structured reporting - potential, promise, and problems
TRANSCRIPT
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Structured Reports in Radiology
“Promise, Potential, and Problems”
Matt Hawkins, MDAssistant Professor – Emory University SOM
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• History/context of structured reports
• Variations of structured reports
• Data
• Change management
OUTLINE
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• History/context of structured reports
• Variations of structured reports
• Data
• Change management
OUTLINE
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• Structured reports first introduced by Preston M. Hickey, MD• 1922
• “The ARRS should recommend a standardized nomenclature to be used in writing roentgenological reports.”
HISTORY
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• Structured reports first introduced by Preston M. Hickey, MD• 1922
• “The ARRS should recommend a standardized nomenclature to be used in writing roentgenological reports.”
HISTORY
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• RADLEX introduced in 2006
HISTORY
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• Keys to radiology report
CONTEXT
CLARITY
CORRECTNESSCONFIDENCE
CONCISE
COMPLETENESS
CONSISTENCY
Reiner et al. JACR 2007; 4:313-319.
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• Keys to radiology report
CONTEXT
COMMUNICATION
CONSULTATION
Reiner et al. JACR 2007; 4:313-319.
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• Strengths of Structure
• Eliminates ambiguity• Creates mineable data• Auto-population of data• Standardized follow-up• Billing/compliance
CONTEXT
Reiner et al. JACR 2007; 4:313-319.
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CONTEXT
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CONTEXT
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• What do we prefer?
CONTEXT
Naik et al. AJR 2001; 176:591-598.
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• What do we prefer?
CONTEXT
86% of referring clinicians preferred detailed structure
Naik et al. AJR 2001; 176:591-598.
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• What do we prefer?
CONTEXT
56% of radiologists preferred detailed structure
Naik et al. AJR 2001; 176:591-598.
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• History/context of structured reports
• Variations of structured reports
• Data
• Change management
OUTLINE
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• “Structured” has different meanings
• Pure structure• Structured template; no structured
content• Structured “normals”• Hybrid
VARIATIONS
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• “Structured” has different meanings
• Purely structured reports have been ridiculed• Johnson et al – free-text reports had
greater clarity approx. 80% of the time
VARIATIONS
Johnson et al. JACR 2010;7:501-506.
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• “Structured” has different meanings
VARIATIONS
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VARIATIONS
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• History/context of structured reports
• Variations of structured reports
• Data
• Change management
OUTLINE
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• Structure is great, but does it fix everything?
DATA on STRUCTURE
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DATA on STRUCTURE
60% of reports have errors (1.73 errors per report)
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DATA on STRUCTURE
36% of reports have non-grammatical errors
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DATA on STRUCTURE
0.02 errors per dictated word
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DATA on STRUCTURE
Missense errors = 12% of all errors (0.21 per report)
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DATA on STRUCTURE
Omission errors = 10.1% of all errors
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DATA on STRUCTUREOmission errors that change the meaning of a sentence =
1.2% of all errors
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DATA on STRUCTURE
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DATA on STRUCTURE
26% of reports contained non-grammatical errors (p=0.024)
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DATA on STRUCTURE
Missense omission errors: 3.5% 1.2% (p=0.0175)
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DATA on STRUCTURE
Comission errors: 3.9% 0.8% (p=0.0007)
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DATA on STRUCTURE
37% of reports STILL had errors
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• History/context of structured reports
• Variations of structured reports
• Data
• Change management
OUTLINE
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Change Management
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Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early
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Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early
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Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early
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Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early
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Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early
![Page 40: Structured Reporting - Potential, promise, and problems](https://reader035.vdocuments.us/reader035/viewer/2022062523/58f25c431a28ab8b618b4569/html5/thumbnails/40.jpg)
Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informaticists early
![Page 41: Structured Reporting - Potential, promise, and problems](https://reader035.vdocuments.us/reader035/viewer/2022062523/58f25c431a28ab8b618b4569/html5/thumbnails/41.jpg)
Change Management• Understand resistance to change• Span boundaries• Engage key stakeholders• Get leadership buy-in• Establish consensus• Define the project improvement team• Engage informatics team early
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Change Management