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Among the Imaging IT vendors announcing new capability at RSNA was Visage Imaging, which announced the inclusion of radiologist video reports as a standard feature included in the latest version of the Visage 7 Enterprise Imaging Platform.
The update is focused on facilitating the communication between radiologists and patients, enabling them to record a report of approximately one minute in length in order to explain key findings to patients in “plain speak”. However, Visage has stressed that these reports aren’t designed to be comprehensive in nature, nor are they meant to replace the traditional radiology report for referring physicians. According to Visage, it is easy for radiologists to create the videos, which can include 2D and 3D image manipulations, directly within Visage 7, while patients are able to access the video reports at home or on mobile devices via their electronic health record.
The Signify View
The role of the radiologist has always been conceptually very simple. While the profession requires a great deal of knowledge, skill and insight, radiologists are fundamentally tasked with interpreting medical images and passing their findings on to other physicians. If Visage’s new feature gains traction, this job could undergo an essential change and radiologists may also be charged with explaining their findings directly to patients. Forcing radiologists away from the learned language of radiology, and the comfort of its specificity and clarity may prove difficult for some. This reshaping of a radiologist’s role and the challenges it presents, is not necessarily a problem for Visage and the providers that it will serve, but that is also dependent on how much of a difference the additional feature makes. The development of the video reporting concept was made in partnership with a specific customer, NYU Langone, but now Visage believes it is viable in other customer settings. Several vendors in different areas are focusing on improving patient engagement. In doing so, and by keeping patients more involved in their treatment, they hope that patients can be more invested in their own care, avoiding appointment no-shows and avoiding unnecessary care, for example, and resultantly enjoy better outcomes. Visage will hope for similar benefits in making radiology reports more accessible to the patients themselves.
As much as these video reports could offer clinical advantages, they could also improve a patient’s care experience. With the growing trend toward outpatient imaging and the proliferation of smaller imaging centres all competing for a patient’s patronage, this is an important consideration. If patients feel comfortable, valued and involved in their diagnosis, they are more likely to return to, and recommend an imaging centre and radiology group, whether that is selecting one outpatient centre over another, or an outpatient centre over a larger IDN. This could be particularly pertinent given the increase in telehealth adoption during the coronavirus pandemic, with patients becoming more used to accessing healthcare on their phones or computers. Payers are also increasingly aware of the higher costs of in-hospital imaging versus outpatient settings (exemplified in the recently announced study from John Hopkins: Commercial Negotiated Prices for CMS-specified Shoppable Radiology Services in U.S. Hospitals: Research Letter).
It is unlikely this capacity for improved ‘customer service’ alone will be enough to make providers choose Visage’s imaging IT software over competitors, but it will add another measure to the balance. This will be particularly true if imaging centres find they can charge patients an additional fee for a video report.
Setting the Stage
The success of video reporting may also depend on the setting in which it is used. The functionality has been developed and tested at a provider known for its preference for multimedia-enriched radiology reports. Academic providers such as this have the resource and inclination to incorporate such reporting developments, but for other providers the demands placed on radiologists may be too great.
With acute and worsening shortages of radiologists in many countries, and general increases in both the volume and complexity of medical imaging, expecting radiologists to devote an additional two minutes to record a video report may prove unfeasible. These two minutes would be particularly impactful on less complex images that are more quickly read. Guidance from the Royal College of Radiologists in 2012 suggests radiologists could (with no confounding factors) read 3-6 CTs or MRI scans per hour. An additional two minutes to record a video report on each of these scans would therefore represent the loss of almost one hour of reading time per day.
A Star Upstaged
Another challenge facing the adoption of video reports is that it could somewhat undermine the role of the referring physician. Presently, the referring physician interacts with the patient, explains his condition, details the radiologist’s findings, conveys details of his case, and addresses the patient’s concerns and questions. Increases in the prevalence of video reporting could somewhat devalue the role of the primary physician, with the radiologist breaking down findings for the patient. This could also be the root cause of some issues further down the line.
These could be as simple as disagreements or inconsistencies between the radiologist and the referring physician, if the referring physician has additional or supplementary information about the patient’s lifestyle, for example. More seriously, it could open a provider up to legal challenges. Language in radiology reports is, by necessity, subject specific, mostly very precise and unambiguous. Common language, in contrast, can be vague, have multiple meanings and be figurative or rich in analogy. Such ambiguities could leave a patient uncertain as to the severity of a diagnosis or unclear about the prognosis, potentially leaving a provider open to lawsuits and litigation.
The Critic’s Choice?
Despite these headwinds, there is still intriguing potential for video reporting. Perhaps it will not be suitable in all situations – receiving news of a terminal cancer via a video on a mobile phone, for example, is a possibility that doesn’t bear thinking about. But for the right provider, if the technology is handled sensibly and utilised carefully, and radiologists given the right training, the innovation could be a powerful competitive differentiator. Patients could be bestowed with a feeling of control over their care and ultimately given a far better experience.
What’s more, the inclusion of video reporting shows that Visage remains willing to innovate and, alongside advanced academic partners, is both trying to push enterprise imaging forward, while also supporting innovation in radiology. Developments such as video reporting may not gain traction and be forgotten as a novelty, but, Visage’s willingness to explore it ensures that it retains mindshare far larger than its market share warrants.
Alternatively, video reporting could prove popular and win the vendor business. Given the comparatively low technical barriers, other vendors would surely add the functionality to their own products. Video reporting could, in time, become a standard feature, patients could become more engaged and the role of radiologists could be fundamentally changed forever.
The reality, as is usually the case, will likely fall somewhere between the two extremes, but the potential rewards mean that Visage would be remiss not to take the chance.
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