On Dec. 30, 2019, the American Journal of Roentgenology published the results of a study that analyzed the compliance of referring physicians with the follow-up recommendations provided in the musculoskeletal MRI reports that they received from radiologists. The results of this study indicate that when the radiologist directly communicates with the referring doctor, compliance with follow-up recommendations greatly improves.
This Study Reviewed More Than 650 Musculoskeletal MRI Reports
The researchers who conducted this study are from the Columbia University Medical Center, which is located in New York City. After reviewing more than 650 musculoskeletal MRI reports, researchers discovered that when the radiologist communicated with the referring clinician directly, via a phone call or with an email, the clinician was more than 25 percent more likely to follow-up on the radiologist’s recommendations.
“I think the biggest hurdle radiologists face in direct communication is getting in touch with the ordering physician. Collaborative Imaging is currently in the process of consolidating and integrating contact information for our wide range of referring clinicians so that we have an easily accessible, integrated solution to encourage more direct communication customized to the preferences of our referring physicians. This communication is documented throughout the process.” Dr. Lori Sedrak from Texas Radiology Associates.
The Reports Analyzed Were Created Between January 2016 and January 2018
The researchers wanted to investigate the musculoskeletal MRI report recommendation trends from January 2016 to January 2018. After querying their database for the reports created during this time frame, they found that the referring physicians overall compliance rate with the radiologists’ recommendations for follow-up was only 73 percent.
Since communicating directly with the referring clinicians improves compliance, a team of authors, led by researcher John S. Nemer, states that this could be particularly helpful for orthopedic referrers.
As the researchers delved deeper into the study, they found that when recommendations were communicated over the phone or with an email, the difference in the compliance rate was statistically significant: The direct communication compliance rate was substantial, at 93 percent, which is 22 percent higher than the compliance rate was when the radiologist and the referring clinician had no direct communication.
“The reality of incorrect, or altogether missing referring physician information creates a logistical nightmare for a radiologist when it comes time to notify the referring physician of an abnormal or worse yet, critical finding. In the industry, we hear about highly educated physicians who are forced to do clerical level work at the cost of interpreting studies to try to track down who is the referring Internist or Orthopaedic physician, and then find their correct contact information at the time of interpretation.
We are addressing this significant issue with our integrated solutions that consume the radiology report and identify abnormalities, critical findings, and recommendations. This information is then passed on to our 24/7, in-house, critical findings notification team to relay the results to the referring physician who will then view the images and reports with one touch and can initiate a secure video-conference with the radiologist in real-time to review the study.
This would not be possible without the proprietary, integrated solutions we have built based on our collaboration with physicians and clinical partners. This solution works wonders for incidental findings in addition to notifying referring physicians and clinical institutions when recommendations are not adhered to, should that be warranted. ” Dhruv Chopra, CEO of Collaborative Imaging
Follow-Up Recommendation Requests Compliance Rate
According to the researchers, additional imaging ranked as the number one follow-up recommendation request and yet, these requests had the lowest compliance rate. The researchers did acknowledge that there are cases when a referring physician can determine whether additional imaging is necessary. However, when this scenario is excluded and there is an actual lack of compliance, patient- and physician-related factors might both be to blame for the failure to follow up.
Reasons for the Follow-Up Recommendations from the Radiologists
There were 109 follow-up recommendations that a referring clinician neglected to follow-up on. Of these 109, 80 requests, or 73 percent, related to the possibility of a neoplasm. When referring clinicians did follow-up on the 291 reports that were considered suspicious for neoplasms, subsequent workups confirmed the presence of neoplasms in about 26 percent.
Disease concerns included:
- Pancreatic cancer.
- Prostate cancer metastases.
- Tonsillar cancer.
- Chondrosarcoma.
- Spinal cord glioma.
According to the research team, the effect of the clinician neglecting to follow up is not trivial. Of the radiologist recommendation requests that cited the possibility of a neoplasm that were followed up on, 8 percent were found to be malignant. It can be assumed then that the unacknowledged cases would have a similar malignancy rate, which stresses the significance of finding ways to improve radiology recommendation compliance among referring physicians.
“At Collaborative Imaging, we understand how important direct communication between the radiologist and the referring clinician can be, especially when unexpected and/or critical findings arise: To ensure clinicians receive the vital information they need to diagnose and treat their patients, CI has developed technology that allows radiologists to initiate a real time, interactive review of images with the referring physician. Furthermore, either physician can initiate the communication via a direct link. This secure link, accessible via a phone or tablet, even allows for real time annotation of images so both parties can discuss that exam with much more precision and accuracy.” Dr. Ted Wen, Medical Officer at Collaborative Imaging
Factors Affecting Compliance
The recommending radiologist’s experience level, recommendations that were based on time intervals and conditionality made no difference in the clinicians’ compliance with the recommendation requests. However, when a referring physician’s specialty is considered, internists’ rates for acknowledging and then following the radiologists’ recommendations are significantly higher when they are compared to those of orthopedists.
Even if there was a concern related to an issue that was outside the orthopedists’ area of expertise, the likelihood of the orthopedist following-up on the recommendation request did not increase. Researchers wrote that, “It is conceivable that orthopedists may have additional information unknown to radiologists for recommendations relevant to the musculoskeletal system and, therefore, may be more capable of making an alternative clinical decision without the need for further evaluation. Conversely, when faced with recommendations pertaining to findings outside the musculoskeletal system, orthopedists may have lower compliance because of poor handoffs in care.”
Although this study focused on the musculoskeletal system, orthopedists do have some training related to reading radiological findings; however, general practitioners and internists rely heavily on the skills of the radiologist. Closing the communication gap between these clinicians and the radiologist is essential to providing patients with effective and efficient medical care.