Individualized reports historically have been considered sacrosanct as the medical specialty of radiology pioneered "going digital" in medicine and adopting electronic technologies to replace paper and x-ray film. But the pedestal upon which individual reports have been placed is being undermined by the need for greater consistency, increased efficiency, and improved communication with clinicians and other medical professionals.
As stated bluntly in a standing-room-only session at last year's meeting, the question is not whether electronic structured reporting will be adopted, but rather whether it will be happen within this decade. Quite a bit of progress is being made.
AuntMinnie.com caught up with Dr. Charles Kahn Jr., vice chairman of RSNA's Structured Reporting Subcommittee, to discuss what's happened over the past 12 months.
In 2007, RSNA established a subcommittee responsible for evaluating and developing reporting systems, processes, and tools that enable radiology information to be captured, stored, and presented in a clear and consistent format. Two years later, at the 2009 RSNA meeting, the first tangible efforts of the RSNA Structured Reporting Initiative made their debut.
Subcommittee chairman Dr. Curtis Langlotz, PhD, also professor and vice chair for informatics in the department of radiology at the Hospital of the University of Pennsylvania, introduced a library of 70 "best practice" templates based on the recommendations of more than 100 experts from 12 radiology specialties.
Last year, 30 more reports made their debut. Langlotz also announced that a dedicated RSNA-sponsored website, RadReport.org, would be established to contain them.
The website has been established, supported in part by a grant from the National Institute of Biomedical Imaging and Bioengineering (NBIB). An additional 30 report templates in English have been added, and translation initiatives in Arabic, Chinese, and Turkish have been initiated. Work is also under way to add other languages.
The templates are available in both text and Extensible Markup Language (XML) formats. Elements of the text format can be made as macros to incorporate into a speech recognition dictation system. The XML format contains links to RadLex terms.
To date, almost 25,000 templates have been downloaded around the world. The top three are reports for a CT brain exam, chest radiography, and abdominal ultrasound.
"Part of the project the subcommittee is trying to accomplish is not just to create a set of reporting templates, but also to link the templates to standardized vocabulary," Kahn explained. "The RSNA's RadLex vocabulary ... contains more than 32,000 terms and continues to increase. The incorporation of RadLex terminology into structured reporting templates improves the consistency and quality of radiology reports. Similarly, the addition of terms in 'best practice' report templates contributes to improving the strength and scope of RadLex."
Kahn, a professor of radiology and chief of its division of informatics at the Medical College of Wisconsin, and others have been testing the vocabulary, grammar, and syntax of the reporting templates against RadLex. "This is a work in progress being undertaken by many people representing many healthcare organizations, and also includes active participation by individuals who work within the vendor community," he said.
Another major effort over the past 12 months has been building an infrastructure: specifically, information system standards that will make it easier for radiologists to incorporate report templates in their practices. This is a two-pronged approach, Kahn said.
A group of volunteers, both members and nonmembers of the RSNA Structured Reporting Subcommittee, are working to create an Integrating the Healthcare Enterprise (IHE) profile for the management of reporting templates (MRRT). The MRRT profile will enable the transfer of templates between reporting systems, and it will potentially foster the use of standard templates from a variety of template libraries. Langlotz and Kevin O'Donnell, senior research and development manager at the Toshiba Medical Research Institute, are the lead co-authors for this profile.
Another initiative under way is DICOM Working Group 8 (Structured Reporting). This working group is developing an implementation guide to describe the transformation of reports from RSNA's report template format into documents that comply with HL7 Clinical Document Architecture, the international standard for clinical reports.
"Our priority for the next year is to get the DICOM standard in place and provide the solid foundation to allow vendors to build systems," Kahn said. "It's our responsibility to develop standards that vendors can implement in commercial systems. This process isn't glamorous and it takes time, but it's what we're focusing on in the next year."
There are courses, scientific presentations, and poster presentations throughout the week on this subject for meeting attendees to prepare for what may be the next sea change in the day-to-day practice of radiology.