Patient Access of Their Radiology Reports Before and After Implementation of 21st Century Cures Act Information-Blocking Provisions at a Large Multicampus Health System.

Background: To implement provisions of the 21st Century Cures Act addressing information blocking, federal regulations mandated that health systems provide patients with immediate access to elements of their electronic health information, including imaging results. Objective: To compare patient access of radiology reports before and after implementation of the information-blocking provisions of the 21st Century Cures Act. Method: This retrospective study included patients who underwent outpatient imaging examinations from January 1, 2021, to December 31, 2022 at three campuses within a large health system. The system implemented policies to comply with Cures Act information-blocking provisions on January 1, 2022. Imaging results were released in patient portals after a 36-hour embargo period before implementation, versus immediately upon report finalization after implementation. Data regarding patient report access in the portal and ordering provider report acknowledgment in the EMR were extracted and compared between periods. Results: The study included reports for 1,188,692 examinations in 388,921 patients (mean age, 58.5±16.6 years; 209,589 women, 179,290 men, 8 nonbinary, 34 missing sex information). A total of 77.5% of reports were accessed by the patient before implementation, versus 80.4% after implementation. Median time from report finalization to report release in the patient portal was 36.0 hours before implementation versus 0.4 hours after implementation. Median time from report release to first patient access in the portal was 8.7 hours before implementation versus 3.0 hours after implementation. Median time from report finalization to first patient access was 45.0 hours before implementation versus 5.5 hours after implementation. A total of 18.5% of reports were first accessed by the patient before the ordering provider before implementation, versus 44.0% after implementation. After implementation, median time from report release to first patient access was 1.8 hours for patients with age <60 years versus 4.3 hours for patients with age ≥60 years. Conclusion: After implementing institutional policies to comply with Cures Act information-blocking provisions, the time for patients to access imaging results decreased, and the proportion of patients who accessed their reports before the ordering provider increased. Clinical Impact: Radiologists should consider mechanisms to ensure timely and appropriate communication of important findings to ordering providers.

Effects of Patient Demographics and Examination Factors on Patient Experience in Outpatient MRI Appointments.

OBJECTIVE: The objective of this article is to describe the effects of patient demographics and examination factors on patient-reported experience in outpatient MRI examinations. METHODS: This institutional review board-waived, HIPPA-compliant quality improvement study evaluated outpatient MRI appointments from March 2021 to January 2022 using a postappointment survey consisting of a 5-point emoji scale and text-based feedback. Patient demographics and examination information were extracted from electronic medical records. Ratings ≤ 3 were categorized as negative, and ratings ≥ 4 were categorized as positive. Continuous variables were analyzed using the Kruskal-Wallis test, and categorical variables were analyzed using the Fisher's exact test. A P value less than .05 was considered significant. A natural language processing algorithm was trained and validated to categorize patient feedback. RESULTS: A total of 3,636 patients responded to the survey. Positive ratings had a higher proportion of male respondents compared with negative ratings (47.9% versus 37.0%, P = .004). Examination characteristics were also grouped by positive or negative rating. Patients who endured longer examination time (median 54.0 min versus 44.0 min, P < .001) and longer wait time after check-in (median 61.6 min versus 46.2 min, P < .001) were more likely to give negative ratings. The most common themes of free text feedback included excellent service (84.3%), on-time service (8.4%), and comfortable intravenous line placement (0.4%). Most common negative feedback included long wait times (10.5%), poor communication (8.4%), and physical discomfort during the examination (4.2%). CONCLUSION: Male gender, short examination duration, and on-time start were associated with positive patient ratings.

Differences Between Highly Rated vs Poorly Rated Patient Ratings of Radiology Reports.

OBJECTIVE: To evaluate differences in quantitative features between poorly versus highly rated patient ratings of radiology reports. METHODS: A HIPAA-compliant, IRB-waived study was performed from October 2019 to June 2021. Patients completed an optional 2-question survey ("How helpful was the report?" with a 5-star scale and an open text box) embedded into the patient portal, and reports were assessed for readability and brevity. Quantitative analyses were performed between poorly (≤3 stars) and highly rated (>3 stars) CT and MRI reports, including the use of structured reporting, number of words, words per sentence, Flesch Reading Ease, and Flesh-Kincaid Grade level within the findings and impression sections of the radiology reports. A two-tailed nonparametric Mann U Whitney test was performed for continuous variables and Chi2 for categorical variables. RESULTS: Of the 490 responses, all 135 evaluating CT or MR were included (27%). 106/135 (78%) of the patients gave high ratings (score of 4 or 5). 46/135 (34%), the radiology reports were in a structured format. The proportion of highly rated reports were significantly higher for structured than freeform reports (93.5 vs. 70.8%, p = 0.002). In the findings section, highly rated reports had a lower Flesch Reading Ease score than poorly rated reports (19.6 vs. 28.9, p <0.01). No significant differences were observed between number of words (p=0.27), words per sentence (p=0.94), and Flesh-Kincaid Grade level (p=0.09) in the findings section. In the impression section, no differences were observed between highly vs. poorly rated reports among the measured parameters. CONCLUSION: Patients preferred highly rated reports that were structured and had lower Flesch Reading Ease scores in the findings section.

Sharing Patient Praises With Radiology Staff: Workflow Automation and Impact on Staff.

OBJECTIVE: This study aims to develop and evaluate a semi-automated workflow using natural language processing (NLP) for sharing positive patient feedback with radiology staff, assessing its efficiency and impact on radiology staff morale. METHODS: The HIPAA-compliant, institutional review board-waived implementation study was conducted from April 2022 to June 2023 and introduced a Patient Praises program to distribute positive patient feedback to radiology staff collected from patient surveys. The study transitioned from an initial manual workflow to a hybrid process using an NLP model trained on 1,034 annotated comments and validated on 260 holdout reports. The times to generate Patient Praises e-mails were compared between manual and hybrid workflows. Impact of Patient Praises on radiology staff was measured using a four-question Likert scale survey and an open text feedback box. Kruskal-Wallis test and post hoc Dunn's test were performed to evaluate differences in time for different workflows. RESULTS: From April 2022 to June 2023, the radiology department received 10,643 patient surveys. Of those surveys, 95.6% contained positive comments, with 9.6% (n = 978) shared as Patient Praises to staff. After implementation of the hybrid workflow in March 2023, 45.8% of Patient Praises were sent through the hybrid workflow and 54.2% were sent manually. Time efficiency analysis on 30-case subsets revealed that the hybrid workflow without edits was the most efficient, taking a median of 0.7 min per case. A high proportion of staff found the praises made them feel appreciated (94%) and valued (90%) responding with a 5/5 agreement on 5-point Likert scale responses. CONCLUSION: A hybrid workflow incorporating NLP significantly improves time efficiency for the Patient Praises program while increasing feelings of acknowledgment and value among staff.

Management of Patients With a Negative Multiparametric Prostate MRI Examination: AJR Expert Panel Narrative Review.

Multiparametric prostate MRI (mpMRI) aids risk stratification of patients with elevated PSA levels. While most clinically significant prostate cancers are detected by mpMRI, insignificant cancers are less evident. Thus, multiple international prostate cancer guidelines now endorse routine use of prostate MRI as a secondary screening test before prostate biopsy. Nonetheless, management of patients with negative mpMRI results (defined as PI-RADS category 1 or 2) remains unclear. This AJR Expert Panel Narrative Review summarizes the available literature on patients with an elevated screening PSA level and a negative prostate mpMRI, and provides guidance for these patients' management. Systematic biopsy should not be routinely performed after a negative mpMRI in patients at average risk but should be considered in patients at high risk. In patients who undergo PSA screening rather than systematic biopsy after negative mpMRI, clear triggers should be established for when to perform a repeat MRI. Patients with negative MRI followed by negative biopsy should follow their healthcare practitioners' preferred guidelines concerning subsequent PSA screening for the patient's risk level. Insufficient high-level data exist to support routine use of adjunctive serum or urine biomarkers, artificial intelligence, or PSMA PET to determine the need for prostate biopsy after negative mpMRI.

Initial Experience with a COVID-19 Screening Chatbot Before Radiology Appointments.

Guidelines for COVID-19 issued by the Centers for Disease Control and Prevention prompted state and local governments to mandate safety measures for screening high-risk patient populations and for institutions to look for ways to limit human contact when possible. The aim of this study was to determine the feasibility of an automated communication system (chatbot) for COVID-19 screening before patients' radiology appointments and to describe patient experiences with the chatbot. We developed a chatbot for COVID-19 screening before outpatient radiology examination appointments and tested it in a pilot study from July 6 to August 31, 2020. The chatbot assessed the presence of any symptoms, exposure, and recent testing. User experience was assessed via a questionnaire based on a 5-point Likert scale. Multivariable logistic regression was performed to predict response rate. The chatbot COVID-19 screening SMS message was sent to 4687 patients. Of these patients, 2722 (58.1%) responded. Of the respondents, 46 (1.7%) reported COVID-19 symptoms; 34 (1.2%) had COVID-19 tests scheduled or pending. Of the 1965 nonresponders, authentication failed for 174 (8.8%), 1496 (76.1%) did not engage with the SMS message, and 251 (12.8%) timed out of the chatbot. The mean rating for the chatbot experience was 4.6. In a multivariable logistic regression model predicting response rate, English written-language preference independently predicted response (odds ratio, 2.71 [95% CI, 1.77-2.77]; P = .007). Age (P = 0.57) and sex (P = 0.51) did not predict response rate. SMS-based COVID-19 screening before scheduled radiology appointments was feasible. English written-language preference (not age or sex) was associated with higher response rate.

Using Evidence-Based Criteria to Decrease CT Utilization for Liver Imaging.

PURPOSE: Overutilization of imaging in radiology increases costs without improvement in patient outcomes. As a part of the regular quality measures, the Centers for Medicare and Medicaid Services deemed our institution to be overutilizing abdomen and abdominopelvic computer tomography (CT) with and without intravenous (IV) contrast. We implemented a quality improvement (QI) effort to reduce use of abdomen CT with and without IV contrast. METHODS: We found high use of abdomen CT with and without IV contrast for liver imaging and implemented an intervention from July 2018 to June 2020. The intervention included updating the liver imaging protocols in alignment with LI-RADS guidelines and hosting educational sessions with the clinical and radiology team to review the updates. Control charts were generated to display changes in the number of CT examinations over time with phase variables indicating two averages, pre- and post-intervention. RESULTS: Guidelines combined with targeted educational and engaged interventions with providers demonstrated a downshift in the use of abdomen CT with and without IV contrast and upshift in the concurrent abdomen CT with IV contrast only for liver imaging. DISCUSSION: Our quality improvement effort suggests that a combination of national quality metrics guidelines and radiology-led interventions such as education and engagement can reduce overutilization.

Lessons learned from radiology mentors.

As in any field, radiologists may face a number of challenges as they navigate their early careers. Because with experience comes wisdom, early-career radiologists may find helpful the advice and perspectives of mid- and late-career radiologists. The Society of Abdominal Radiology recognizes the value of this pool of knowledge and experience, prompting the establishment of the Early Career Committee. This group is designed to support early-career radiologists by sharing the experiences and insights of leaders in the field. In this series, the authors interview trailblazers Matthew S. Davenport, MD; Jonathan B. Kruskal, MD, PhD; Katherine E. Maturen, MD, MS; David B. Larson, MD, MBA; and Desiree E. Morgan, MD. This perspective explores a wide range of subjects, including personal values in medicine, the role of teleradiology, diversity of backgrounds in radiology, how to navigate workplace conflict, and lifelong learning in medicine. Beyond conveying these pearls of wisdom, the aim of this perspective is to highlight for early-career radiologists the value that mid- and late-career mentors can provide in navigating careers in medicine.

Perspective: in pursuit of a learning culture.

Transitioning from peer review to peer learning is an important step forward in developing a learning culture. Additional measures are going to be required to meet this goal. Ideas toward establishing a learning culture are detailed in this perspective.

Patient and Provider Feedback for Radiology Reports: Implementation of a Quality Improvement Project in a Multi-Institutional Setting.

BACKGROUND: Radiology does not routinely solicit feedback on radiology reports. The aim of the study is to report the feasibility and initial results of a multi-institutional quality improvement project implementing patient and provider feedback for radiology reports. METHODS: A HIPAA-compliant, institutional review board-waived quality improvement effort at two institutions obtaining patient and provider feedback for radiology reports was implemented from January 2018 to May 2020. INTERVENTION: A two-question survey (quantitative review and open text box feedback) was embedded into the electronic health records for patients and providers. Text-based feedback was evaluated, and patterns of feedback were categorized: thoroughness of reports, error in reports, timeliness of reports, access to reports, desire for patient summary, and desire for key images. We performed the χ2 test for categorical variables. P < .05 was considered significant. RESULTS: Of 367 responses, patients provided 219 of 367 (60%), and providers provided 148 of 367 (40%) of the feedback. A higher proportion of patients reported satisfaction with reports (76% versus 65%, P = .023) and provided more feedback compared with providers (71% versus 50%, P < .0001). Both patients and providers commented on the thoroughness of reports (12% of patients versus 9% of providers) and errors in reports (8% of patients and 9% of providers). Patients disproportionately commented on timeliness of reports (11%) and access to the reports (6%) compared with providers (3% each). In addition, 7% of patients expressed a desire for patient summaries. CONCLUSION: Report-specific patient and provider feedback demonstrate the feasibility of embedding surveys into electronic medical records. Up to 9% of the feedback addressed an error in reports.

Implementation of peer learning conferences throughout a multi-site abdominal radiology practice.

PURPOSE: To initiate a peer learning conference for our abdominal radiology division across multiple geographically separated sites and different time zones, and to determine radiologist preference for peer learning versus traditional score-based peer review. METHODS: We implemented a monthly peer learning videoconference for our abdominal radiology division. Surveys regarding radiologist opinion regarding traditional peer review and the new peer learning conferences were conducted before and after 6 months of conferences. RESULTS: Peer learning conferences were well attended across our multiple sites, with an average of 43 participants per conference. Radiologist opinion regarding peer review was poor, with survey radiologists responding positively to only 1 out of 12 process questions. Opinion regarding peer learning was extremely favorable, with radiologists responding positively to 12 out of the same 12 process questions. After 6 months of peer learning conferences, 87.9% of surveyed radiologists wished to continue them in some fashion, and no one preferred to return to score-based peer review alone. CONCLUSION: We successfully implemented a peer learning conference for our abdominal radiology division spread out over multiple geographic sites. Our radiologists strongly preferred peer learning conferences over our traditional peer review system for quality control.

Availability of a final abdominopelvic CT report before emergency department disposition: risk-adjusted outcomes in patients with abdominal pain.

OBJECTIVE: To determine whether availability of a final radiologist report versus an experienced senior resident preliminary report prior to disposition affects major care outcomes in emergency department (ED) patient presenting with abdominal pain undergoing abdominopelvic CT. MATERIALS AND METHODS: This single-institution, IRB-approved, HIPAA-compliant retrospective cohort study included 5019 ED patients with abdominal pain undergoing abdominopelvic CT from October 2015 to April 2019. Patients were categorized as being dispositioned after either an experienced senior resident preliminary report (i.e., overnight model) or the final attending radiologist interpretation (i.e., daytime model) of the CT was available. Multivariable regression models were built accounting for demographic data, clinical factors (vital signs, ED triage score, laboratory data), and disposition timing to analyze the impact on four important patient outcomes: inpatient admission (primary outcome), readmission (within 30 days), second operation within 30 days, and death. RESULTS: In the setting of an available experienced senior resident preliminary report, timing of the final radiologist report (before vs. after disposition) was not a significant multivariable predictor of inpatient admission (p = 0.63), readmission within 30 days (p = 0.66), second operation within 30 days (p = 0.09), or death (p = 0.63). Unadjusted event rates for overnight vs daytime reports, respectively, were 37.2% vs. 38.0% (inpatient admission), 15.9% vs. 16.5% (30-day readmission), 0.65% vs. 0.3% (second operation within 30 days), and 0.85% vs. 1.3% (death). CONCLUSION: Given the presence of an experienced senior resident preliminary report, availability of a final radiology report prior to ED disposition did not affect four major clinical care outcomes of patients with abdominal pain undergoing abdominopelvic CT.

Peer Learning Through Multi-Institutional Case Conferences: Abdominal and Cardiothoracic Radiology Experience.

RATIONALE AND OBJECTIVES: We describe a model of multi-institutional, multisociety, online case conferences that is a case-based group discussion of selected (nonrandom) cases which are subsequently hosted on social media and online platforms (e.g., YouTube, websites) to be available for a wider audience. MATERIALS AND METHODS: Using online conferencing software (Zoom, GoToMeeting), participants from both abdominal and cardiothoracic radiologists engage in separate, subspecialty one-hour meetings discussing a variety of meaningful cases. Participants take turns presenting their cases to the group and discuss significant findings, interpretations, differential diagnoses, and any other teaching points. All of the case conferences for both societies are recorded and edited to be uploaded on YouTube and their respective websites. RESULTS: Participants from these conferences log in from 14 institutions in 7 states across the United States. The YouTube videos reach thousands of people around the world. The abdominal case conference on YouTube has received almost 1,300 views with 90 videos uploaded. The thoracic (the Society of Thoracic Radiology) case conference has been running for over 7 years, with 226 videos uploaded to YouTube and 38,200 views, 1426 subscribers, and a total watch time of over 525,800 minutes. Twitter has been utilized by both groups to promote online viewership. CONCLUSION: Our model is feasible and effective compared to traditional peer review. The cases selected are deliberate and focused on quality improvement and/or education. We harness online engagement, specifically social media presence, which has opened new opportunities to educate our peers and reach a global audience, including the nonradiologic community, to learn about radiology and unique practices.

Emergency department length of stay following discontinuation of routine oral contrast material.

PURPOSE: To determine the effect of discontinuing routine oral contrast material on emergency department (ED) length of stay (LOS), time from order to CT completion, and preliminary report turnaround time (TAT). METHODS: A HIPAA-compliant, IRB-waived, single-institution, retrospective cohort study was conducted on adult patients presenting with abdominal pain to the ED from October 2015 to April 2019. Routine oral contrast material was administered prior to July 2018 and discontinued thereafter. CT workflow (ED LOS, exam completion time, report TAT) data were analyzed in a univariate analysis before and after discontinuation of oral contrast. Pre- versus post-policy data were compared with 2-sided t tests. The primary outcome was ED LOS. Data were analyzed on a process control chart and confidence limits were adjusted using established criteria. RESULTS: There were 5020 included abdominopelvic CTs. After routine oral contrast material was discontinued, ED LOS (13.4 h vs 10.7 h, p < 0.001) and time from CT order to CT completion (2.7 h vs 2.1 h, p < 0.001) declined. However, control chart analysis revealed improvement in overall LOS preceded the policy change by 9 months, while improvement in time to CT completion coincided with the policy change. Preliminary report TAT increased by 4 min after the policy change (29 min vs. 33 min, p < 0.001). CONCLUSIONS: Discontinuation of routine oral contrast material in the ED accelerated time to CT completion but had a minor non-significant effect on overall ED LOS. Much of the reduction in overall LOS likely was due to unrelated process improvements.