How IT is helping radiologists to get closer to colleagues and patients

CHICAGO – While booking a trip online to Disneyland, and searching for hotels and new rides for his children, a pop-up asked Dr. Michael Recht if he could use some help. “Why not,” he thought, and found the virtual assistant to be just what he needed.

Afterwards, he realized, what if you could do this in radiology? To improve communication between referring physicians and radiologists, you could create a button on the referring doctors’ computer that would connect him or her to a radiologist for quick answers to questions.

Dr. Recht, chair of radiology at NYU Langone Health, in New York City, proceeded to have this done at his organization – with great success. He talked about this and other ways of using IT to enhance radiology, and medicine in general, during his keynote address at the RSNA conference in November.

“It’s especially popular with our ER physicians,” he said. When the ER docs hit the help button, they’re put into instant communication with a radiologist in the reading room. Dr. Recht explained that a rad each day is tasked with handling these queries. If the ordering doctor wants to know, for example, if something in an image is a lesion, they can circle it on screen and find out right away.

Some radiologists might balk at this solution, countering that radiologists are already busy and don’t need further interruptions. But Dr. Recht asserted, “It isn’t an interruption of your day – it is your day. It is a privilege to be called.”

Indeed, this new system creates closer ties between radiologists and other physicians at a time when many have lamented the isolation of imaging specialists, who are often hidden away in their dark reading rooms.

Dr. Recht noted that radiologists used to be at the centre of a hospital’s medical activities – referring physicians and specialists would regularly congregate in the diagnostic imaging department to look at films and discuss cases with radiologists.

In recent years, however, with the rise of PACS, the role of radiologists has changed drastically. Images and reports can be easily transmitted to ordering doctors over electronic networks, leaving little reason for them to visit the reading room.

Some have gone so far as to suggest that PACS have destroyed the role of radiologists as the “doctors’ doctor”, since fewer clinicians are taking the time or trouble to consult them. But with the help button at NYU Langone, relationships among rads and other doctors are being revived.

The “virtual consulting” system is even being used during morning rounds, when teams of doctors and residents visit patients at their bedsides. They can instantly query a radiologist on the particular problems of each patient. Dr. Recht noted that this application has become extremely popular in teaching – so much so that nurses, too, have joined the rounds to find out more about their patients.

Not only are today’s radiologists isolated from other physicians, they’re largely removed from the patient population, too. At the same time, they’re being told by their imaging leaders that to remain relevant, they’ve got to get closer to their patients in this “patient-centric” world.

However, as RSNA President Dr. Vijay Rao observed in her own address at the conference, the only radiologists who actually see patients regularly are breast imagers and interventional radiologists.

This could be countered by opening the door to patients. She said a day will come when radiologists will not only send their reports to ordering doctors, but to patients, too. And the reports will contain an invitation for the patient to contact the radiologist, if he or she has any questions. “It’s only in this way that the patient will see that the radiologist is a real doctor who can be contacted,” she said.

“We need to act like clinicians, and not just as image readers,” she added.

Another important IT tool being implemented at NYU Langone to improve radiology is analytics. Without data, quipped Dr. Recht, the HIPPO principle usually prevails – the Highest Paid Person’s Opinion will win out, which is often not the best opinion or idea.

At NYU Langone Health, a major effort has been made in the DI department to collect, present and analyze data. “We’ve created dashboards for all areas,” he said.

And the views can be easily customized, according to the preferences of the users. “Some people like tables, others prefer to look at graphs,” he said. Dr. Recht commented that an MRI machine installed at the hospital was only being used 25 percent of the time that was originally planned. Using collected data – including RTLS information that showed how long patients were spending in prep, on the table, in the machine, and in the change rooms – the department discovered that too many steps were occurring in the MRI room. This was slowing down throughput considerably.

The answer was to create prep rooms surrounding the MRI room. “We built two doors on the MRI room – one to go in, and the other to go out.”