Researchers implement a structured reporting system for describing adnexal masses in a large health system

In 2014, researchers implemented a structured reporting system for describing adnexal masses identified in ultrasound examinations in a healthcare system that treats more than 4.1 million patients annually. They then wrote about the experience in the Journal of the American College of Radiology, providing insight into what it takes to get so many individuals on board with such a transformative change.

“The absence of structured reporting of adnexal masses hinders the ability to align management with risk and engage in a data-driven process that improves clinical care over time,” wrote lead author Elizabeth J. Suh-Burgmann, MD, of Kaiser Permanente in Walnut Creek, California. “To address this problem, we developed and implemented a structured reporting system aimed at increasing the reliability and clinical utility of ultrasound reporting of adnexal masses.” 

The team’s structured reporting system required radiologists to file abnormal adnexal masses under one of five categories—category 0, category 1, category 2, category 3 or category X—based on the concern for malignancy and the overall size. Hashtags were associated with each category for simple data extraction. Reports without a category designation could not be finalized. After a three-month pilot study, large-scale implementation of the new system occurred using “web-based conferences, email announcements and local presentations.”

The authors noted that their structured reporting system wasn’t necessarily like other systems radiologists have encountered in the past. “An unusual aspect of our system, aside from its scale, was the fact that recommendations for follow-up imaging are excluded from reports to allow management decisions to be directed by clinical providers who are in the position to consider patient preferences and other important individual patient characteristics,” they wrote.

In the end, did the health system’s radiologists adapt to the new system? Suh-Burgmann and colleagues audited 245 reports to find out, reporting a nonadherence rate of just 0.4 percent. The authors also surveyed specialists to judge their satisfaction with the new system. Overall, 39 percent of respondents said they were “highly satisfied” while 48 percent said they were “satisfied” and 12 percent said they were “neutral.” Just 0.5 percent reported feeling “dissatisfied.”

“Uniformity in radiology reporting systems across medical centers and easy accessibility of educational material in the dictation software system enabled the rapid dissemination of information and installation of reporting templates,” the authors wrote. “The fact that the template required no additional clicks to select a category in the case of a normal examination further increased acceptability. The inclusion of hard stop measures for finalization of reports was likely critical to adherence.”