The University of Pennsylvania Health System has experimented with the use of a virtual radiology consult service as a way to add value for patients while helping to alleviate malpractice concerns.
Researchers detailed the novel program in a study published Friday in Current Problems in Diagnostic Radiology [1]. Patients scheduled for lung cancer screening during a three-month window were pinpointed using a custom scheduling system, receiving a text message asking if they’re interested in a free 15-minute consultation with a radiologist to discuss their results.
Of 38 individuals who received texts, sent three hours after imaging, 10 (26%) responded, nine of whom scheduled a consultation. But only three ended up actually attending their appointments, for an overall text-to-consult conversion rate of 8% (3/38).
Lead authors Colbey W. Freeman, MD, and colleagues believe there is validity to this idea. But getting patients to follow through may prove more challenging than initially anticipated.
“In the setting of patient-centered care and increasing patient access to their medical records, radiologists must strive to optimize the value of our work and consider patient outreach programs to improve patients’ radiology experiences, understanding of their radiology results, and overall radiology care,” the study concluded. “Direct patient-radiologist interactions can help achieve those goals. However, given the potential time-costs of consults and rising radiology volumes, radiology departments may benefit from identifying patient populations for whom the benefits of consultations would be maximized as well as identifying optimal consultation modality by patient population.”
The three consults conducted lasted an average of 18 minutes. One had a CT impression of Lung-RADS 4A (suspicious, with a 5%-15% risk of cancer and a follow-up recommendation for a repeat exam in three months). The other two individuals demonstrated Lung-RADS 1, with no nodules spotted. One had a “potentially significant” noncancerous finding (severe coronary atherosclerosis), while the other had mild coronary atherosclerosis.
Freeman et al. believe their study presents an “important quandary for radiologists.” While many patients initially expressed interest in the service, receiving the results ended up reducing the need for such a call. They believe the specialty would need to do greater work to target those who would still be interested in a virtual chat, even after receipt of their results. Payment also remains a potential barrier for busy members of the specialty.
“While consultations may have benefits for patients, there are potential costs to radiology,” the authors noted. “The primary source of revenue for radiologists is reading exams. Once a report is produced, additional consultation time is often unreimbursed. This poses a challenge for radiology departments, which are increasingly under pressure to read more cases with similar or fewer personnel. However, these consultations may ultimately increase patient retention through improved patient satisfaction and patient understanding of, and compliance with, follow-up recommendations. Future studies can assess the financial costs and potential financial benefits of radiology consult services to radiology departments and their institutions.”
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Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.