Clinical Communication in Diagnostic Imaging Studies

Summary

Objective: To examine how and why the quality of clinical communication between radiologists and referring physicians was changed in the inpatient imaging process after implementation of a hospital information system (HIS).

Methods: A mixed-method study of the chest X-ray (CXR) requests and reports, and their involved processes within a pre- and post-HIS implementation setting.

Results: Documentation of patient age, patient ward, and name and signature of requesting physician decreased significantly in post-HIS CXR requests (P<0.05). However, documentation of requested position and technique increased significantly (P<0.05). In post-HIS CXR reports, documentation of patient age, patient chart number, urgent/normal status of requisition, position and technique of CXR, name of referring physician, and date of request were increased significantly (P<0.05). However, documentation of discussion for important findings was decreased significantly (P<0.05). The mean number of words in the body text of post-HIS reports was increased significantly (18.65 vs. 16.3, P = 0.00).Our qualitative findings highlighted that involving nursing and radiology staff in the communication loop between physicians and radiologists after the implementation resulted in extra steps in the workflow and more workload for them. To cope with the new workload, they adopted different workarounds that could explain the results seen in the quantitative study.

Conclusion: The HIS improved communication of administrative and identification information but did not improve communication of clinically relevant information. The reason was traced to the complications that the inappropriate implementation of the system brought to clinical workflow and communication loop.

Citation: Pirnejad H, Niazkhania Z, Bal R. Clinical communication in diagnosticimaging studies - mixedmethod study of pre- and post-implementation of a hospital information system. Appl Clin Inf 2013; 4: 541–555

http://dx.doi.org/10.4338/ACI-2013-06-RA-0042

Keywords

Communication - hospital information system - chest X-ray - workflow - patient safety

 

Conflict of interest

The authors declare that they have no conflicts of interest in the research. The ideas discussed here are the authors’ opinion and do not reflect their organization’s position.

• References

• 1 Canadian Institute for Health Information, Hospital Cost Drivers Technical Report –What Factors Have Determined Hospital Expenditure Trends in Canada? (Ottawa, Ont.: CIHI, 2012). Available from: http://www.cihi.ca/CIHI-ext-portal/pdf/internet/HOSPITAL_COSTDRIVER_TECH_EN. (Cited on 5 April 2013)
• 2 The Health Care Cost and Utilization Report: 2011 tracks changes in health care prices, utilization, and spending on people younger than 65 covered by employer-sponsored private health insurance (ESI). Available from: http://www.healthcostinstitute.org/files/HCCI_HCCUR2011.pdf. (Cited on 5 April 2013)
• 3 Mehrotra P, Bosemani V, and Cox J. Do radiologists still need to report chest x rays?. Postgrad Med J 2009; 85 1005 339-341.
• 4 Moncada DC, Rueda ZV, Macías A, Suárez T, Ortega H, and Vélez LA. Reading and interpretation of chest X-ray in adults with community-acquired pneumonia. Braz J Infect Dis 2011; 15 (006) 540-546.
• 5 Turkington P M, Kennan N, Greenstone M A.. Misinterpretation of the chest x ray as a factor in the delayed diagnosis of lung cancer. Postgrad Med J 2002; 78: 158-160.
• 6 Wallis A, and McCoubrie P. The radiology report –Are we getting the message across? Clinical radiology. Clin Radiol. 2011; 66 (011) 1015-1022.
• 7 Donnelly LF, Dickerson JM, Goodfriend MA, and Muething SE. Improving patient safety in radiology. Am J Roentgenol 2010; 194 (Suppl. 05) 1183-1187.
• 8 Cascade PN, and Berlin L. Malpractice issues in radiology. American College of Radiology Standard for Communication. Am J Roentgenol 1999; 173 (Suppl. 06) 1439-1442.
• 9 Stewart MJ, Georgiou A, Hordern A. et al. What do radiology incident reports reveal about in-hospital communication processes and the use of health information technology?. Stud Health Technol Inform 2012; 178: 213-218.
• 10 Naik SS, Hanbidge A, and Wilson SR. Radiology reports: examining radiologist and clinician preferences regarding style and content. Am J Roentgenol 2001; 176 (003) 591-598.
• 11 Song KS, Song HH, Park SH, Ahn KJ, Yang IK, Byun JY, Jeon JS, Kim JY, Kim BS, Lim GY, Kim YJ, Kim HS, Kim CY and Bahk YW. Impact of clinical history on film interpretation. Yonsei medical journal 1992; 33 (002) 168-172.
• 12 Garvey CJ, and Connolly S. Radiology reporting--where does the radiologist’s duty end?. Lancet 2006; 367 9508 443-445.
• 13 Alkasab TK, Alkasab JR, and Abujudeh HH. Effects of a computerized provider order entry system on clinical histories provided in emergency department radiology requisitions. J Am Coll Radiol 2009; 6 (003) 194-200.
• 14 Zlabek JA, Wickus JW, and Mathiason MA. Early cost and safety benefits of an inpatient electronic health record. J Am Med Inform Assoc 2011; 18 (002) 169-172.
• 15 Prevedello L, and Khorasani R. Enhancing quality assurance and quality control programs: IT tools can help. J Am Coll Radiol 2009; 6 (012) 888-889.
• 16 Pirnejad H, Niazkhani Z, Berg M, and Bal R. Intra-organizational communication in healthcare--considerations for standardization and ICT application. Methods Inf Med 2008; 47 (004) 336-45.
• 17 Berg M. Implementing information systems in health care organizations: myths and challenges. Int J Med Inform 2001; 64 –3 143-156.
• 18 Ammenwerth E, Talmon J, Ash JS. et al. Impact of CPOE on mortality rates--contradictory findings, important messages. Methods Inf Med 2006; 45 (006) 586-593.
• 19 ACR.. ACR standard for communication: diagnostic radiology. In: Practice guidelines and technical standards. Reston, VA, USA: 1991. updated in 1995, 1999, 2001, and 2005.
• 20 Ridley LJ. Guide to the radiology report. Australas Radiol 2002; 46 (004) 366-369.
• 21 Poon Eric G, Blumenthal David, Jaggi Tonushree Honour Melissa M, Bates David W, and Kaushal Rainu. Overcoming barriers to adopting and implementing computerized physician order entry systems in U. S. hospitals. Health Aff (Millwood) 2004; 23 (004) 184-190.
• 22 Aarts J, and Berg M. Same systems, different outcomes –comparing the implementation of computerized physician order entry in two Dutch hospitals. Methods Inf Med 2006; 45 (001) 53-61.
• 23 Kazemi A, Fors UG, Tofighi S, Tessma M, and Ellenius J. Physician order entry or nurse order entry? Comparison of two implementation strategies for a computerized order entry system aimed at reducing dosing medication errors. J Med Internet Res 2010; 12 (001) e5.
• 24 Niazkhani Z, Pirnejad H, van der Sijs H, Aarts J. Evaluating the medication process in the context of CPOE use: the significance of working around the system. International journal of medical informatics 2011; 80 (007) 490-506.
• 25 Novak LL, Holden RJ, Anders SH. et al. Using a sociotechnical framework to understand adaptations in health IT implementation. Int J Med Inform. 2013 Apr 2. pii: S1386–5056(13)00020–8. doi: 10.1016/j.ijmedinf.2013.01.009.
• 26 Amis Jr ES, Butler PF, Applegate KE. et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 2007; 4 (005) 272-284.
• 27 Pirnejad H. Computerization of Healthcare Communication: On applying information technology to improve healthcare communication and concerns for patient safety. (PP: 126–130); VDM Verlag (24 Jul 2009). ISBN 9783639158618