The U.S. healthcare system is bloated—no doubt about it. According to the Institute of Medicine, between $800 billion and $1 trillion is wasted every year—higher than the GDP of Turkey, Switzerland or Saudi Arabia.
“Everyone has said we’ve got to tackle this one way or another,” said Giles W.L. Boland, MD, head of the department of radiology at Brigham and Women’s Hospital. “Right now the zeitgeist is looking for better value, but we need to determine that from the patient’s perspective—not ours.”
Un-actionable language in a radiology report can often doom a patient to more screening, heightening anxiety and uncertainty about a condition. While reports should strive to be precise, Boland posits that a culture of silence masks feedback to radiologists about their reports, citing the few times he’s ever been chided for vague reports.
“Even more disheartening, this is happening all the time, in all of our practices,” Boland said. “We’re ordering these exams without any real feedback to the patient, or any feedback to ourselves about whether it’s the right test or not.”
Boland used the case of a 44-year-old woman with breast cancer as an example of the human cost.
“She comes in with abdominal pain, we see something on her liver on ultrasound and someone recommended CT as the next step,” said Boland. “We performed the exam, it was considered indeterminate and we went to MRI.”
The problem?
“Look at this from the patient’s perspective. She’s scared to death, wondering about what to tell her husband and children,” said Boland. “This is a young woman with cancer. Yet we flippantly dilute our own protocol for a patient with cancer: When you detect a liver lesion in a patient with cancer on ultrasound, you go straight to MRI.”
Aggregating usable data, clinical history and relevant documents into a report can aid the referring physician in reaching a conclusion and giving the patient the best value. Boland uses the disease-specific electronic reporting at Massachusetts General Hospital as an example, demonstrating the standardized language and pre-populated text based on several different inputs.
A decision support system such as this can help physicians avoid unnecessary or confusing variation, which can cost the system millions of dollars in reduced productivity, manifesting in incorrectly ordered exams or delays for clarification from other care providers.
Boland cites his practice’s vast improvement in reporting on pulmonary nodules as evidence of the tool’s value.
“Before we had this tool, abdominal radiologists were concordant to guidelines 50 percent of the time: variation, waste, cost,” said Boland. “Since we introduced the tool, they’ve been approaching 95 percent concordance, delivering best practices and better outcomes.”
Boland ended the presentation by asking how many attendees used decision support systems. Only a couple hands went up.
“It’s about to be 2017, you should catch up folks, you need to get on board with this,” he said. “Because if everyone else is getting lined up to buy these products, you’re going to be at the end of that line. This should be a wakeup call to you and your institutions.”