Quick Question

[mglavin]

When a radiologist is asked to look at an imaging study to help with the diagnosis of a patient do they receive any more information such as the CC, HPI, PMHx, results of physical exam, labs? Does the radiologist get a full picture of the patient or just an image and nothing more? Or some combination of these two extremes? Do you ever wish to get a more complete picture or are you happy with just dealing with any images?

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[colbgw02]

Haha. If you weren't a medical student, then I'd think you're just trying to get a rise out of the radiology forum.

The histories provided are notoriously lacking in detail; it's pretty much a joke. Even the best clinicians can only provide a handful of details, and most of the time we get something like "rule out fracture", "rule out abnormalities", or - my personal favorite - "follow-up". Technically, the insurance companies won't pay for a study for which the indication is "rule out [whatever]", so you'll see something like "fever" for an abdominal CT.

Getting a complete clinical picture is pretty impractical anyway; there are just too many studies. It's also unnecessary most of the time. On those occasions where we really need more information, we pick up the phone and call. Also, at my hospital, the computer system that holds the lab values is accessible from the PACS.

 

[Docxter]

When a radiologist is asked to look at an imaging study to help with the diagnosis of a patient do they receive any more information such as the CC, HPI, PMHx, results of physical exam, labs? Does the radiologist get a full picture of the patient or just an image and nothing more? Or some combination of these two extremes? Do you ever wish to get a more complete picture or are you happy with just dealing with any images?

Most of the time there is minimal information. Sometimes there is pretty much nothing (i.e., Abdominal CT, r/o disease), sometimes it is pretty good, sometimes it is outright wrong and misleading (e.g, for a brain MRI it says trauma, but in fact it's for assessing metastatic disease in a lung cancer patient). Some places have access to a decent electronic health record which if necessary the data in there (widely variable as to how much is actually in there) may be useful, though in reality it's impractical to spend 15-30 min to try to get a decent history from the EHR or getting in touch with the referring doc (good luck with that) for every case.

Most radiologists have learned to live without a getting decent history. Nevertheless, having a decent relevant indication and history certainly helps. Providing the minimal information for a radiology request is just practicing good medicine and in line with actually caring for the patient. Alot of times it may not matter if there is a history on the rquest or not. However, a lot of times the wrong study is ordered, or the study protocol (especially in MRI) may be altered to better answer the clinical question at hand. If the radiologist knows what the referring physician is looking for, the study will be done in a way to better answer the question at hand. This way better care is provided for the patient.

 

[hans19]

The best one I've gotten is 'sick' from the ER.
Are you f---ing sh--ing me? Really?!? Is the guy sick? Gee thanks, I guess he wouldn't be in your ER otherwise.

 

[DrGregoryHouse]

The best one I've gotten is 'sick' from the ER.
Are you f---ing sh--ing me? Really?!? Is the guy sick? Gee thanks, I guess he wouldn't be in your ER otherwise.

hahaha

 

[osli]

When shadowing a local radiologist as a first and second year student, I've noticed that a lot of the scans in his rad station are accompanied by the H&P as well as tied into previous imaging studies for that patient. It sounds like this type of system/arrangement not the norm?

"Sick"... haha

 

[f_w]

I've noticed that a lot of the scans in his rad station are accompanied by the H&P as well as tied into previous imaging studies for that patient. It sounds like this type of system/arrangement not the norm?

Highly desireable, but certainly not the norm.

I have seen this at one academic place. EMR and rad workstation where fully transparent. If you pulled up a CT on a cancer patient, the last comprehensive note from the main onc provider (med-onc, rad-onc or surgical specialty) was automatically pulled up.

 

[osli]

Wow. Funny thing is that this was at a community hospital in rural Mississippi. I had no idea while watching him that this wasn't commonplace... I wonder what happened at that particular hospital to convince administrators to go for something like that?

 

[AD2020]

I have seen this at one academic place. EMR and rad workstation where fully transparent. If you pulled up a CT on a cancer patient, the last comprehensive note from the main onc provider (med-onc, rad-onc or surgical specialty) was automatically pulled up.

Do you know if there is a trend towards this? I would think that the quality and relevance of reports for all kinds of studies would increase dramatically if this were the case.

 

[f_w]

Do you know if there is a trend towards this? I would think that the quality and relevance of reports for all kinds of studies would increase dramatically if this were the case.

It falls under the general category of the 'integrated healthcare enterprise'.

At this point, the information systems in many hospitals are cobbled together from a patchwork of legacy systems bought over the years. Rarely ever is there enough capital to make a 'clean cut' and replace everything in one sweep. Integration between different hospital systems tends to be very expensive with the cost for the programming of a simple seeming interface often running in the 50k-100k range. So creating integration between seemingly parallel systems (like PACS and EMR) is often not a priority.

Also, few of the hospital IS vendors have the breadth of experience to offer everything out of one hand. Often, those companies are the combination of different smaller vendors bought up over the years with various generations of their products unable to talk to each other.

The only place with a true IHE at this point is the VA. In their single-payor environment, there is an actual payback to the organization from investments into an integrated IS environment.