Devising a Blueprint for Radiology: Standardization

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Standardization in radiology can take a dozen different paths, and it is clearly complex—but why is there a need for standardization in the first place? Debra L. Monticciolo, MD, FACR, is vice chair for research at Scott & White Healthcare (Temple, Texas), a nonprofit health system. She is a professor of radiology at the allied Texas A &M Health Science Center College of Medicine and is a subspecialist in mammography. Monticciolo is chair of the ACR® Commission on Quality and Safety. Of course, quality and safety are among the primary reasons that standardization is a talking point for so many who hold stakes in radiology’s future. “You have to go back to the way medical practice developed—in this country and elsewhere,” Monticciolo says. “Physicians go out and practice. They respond to their local environments and their patients’ needs. They develop their own ways of doing things. It’s not that there’s anything wrong with that, but these variations in care, over time, can be amplified when you get to taking care of large numbers of patients systematically. You don’t want things being done in 20 different ways if they can be done in two different ways.” From the standpoints of both safety and quality of care, patients are best served when practice standards are developed and used by all providers, Monticciolo says. She uses an example from the ACR’s effort to develop its Dose Index Registry to protect patients from excess radiation during one or multiple imaging exams. “When we first looked at something as simple as a CT exam of the head with contrast, in the systems that we looked at—at the hospitals that were initially working on this—we discovered that this single exam was being named in 1,200 different ways,” she says. “You can’t do anything if you can’t gather data. There needed to be one name for the procedure; then, we could look at how we can do things better.” Curtis Langlotz, MD, PhD, a professor of radiology and vice chair for informatics in the radiology department at the University of Pennsylvania Health System in Philadelphia, has spent years developing a common nomenclature for imaging procedures and processes. He says, “There is a growing consensus across health-care disciplines—not just in radiology—that variability in care is undesirable. We can’t always agree on the optimal level of care, but we can often agree that care at the extremes is suboptimal.” Mitchell D. Schnall, MD, PhD, is a professor of radiology and, since October 2012, chair of the radiology department at the University of Pennsylvania Health System. Schnall also chairs the ACR Imaging Network (ACRIN). He is personally working on quantitative biomarker standardization in clinical trials involving cancer patients, driving home the point that it is those who order imaging exams who are impelling radiology toward standardization. “Other people are asking us for standardization. Our users are starting to ask for it. The oncologists like to see standard and quantitative reports. This is what the customer base is asking for,” Schnall says. Digital technology plays a part, too. Convergence Anthony A. Mancuso, MD, is professor and radiology department chair at the University of Florida College of Medicine in Gainesville. Mancuso says that timing has a lot to do with what radiology is undergoing. Standardization represents a convergence of accumulated radiological knowledge and applications made possible by IT and digital communication. “We know what we don’t know,” Mancuso says. Exams that work well for given clinical scenarios are well documented. Digital technology makes standardized protocols and procedures more efficient to implement. Speech-recognition transcription systems that build structure into the exam-reporting process will soon allow data to be mined from imaging exams as never before, Mancuso adds. “There are tremendous systems out there. You can now embed some principles, in creating a proper reporting structure, that make it very efficient,” he says. In May, the US DHHS announced that a tipping point has been reached: Physicians and health-care systems have responded to federal financial incentives to create electronic health records (EHRs). By the end of 2013, the DHHS estimates, more than half of physicians and 80% of hospitals will be using EHRs. In 2008, prior to the inclusion of financial incentives in the American Recovery and Reinvestment Act of 2009, only 17% of physicians and 9% of hospitals were using EHRs.¹ What