The more information, the better: Giving radiologists additional context leads to better patient care

Daniel R. Gale, MD, and M. Elon Gale, MD, both worked in academics before they began working at Lowell General Hospital (LGH), a nonprofit community hospital in Lowell, Mass. And while the brothers both enjoyed their new practice, there was one thing they missed from the days of working with trainees: reviewing and interpreting each exam with a fellow with post-graduate training.

“The fellow would be the person who accumulated all of the information that was necessary to interpret the exams,” says Daniel, a diagnostic radiologist at LGH. “The fellow would review the hand written medical record, filter it, process it and give us a synopsis so our interpretations would have appropriate context and determine the clinical question not necessarily provided on the hand-written order. When we entered private practice, the concept of the fellow—someone who provided all the information in a digestible form—became critical. There’s a lot of information out there, and when you’re sitting down to interpret an exam, it’s for the patient’s, the referring clinician’s, and your own benefit to understand the context in which study is being ordered and what questions the clinician is asking.”

[[{"fid":"23404","view_mode":"1_col_no_crop","type":"media","attributes":{"height":214,"width":300,"style":"width: 210px; height: 150px; float: left; margin: 10px;","alt":" - M. Elon Gale, MD","class":"media-element file-1-col-no-crop"}}]]Elon, associate chief of radiology at LGH, agrees with his brother’s assessment. “The more information you gather, the better your interpretation is and the more reliable you are as a reference physician,” he says. “The more radiologists can provide useful information, the more we are respected and valued."

_{M. Elon Gale, MD}

Better interpretations, less unnecessary imaging

Approximately one year ago, LGH made an announcement that sounded like music to Daniel and Elon’s ears: the hospital was installing Change Healthcare’s Conserus Imaging Fellow, a zero-footprint solution that displays key information from the electronic medical record (EMR) such as physician notes, lab results and pathology reports. When users begin a new exam, Imaging Fellow instantly gives them all the relevant medical information they need, with no additional steps or added hardware required.

Daniel and Elon agree that Imaging Fellow made an immediate impact on the quality of patient care at LGH. Daniel, for instance, recalls a case involving a patient in the ER who was referred for a CT scan due to abdominal pain and chest pain. Before beginning the interpretation of the abdominal CT, Daniel reviewed Imaging Fellow and caught an important detail: the referring physician had left a clinical note that stated that they were particularly worried about the patient’s pain around the area of the T7 and T8 vertebra.

“Those were key words that told me where I needed to look,” Daniel says. “And lo and behold, there were tiny, subtle nondisplaced fractures of the spinous processes. Quite honestly, if I hadn’t been directed to the particular level, I may not have seen them. And I’m lucky to have seen them even after being told where to look—that’s how subtle the fractures were.”

Daniel described occasions when Imaging Fellow made a significant impact on his interpretation. For example, there was the time a referring physician’s notes told him he already knew about a lesion from a scan the oncology patient had undergone at another facility. The physician explained that he knew the story behind that lesion, so if that was all that was found, no new imaging would be necessary.

“Suddenly, the way I dealt with this lesion was completely different,” Daniel explained. “The note led to less imaging. I’m not about to recommend a biopsy of this liver lesion, because the clinician already knew about it. Why suggest additional imaging or make a recommendation that makes me look silly?”

Elon adds that this is common when using Imaging Fellow on a regular basis. It’s hard to quantify exactly how often it happens, he says, but it doesn’t take long for radiologists to realize how much patient care is affected.

“When you’re able to avoid someone having an exam or a procedure—well, it doesn’t take many instances of that happening to make it worth having Imaging Fellow,” he says. “When you gain relevant information, you avoid unnecessary testing. That’s the bottom line.”

A user-friendly design that benefits the entire system

Of course, it isn’t as if the information Imaging Fellow provides was unavailable to radiologists before. What makes Change Healthcare’s solution so revolutionary, the brothers explain, is that it’s so convenient and easy to use. In the past, radiologists might need to log in to an entirely different system to find physician notes, encountering one obstacle after another. Now, users can choose to have the information provided automatically, ending the inconvenience of searching for the facts.

Since Imaging Fellow is a web-based solution with zero footprint, it’s also easy on IT departments. Specialists may associate big changes to their equipment with long meetings, delays and disappointing results, but Imaging Fellow is quick to install and can be modified without starting all over. And those modifications are critical—Daniel and Elon say they’ve appreciated the ability to tinker with various display settings along the way without jumping through hoops. “We’ve had Imaging Fellow for about a year now and we are continuing to tinker with the template—different ways to organize information, different views, different subgroups, different values,” Daniel says. “That flexibility is huge for us.”

Elon explains that using Imaging Fellow is also beneficial for referring physicians and billing departments.

“As medicine has become much more time constrained, the amount of time that clinicians actually have to enter the patient history in a standard format has diminished,” he says. “So now, EMRs often have a pick list for very simple information, which doesn’t come anywhere near the level of specificity required for interpretation or for billing purposes with ICD-10 codes.”

No turning back

Adoption of Imaging Fellow is significant at LGH, especially among younger radiologists Younger radiologists use Imaging Fellow once and then never want to give it up. It’s instantly something they want to have in their toolbox for the rest of their careers.

Older specialists, Daniel explains, have lived without having this extra context so long that they have “developed a practice pattern and a way of dealing with not getting the information, but even they appreciate accessibility of medical record, and don’t want to give it up either.”

“It’s like giving them chocolate candy—they become addicted,” Daniel says, smiling. “Within a day, they can’t go back to how things were before. There’s no turning back from the power of this tool.”