9 ways to improve radiology report quality in the age of patient portals

Added focus on report quality could make radiology more visible and enhance radiologists’ value in health care, according to an article published online May 16 by the Journal of the American College of Radiology.

While reports are used for purposes beyond providing clinical information, they have been used traditionally for private communication between radiologists and other physicians. This reality, however, is changing.

“Although the core purpose of these reports as written communications among health care providers remains unchanged, evolving expectations in patient care are forcing changes to the reports’ construction, purpose, transparency, and ostensible ownership,” wrote the article’s lead author, Michael A. Bruno, MS, MD, of the Penn State Milton S. Hershey Medical Center in Hershey, Penn., and colleagues.

Disruptive changes in the written radiology report have consequently brought attention to quality and safety initiatives, patient-centered care norms, risk management and malpractice procedures and ready access to patients through web-based portals. In the experience of the authors, many patients are sensitive to language, grammar, organization, clarity, word choice and spelling. This sensitivity requires improvement of report quality, which Bruno and colleagues believe can be achieved through the following nine means:

• Unveil the full history: Radiologists should gather available patient information from electronic health records, or the patients themselves when possible. Instead of relying on limited histories provided by requesting physicians, radiologists should try to obtain accurate patient history details in order to assure patients that they are valued.
• Implement standardized organization: Report content should be logically and clearly organized, and structured or semi-structured report templates are ideal for achieving this aim.
• Avoid excessive jargon: Because more patients will be directly reading their reports, radiologists need to make a point in using well-defined, specific vocabulary. Technical jargon could be appropriate in some clinical communications, but radiologists should be aware that use of such terms could prohibit patient understanding or inadvertently offend them.
• Be upfront about uncertainty: Confidence levels in suggested diagnoses should be communicated in a straightforward manner for both clinicians and patients. Related recommendations for additional studies should be explained with clarity.
• Describe patient behavior thoughtfully: Utilize prudence and sensitivity in describing patient behavior, cooperativeness and appearance. Factually correct, nonjudgmental descriptive language should be used in reports. When describing why a study was difficult or declined, radiologists should try to incorporate the patient’s perspective.
• Act sensitively toward patients, but don’t avoid sensitive topics: Appropriate medical language or diagnoses should not be diluted. Although some patients may take offense to language related to sensitive subjects like obesity, mental health, cancer and substance abuse, others have said that they have been motivated to embrace challenging behavioral change after seeing their conditions candidly described.
• Make evidence-based recommendations: When feasible, recommendations for further clinical actions should be evidence-based to avoid perceptions of defensive action and meaningless malpractice protection by recommending nonindicated studies.
• Document all direct communication: Radiologists should document all relevant communication with patients at the time of radiological procedures and any relevant direct communications among providers. The radiology report is currently viewed as the best place for this information.
• Proofread: A quality check for correct spelling and grammar is necessary despite pressures for rapid report turnaround time.

“By boosting radiology's visibility to and direct engagement with patients, web-based patient portals are an opportunity for radiologists to counterbalance marketplace trends toward commoditization of the specialty,” wrote Bruno et al. “Although many questions remain regarding best practices, patient portals may ultimately prove to be one of the most powerful tools radiologists have to enhance the value they bring to health care.”