it leads to more consistent inclusion of all relevant information, easier parsing of reports for ordering clinicians, and, in the case of LI-RADS, consistent characterization of hepatic observations as probably or definitely HCC. If I were a patient being assessed for possible HCC, I’d want my radiologist to report it in a structured fashion using LI-RADS terminology and categorization.”

Time-saving automation

A tool that streamlines structured reporting is one thing, but an application that