Structured reporting success balances uniformity + individuality

For a department to successfully implement common structured reporting, it must overcome organizational challenges that require at least as much attention as the technical challenges, according to an article published online Jan. 17 in Radiology.

The article, written by members of the radiology department at Cincinnati Children’s Hospital Medical Center, provided an example of an effective rollout of a department-wide standardized structured reporting program that achieved widespread adoption.

The program began with the formation of a work group in February 2010 to oversee development of standardized structured reports. Report drafts were reviewed and revised by a subcommittee working with report authors, and each standard report format was vetted by all radiologists who would be using it. Reports formats were then associated with a procedure code or group of codes in the speech recognition system, enabling automatic report population within the system.

Quarterly audits and a survey were used to evaluate utilization of the standard formats and radiologist satisfaction.

In the balance between standardization and report specificity, a total of 228 standardized structured report formats were created within two years after initiation of the project, according to David B. Larson, MD, and colleagues. These formats corresponded to 94 percent of the more than 212,000 departmental studies by volume.

“While it is feasible to maintain an array of 228 reports for the department, if each of the 36 radiologists had generated his or her customized reports, thousands of customized reports could easily have been created that would have to be maintained,” wrote Larson. “If a radiologist or clinician discovered a report error or desired a consistent change in report language for all reports for billing or other purposes, each of his or her reports would have to be changed individually.”

In September 2011, all 223 reports selected for audit adhered to the standard format. Surveys of radiologists feedback were largely favorable, according to the authors.

Larson and colleagues provided a list of program characteristics that are essential to success:

• Balance between a desire for uniformity and respect for individual expertise;
• Include representation from all specialty areas;
• Do no over-restrict radiologists in describing abnormal findings;
• Be consistent in application of departmental standards;
• Be reasonable and responsive when changes are requested; and
• Sparingly use modest incentive bonuses.

“We acknowledge that it can be difficult for a large group of independent radiologists with strongly held beliefs to achieve consensus on an issue as sensitive as the radiologic report,” wrote the authors. “We found that by focusing on the organizational challenges and technical aspects, we were able to enjoy the benefits of structured reporting, including improved consistency in reporting, automatic population of examination-specific reports, and more efficient report monitoring for quality assurance and research.”