Structured reporting could cement radiology as a crucial data provider

Researchers found a modified structured reporting template to monitor ultrasound (US)-performed deep vein thrombosis (DVT) outcomes was widely adopted at their institution and accurately determined positive DVT rates across various patient locations.

Authors of the study published online Oct. 8 in the Journal of Digital Imaging believe their results could serve as a bedrock for an effective enterprise assessment of imaging outcomes.

“Determining the clinical impact of imaging exams at the enterprise level is problematic, as radiology reports historically have been created with the content meant primarily for the referring provider,” the authors noted. “Structured reporting can establish the foundation for enterprise monitoring of imaging outcomes without manual review providing the framework for assessment of utilization and quality.”

The team updated a standard Doppler US template for extremity venous evaluation of DVT to include a discrete fixed picklist of impression options, wrote lead author Travis Browning, with Parkland Health and Hospital System in Dallas, Texas, and colleagues. Researchers rolled out the reporting template system-wide, monitored utilization and interpretive outcomes and reinforced its use.

During the study period, Jan. 1 through Dec. 31, 2017, a total of 9,111 US exams for DVT were performed—more than 98 percent utilized structured reporting. Of the structured reporting total, 1,074 were positive for DVT, with 732 reported as acute/new above the knee.

In the emergency department, positive DVT rates were slightly more than 10 percent, 14 percent for inpatient and 13.2 percent for outpatient.

Browning et al. wrote their study results could be used by radiology departments to monitor reporting and guideline adherence, but noted its benefits could extend beyond imaging.

“Eliminating the need for manual review of a subset of reports to identify statistical rates removes a primary cost barrier to utilizing radiology reporting interpretive outcomes as metrics in quality practice assessment,” the authors wrote. “In this manner, radiology departments can position themselves as suppliers of metric data for health care practices, not just on appropriateness criteria at order entry but also on sensitivity, specificity, and predictive value of the clinical practice patterns of those practices.

For example, the researchers argued the power of having access to thousands of records within seconds could aid population-based research in a way manual search could never provide.

Browning et al. did suggest expanding their system into more complex imaging such as MR and CT could pose a challenge, but with proper support and active feedback could greatly aid other areas of the health system.

“The data will form the basis of assessment for future quality and clinical initiatives on optimizing health system resource utilization,” the authors concluded. “Future expansion into other facets of imaging could cement radiology’s role in providing such data for health care systems without the expense of manual review.”