- Email: [email protected]
Web Applications for Patient Communication
ORIGINAL ARTICLE
Web Applications for Patient Communication Kristopher Lewis, MD a, Murray A. Reicher, MD b Abstract Communication between imaging professionals and patients can help achieve many goals, including improved patient understanding of imaging-related diagnostic and treatment options, better compliance with appropriate imaging screening procedures, and improved efficiency of service. The explosive growth of out-of-pocket consumer spending on health care has heightened health care shopping, thus making patient communication an important goal of any imaging practice or health care organization. Furthermore, the Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians’ quality ratings, which are in part dependent on patient engagement. The authors summarize the rationale for web communication with patients, the range of content that should be considered, and the technology options. The aim is to help imaging providers develop organized patient communication strategic and implementation plans. Key Words: Patient, direct patient communication, web applications, apps J Am Coll Radiol 2016;13:1603-1607. Copyright 2016 American College of Radiology
INTRODUCTION Many diagnostic radiologists today have little or no patient contact, in person or via the web, as a result of multiple professional trends [1]. Imaging examinations that bring diagnostic radiologists and patients face to face, such as fluoroscopic and interventional procedures, have been largely replaced with endoscopic and crosssectional imaging exams or are increasingly performed by others (technologists, nurses, and interventional radiologists). Off-site reading via teleradiology makes inperson contact impossible. Many radiologists simply do not enjoy direct patient contact; others find that the pressure to interpret examinations is not compatible with taking time to speak with patients [2]. As a result of these technical trends, cultural changes, and financial disincentives, it is no wonder that the interaction between diagnostic radiologists and patients is limited. a Department of Radiology and Imaging, Augusta University, Augusta, Georgia. b Merge Healthcare, San Diego, California. Corresponding author and reprints: Murray A. Reicher, MD, Merge Healthcare, 10140 Mesa Rim Road, San Diego 92121; e-mail: mreicher@ us.ibm.com. Dr Reicher is an investor in Health Companion (Rancho Santa Fe, California). Dr Lewis has no conflicts of interest related to the material discussed in this article.
ª 2016 American College of Radiology 1546-1440/16/$36.00 n http://dx.doi.org/10.1016/j.jacr.2016.09.013
However, communication with patients provides several benefits. Patients value direct communication of results: Patients want to receive accurate information regarding imaging, and radiologists are best equipped to provide it. Studies investigating how patients feel about direct interaction with radiologists have shown that at least a significant minority, if not the majority, of patients value access to imaging reports and the radiologists who interpreted the examinations [3,4]. Communicating with a patient (in person or electronically), including providing patients with direct access to imaging reports, creates a service event that patients value and that does not negatively affect referring physicians’ workflow [5]. Increased appropriate screening adherence: Patient communication, especially if combined with appropriately designed registration software and processes, also creates an opportunity for both the health care system and patients to better understand patients’ appropriate imaging screening needs. The US Preventive Services Task Force and other organizations now provide guidelines for imaging screening, including such examinations as mammography, bone densitometry, CT lung cancer screening, abdominal aortic aneurysm ultrasound screening, and breast MRI. Other tests that have more controversial screening indications include CT coronary
1603
calcium scoring, CT colonography, and perhaps prostate imaging (ultrasound or MRI) in high-risk patients [6]. Today, adherence to each of these procedures is poor [7,8]. Physician and patient reminders have previously been demonstrated to improve adherence to screening. More targeted or tailored web-based interventions, perhaps delivered through patient portals, may similarly increase adherence to appropriate screening services while reducing overuse of inappropriate or low-value services. Economic incentives for patient communication: Growing health care deductibles have resulted in patients spending more out of pocket for imaging and other health care services than ever before. Some estimates indicate that US consumers will spend about $350 billion out of pocket for health care this year [9]. Although limited by insurance networks, patients are increasingly selecting their providers, when possible. Without any direct patient contact, imaging practices leave consumers little basis to make informed choices about imaging providers. Therefore, although communicating with patients may hurt reading efficiency in the short run, in the long run, it may well be in the best interest of imaging providers and patients. Furthermore, secure patient messaging is a requirement of the EHR Incentive Program, so-called meaningful use stages 2 and 3. As the EHR Incentive Program evolves into the Merit-Based Incentive Payment System, patient communication may help maximize payments. Under the Merit-Based Incentive Payment System, data reported starting in 2017, some of which will depend on electronic patient communication, will alter CMS payments to physicians by 4% in 2019 and grow to 9% by 2022 [10]. Physician happiness and recruitment: Once one of the most sought-after residency programs, radiology residencies are dropping in popularity for many reasons [11]. Medical students cite financial and social motivations for selecting their fields of residency. Among those who do not choose diagnostic radiology, the lack of patient contact is frequently cited [12], although students may underestimate the opportunities for direct patient contact. Furthermore, burnout among radiologists is on the rise, in part because of the stress related to working on the image interpretation assembly line. Taking a break to communicate with a patient provides a break from the reading grind and provides an intrinsically rewarding social interaction [13]. Although some radiologists may prefer reading examinations to seeing patients, providing diverse opportunities for professional fulfillment, such as direct patient communication, may have beneficial effects with regard to burnout. 1604
PRACTICE COMMUNICATION NEEDS Administrative Patient Communication Activities Preregistration conveniences patients want: Before their appointments, patients today expect web capabilities such as the ability to manage appointments, receive directions about the location of services, view required preparation, directly schedule some types of examinations (such as screening mammography), complete and submit preregistration data, authenticate forms, and receive bill estimates. A Harris Interactive poll reported in September 2012 found that more than half of surveyed patients wanted services such as e-mail access to doctors, proactive communication about preventive care appointments, online cost estimation, and online test results [14]. More recently, a survey of imaging patients found that 52% of patients wanted to speak with radiologists in advance of their imaging examination [15]. Postvisit services patients want: The majority of patients want immediate access to their reports, with most (79.2%) preferring a web portal for communication [16]. Most want to see their images along with copies of the reports [17]. Referring physicians experienced the same or fewer follow-up e-mails, telephone calls, and office visits after electronic release of radiology reports to patients [5]. Regulatory standards, such as the Medical Quality Standards Act, mandate that mammography patients receive written lay-language summaries of their results. At least one state (Louisiana) requires that patients receive actual mammography reports [18]. Other postvisit services patients desire include online bill pay, proactive reminders about follow-up appointments, and electronic communication with health care organizations [14,16]. In addition to the pro-active web delivery of reports, lay-language summaries, and medical images, records departments often receive patient requests for delivery of prior records. Web-based image delivery may improve patient satisfaction while lowering delivery costs. Electronic communication concordant with patient expectation may engender greater patient loyalty, reducing no-shows. Electronic communication with patients may directly influence clinical care. Secure two-way electronic communication: “Direct secure messaging,” which can be loosely characterized as a health care–certified form of secure e-mail, was rare just a few years ago but has grown by 350% in 1 year to 20 million exchanges in the first quarter of 2016 [19,20]. Some vendors (certified health information services providers) now offer patients “level of assurance 3” addresses to electronically communicate with a growing Journal of the American College of Radiology Volume 13 n Number 12PB n December 2016
number of health care providers who also have been issued Direct addresses [20].
consumer engagement. Radiologist, who have long been health care technology leaders, should take note and prepare.
Clinical Patient Communication Activities Previsit needs assessment: Providers may benefit from systematically assessing their populations for appropriate but underutilized screening procedures, concordant with imaging guidelines. This information can then be communicated to both patients and referring physicians. Ideally, risk factors are collected from patients before visits using web communication tools, so that if there are indicated screening procedures, they can be properly ordered and authorized. Inappropriate testing may also be reduced, decreasing the cost of care under alternative payment models. Improving patient health literacy: Overall health literacy remains low. Specific to imaging, among experienced radiology “customers” averaging 8.8 examinations per patient, only 21.7% responded that they knew the definition of ionizing radiation [21]. Even among those claiming to have knowledge of ionizing radiation, 57% correctly said that CT uses it; 48% incorrectly said that MRI uses it, and only 7.4% that said cardiac catheterization uses it. Radiologists have many other opportunities to improve health literacy, such as tailored patient interventions to improve use of appropriate preventive services. Changing regulatory landscape for clinical imaging providers: The Office of the National Coordinator for Health Information Technology’s (ONC) 10-year agenda contemplates that we will achieve a “learning health system” by 2024, as part of a 10-year agenda that began in 2015 [22]. First conceptualized by the Institute of Medicine in 2005, a learning health system is person centered, enabling individuals to become active partners in their health by not only accessing their health information but also providing and managing health information through mobile health, wearable devices, and online services. A core goal is to empower individual, family, and caregiver health management and engagement. The ONC’s Office of Consumer eHealth describes three A’s:
CURRENT STATE OF WEB APPLICATIONS FOR PATIENT COMMUNICATION Patients today routinely access the web for health information and services, including information about medical imaging [23]. A quick Google search as of mid-2016 suggests that there are approximately 165,000 health care apps but fewer than 400 available in radiology. Although the precision of such estimates is questionable, the message is nevertheless clear: if you do not provide patients accurate information about imaging, your organization, and the services you offer, your patients will be receiving information from others, which may be less accurate. When considering your web presence, remember that consumers today use PCs, Macs, tablets, and smart phones, so cross-platform support of your means of communication is essential. The content of communication you offer to patients may range from general to specific:
n
n
n
Access: Increase people’s access to their own digital health information. Actionable: Ensure that information is actionable via apps and tools. Attitudes: Promote a change in attitudes regarding traditional consumer and provider roles.
Clearly, the regulatory landscape is changing toward mandating transparency of health care records and electronic Journal of the American College of Radiology Lewis, Reicher n Web Apps for Patients
n n n
n
n
n n
General information about health care General information about medical imaging Information about your organization, practice, and personnel, such as services, credentials, directions, examination preparation, statistical outcomes, and pricing Web access to services, such as scheduling, appointment reminders, appointment confirmation, preregistration data collection, bill pay, lay-language summary delivery, clinical report delivery, image access, live chats, and professional telemedicine consultations Uploading outside examinations for second opinions or comparison Imaging screening needs assessment Follow-up tracking, outcome tracking, and patient satisfaction assessment
The method of communication may also be subcategorized: n
n
n
Relatively static content, such as a website or links to other websites that post information Asynchronous structured information exchange, such as patient scheduling, preregistration, bill pay, results delivery, appointment notifications, follow-up prompts, and image access Asynchronous unstructured information exchange, such as secure two-way electronic messaging via e-mail-like or text communication, or secure social network messaging (such as sending a monthly post to a subgroup of patients, perhaps smoking patients, women, or seniors) 1605
n
n
Real-time communication such as live chats or telemedicine consultation Face-to-face consultation
Selecting the proper vendor or vendors can be challenging. Many radiologists who practice within large health care organizations believe that vendor selection is outside of their control; patient communication technology and policies are selected at a higher organizational level. Others, especially radiologists involved in imaging centers, may view patient communication technology as a component of their radiology information systems. Some considerations with regard to vendor selection are as follows: n
n n
n
n
Consider whether vendors conform to the requirements of Direct messaging. Look for ONC certification. If you are a radiology group independent contractor, even if your hospital or imaging center already provides a portal, consider whether you want to provide an independent means for patients to communicate with you and your professional organization. Learn about upcoming federal regulations that provide incentives for patient engagement. Before assuming that your patient engagement solution is just a component of a larger system, learn about specialized patient engagement solutions that may interact with your existing technology via Direct messaging or other interfaces.
CONCLUSIONS Communicating with patients is good medicine and serves the enlightened economic interests of imaging professionals as well. Although face-to-face communication creates a memorable and valuable service event, various web approaches to direct patient communication can also offer benefits, such a higher patient satisfaction, improved compliance with screening procedures, lower operational costs, and greater patient health literacy. If you do not communicate with your patients via the web, someone else will. TAKE-HOME POINTS -
Growing health care consumerism raises the need for imaging providers to satisfy patients with web conveniences such as report delivery, image delivery, and preregistration services.
1606
-
-
-
Communication between imaging professionals and patients can improve patient understanding of imaging-related diagnostic and treatment options and improve adherence to appropriate imagingbased screening. The Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians’ quality ratings, which are in part dependent on patient engagement. Electronic communication concordant with patient expectation may engender greater patient loyalty and provide a competitive edge to an imaging practice.
REFERENCES 1. Glazer GM, Ruiz-Wibbelsmann JA. The invisible radiologist. Radiology 2011;258:18-22. 2. Gunderman RB, Tillack AA. The loneliness of the long-distance radiologist. J Am Coll Radiol 2012;9:530-3. 3. Kuhlman M, Meyer M, Krupinski EA. Direct reporting of results to patients: the future of radiology? Acad Radiol 2012;19:646-50. 4. Basu PA, Ruiz-Wibbelsmann JA, Spielman SB, Van Dalsem VF, Rosenberg JK, Glazer GM. Creating a patient-centered imaging service: determining what patients want. AJR Am J Roentgenol 2011;196:605-10. 5. Henshaw D, Okawa G, Ching K, Garrido T, Qian H, Tsai J. Access to radiology reports via an online patient portal: experiences of referring physicians and patients. J Am Coll Radiol 2015;12:582-6. 6. US Preventive Services Task Force. Home page. Available at: http:// www.uspreventiveservicestaskforce.org. Accessed May 18, 2016. 7. Centers for Disease Control and Prevention, National Center for Health Statistics. FastStats: mammography. Available at: http://www. cdc.gov/nchs/fastats/mammography.htm. Accessed May 25, 2016. 8. Amarnath ALD, Franks P, Robbins JA, Xing G, Fenton JJ. Underuse and overuse of osteoporosis screening in a regional health system: a retrospective cohort study. J Gen Intern Med 2015;30:1733-40. 9. Centers for Medicare and Medicaid Services. National health expenditure projections 2012-2022. Available at: https://www.cms.gov/ research-statistics-data-and-systems/statistics-trends-and-reports/national healthexpenddata/downloads/proj2012.pdf. Accessed May 25, 2016. 10. Centers for Medicare and Medicaid Services. MACRA: delivery system reform, Medicare payment reform. Available at: https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ValueBased-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-andAPMs.html. Accessed May 25, 2016. 11. Chen JY, Heller MT. 2014 residency match update and call to action. J Am Coll Radiol 2014;11:835. 12. Fielding JR, Major NM, Mullan BF, et al. Choosing a specialty in medicine: female medical students and radiology. AJR Am J Roentgenol 2007;188:897-900. 13. Harolds JA, Parikh JR, Bluth EI, Dutton SC, Recht MP. Burnout of radiologists: frequency, risk factors, and remedies: a report of the ACR Commission on Human Resources. J Am Coll Radiol 2016;13: 411-6. 14. Harris Interactive. Patient choice an increasingly important factor in the age of the “healthcare consumer.” Available at: http://www.prnewswire. com/news-releases/patient-choice-an-increasingly-important-factorin-the-age-of-the-healthcare-consumer-169140306.html. Accessed October 5, 2016.
Journal of the American College of Radiology Volume 13 n Number 12PB n December 2016
15. Rosenkrantz AB, Flagg ER. Survey-based assessment of patients’ understanding of their own imaging examinations. J Am Coll Radiol 2015;12:549-55. 16. Johnson AJ, Easterling D, Williams LS, Glover S, Frankel RM. Insight from patients for radiologists: improving our reporting systems. J Am Coll Radiol 2009;6:786-94. 17. Cabarrus M, Naeger DM, Rybkin A, Qayyum A. Patients prefer results from the ordering provider and access to their radiology reports. J Am Coll Radiol 2015;12:556-62. 18. Louisiana Legislature. House bill no. 186. Available at: https://www. legis.la.gov/legis/ViewDocument.aspx?d¼931641. Accessed May 20, 2016. 19. Sujansky W, Wilson T. Direct secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers. J Biomed Inform 2015;54:191-201.
Journal of the American College of Radiology Lewis, Reicher n Web Apps for Patients
20. DirectTrust. DirectTrust sees 20M health data exchanges in Q1 2016. Available at: https://www.directtrust.org/directtrust-sees-20m-healthdata-exchanges-in-q1-2016/. Accessed May 25, 2016. 21. Steele JR, Jones AK, Clarke RY, Giordano SH, Shoemaker S. Oncology patient perceptions of the use of ionizing radiation in diagnostic imaging. J Am Coll Radiol 2016;13:768-74. 22. The Office of the National Coordinator for Health Information Technology. Connecting health and care for the nation: a shared nationwide interoperability roadmap. Available at: https://www. healthit.gov/sites/default/files/nationwide-interoperability-roadmapdraft-version-1.0.pdf. Accessed October 5, 2016. 23. Consumer guide to understanding and using the PHR model privacy notice on PHR company data practices. Available at: https://www. healthit.gov/sites/default/files/privacy-security/privacy-model-privacynotice-consumer-guide-final.pdf. Accessed May 25, 2016.
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Web Applications for Patient Communication Kristopher Lewis, MD a, Murray A. Reicher, MD b Abstract Communication between imaging professionals and patients can help achieve many goals, including improved patient understanding of imaging-related diagnostic and treatment options, better compliance with appropriate imaging screening procedures, and improved efficiency of service. The explosive growth of out-of-pocket consumer spending on health care has heightened health care shopping, thus making patient communication an important goal of any imaging practice or health care organization. Furthermore, the Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians’ quality ratings, which are in part dependent on patient engagement. The authors summarize the rationale for web communication with patients, the range of content that should be considered, and the technology options. The aim is to help imaging providers develop organized patient communication strategic and implementation plans. Key Words: Patient, direct patient communication, web applications, apps J Am Coll Radiol 2016;13:1603-1607. Copyright 2016 American College of Radiology
INTRODUCTION Many diagnostic radiologists today have little or no patient contact, in person or via the web, as a result of multiple professional trends [1]. Imaging examinations that bring diagnostic radiologists and patients face to face, such as fluoroscopic and interventional procedures, have been largely replaced with endoscopic and crosssectional imaging exams or are increasingly performed by others (technologists, nurses, and interventional radiologists). Off-site reading via teleradiology makes inperson contact impossible. Many radiologists simply do not enjoy direct patient contact; others find that the pressure to interpret examinations is not compatible with taking time to speak with patients [2]. As a result of these technical trends, cultural changes, and financial disincentives, it is no wonder that the interaction between diagnostic radiologists and patients is limited. a Department of Radiology and Imaging, Augusta University, Augusta, Georgia. b Merge Healthcare, San Diego, California. Corresponding author and reprints: Murray A. Reicher, MD, Merge Healthcare, 10140 Mesa Rim Road, San Diego 92121; e-mail: mreicher@ us.ibm.com. Dr Reicher is an investor in Health Companion (Rancho Santa Fe, California). Dr Lewis has no conflicts of interest related to the material discussed in this article.
ª 2016 American College of Radiology 1546-1440/16/$36.00 n http://dx.doi.org/10.1016/j.jacr.2016.09.013
However, communication with patients provides several benefits. Patients value direct communication of results: Patients want to receive accurate information regarding imaging, and radiologists are best equipped to provide it. Studies investigating how patients feel about direct interaction with radiologists have shown that at least a significant minority, if not the majority, of patients value access to imaging reports and the radiologists who interpreted the examinations [3,4]. Communicating with a patient (in person or electronically), including providing patients with direct access to imaging reports, creates a service event that patients value and that does not negatively affect referring physicians’ workflow [5]. Increased appropriate screening adherence: Patient communication, especially if combined with appropriately designed registration software and processes, also creates an opportunity for both the health care system and patients to better understand patients’ appropriate imaging screening needs. The US Preventive Services Task Force and other organizations now provide guidelines for imaging screening, including such examinations as mammography, bone densitometry, CT lung cancer screening, abdominal aortic aneurysm ultrasound screening, and breast MRI. Other tests that have more controversial screening indications include CT coronary
1603
calcium scoring, CT colonography, and perhaps prostate imaging (ultrasound or MRI) in high-risk patients [6]. Today, adherence to each of these procedures is poor [7,8]. Physician and patient reminders have previously been demonstrated to improve adherence to screening. More targeted or tailored web-based interventions, perhaps delivered through patient portals, may similarly increase adherence to appropriate screening services while reducing overuse of inappropriate or low-value services. Economic incentives for patient communication: Growing health care deductibles have resulted in patients spending more out of pocket for imaging and other health care services than ever before. Some estimates indicate that US consumers will spend about $350 billion out of pocket for health care this year [9]. Although limited by insurance networks, patients are increasingly selecting their providers, when possible. Without any direct patient contact, imaging practices leave consumers little basis to make informed choices about imaging providers. Therefore, although communicating with patients may hurt reading efficiency in the short run, in the long run, it may well be in the best interest of imaging providers and patients. Furthermore, secure patient messaging is a requirement of the EHR Incentive Program, so-called meaningful use stages 2 and 3. As the EHR Incentive Program evolves into the Merit-Based Incentive Payment System, patient communication may help maximize payments. Under the Merit-Based Incentive Payment System, data reported starting in 2017, some of which will depend on electronic patient communication, will alter CMS payments to physicians by 4% in 2019 and grow to 9% by 2022 [10]. Physician happiness and recruitment: Once one of the most sought-after residency programs, radiology residencies are dropping in popularity for many reasons [11]. Medical students cite financial and social motivations for selecting their fields of residency. Among those who do not choose diagnostic radiology, the lack of patient contact is frequently cited [12], although students may underestimate the opportunities for direct patient contact. Furthermore, burnout among radiologists is on the rise, in part because of the stress related to working on the image interpretation assembly line. Taking a break to communicate with a patient provides a break from the reading grind and provides an intrinsically rewarding social interaction [13]. Although some radiologists may prefer reading examinations to seeing patients, providing diverse opportunities for professional fulfillment, such as direct patient communication, may have beneficial effects with regard to burnout. 1604
PRACTICE COMMUNICATION NEEDS Administrative Patient Communication Activities Preregistration conveniences patients want: Before their appointments, patients today expect web capabilities such as the ability to manage appointments, receive directions about the location of services, view required preparation, directly schedule some types of examinations (such as screening mammography), complete and submit preregistration data, authenticate forms, and receive bill estimates. A Harris Interactive poll reported in September 2012 found that more than half of surveyed patients wanted services such as e-mail access to doctors, proactive communication about preventive care appointments, online cost estimation, and online test results [14]. More recently, a survey of imaging patients found that 52% of patients wanted to speak with radiologists in advance of their imaging examination [15]. Postvisit services patients want: The majority of patients want immediate access to their reports, with most (79.2%) preferring a web portal for communication [16]. Most want to see their images along with copies of the reports [17]. Referring physicians experienced the same or fewer follow-up e-mails, telephone calls, and office visits after electronic release of radiology reports to patients [5]. Regulatory standards, such as the Medical Quality Standards Act, mandate that mammography patients receive written lay-language summaries of their results. At least one state (Louisiana) requires that patients receive actual mammography reports [18]. Other postvisit services patients desire include online bill pay, proactive reminders about follow-up appointments, and electronic communication with health care organizations [14,16]. In addition to the pro-active web delivery of reports, lay-language summaries, and medical images, records departments often receive patient requests for delivery of prior records. Web-based image delivery may improve patient satisfaction while lowering delivery costs. Electronic communication concordant with patient expectation may engender greater patient loyalty, reducing no-shows. Electronic communication with patients may directly influence clinical care. Secure two-way electronic communication: “Direct secure messaging,” which can be loosely characterized as a health care–certified form of secure e-mail, was rare just a few years ago but has grown by 350% in 1 year to 20 million exchanges in the first quarter of 2016 [19,20]. Some vendors (certified health information services providers) now offer patients “level of assurance 3” addresses to electronically communicate with a growing Journal of the American College of Radiology Volume 13 n Number 12PB n December 2016
number of health care providers who also have been issued Direct addresses [20].
consumer engagement. Radiologist, who have long been health care technology leaders, should take note and prepare.
Clinical Patient Communication Activities Previsit needs assessment: Providers may benefit from systematically assessing their populations for appropriate but underutilized screening procedures, concordant with imaging guidelines. This information can then be communicated to both patients and referring physicians. Ideally, risk factors are collected from patients before visits using web communication tools, so that if there are indicated screening procedures, they can be properly ordered and authorized. Inappropriate testing may also be reduced, decreasing the cost of care under alternative payment models. Improving patient health literacy: Overall health literacy remains low. Specific to imaging, among experienced radiology “customers” averaging 8.8 examinations per patient, only 21.7% responded that they knew the definition of ionizing radiation [21]. Even among those claiming to have knowledge of ionizing radiation, 57% correctly said that CT uses it; 48% incorrectly said that MRI uses it, and only 7.4% that said cardiac catheterization uses it. Radiologists have many other opportunities to improve health literacy, such as tailored patient interventions to improve use of appropriate preventive services. Changing regulatory landscape for clinical imaging providers: The Office of the National Coordinator for Health Information Technology’s (ONC) 10-year agenda contemplates that we will achieve a “learning health system” by 2024, as part of a 10-year agenda that began in 2015 [22]. First conceptualized by the Institute of Medicine in 2005, a learning health system is person centered, enabling individuals to become active partners in their health by not only accessing their health information but also providing and managing health information through mobile health, wearable devices, and online services. A core goal is to empower individual, family, and caregiver health management and engagement. The ONC’s Office of Consumer eHealth describes three A’s:
CURRENT STATE OF WEB APPLICATIONS FOR PATIENT COMMUNICATION Patients today routinely access the web for health information and services, including information about medical imaging [23]. A quick Google search as of mid-2016 suggests that there are approximately 165,000 health care apps but fewer than 400 available in radiology. Although the precision of such estimates is questionable, the message is nevertheless clear: if you do not provide patients accurate information about imaging, your organization, and the services you offer, your patients will be receiving information from others, which may be less accurate. When considering your web presence, remember that consumers today use PCs, Macs, tablets, and smart phones, so cross-platform support of your means of communication is essential. The content of communication you offer to patients may range from general to specific:
n
n
n
Access: Increase people’s access to their own digital health information. Actionable: Ensure that information is actionable via apps and tools. Attitudes: Promote a change in attitudes regarding traditional consumer and provider roles.
Clearly, the regulatory landscape is changing toward mandating transparency of health care records and electronic Journal of the American College of Radiology Lewis, Reicher n Web Apps for Patients
n n n
n
n
n n
General information about health care General information about medical imaging Information about your organization, practice, and personnel, such as services, credentials, directions, examination preparation, statistical outcomes, and pricing Web access to services, such as scheduling, appointment reminders, appointment confirmation, preregistration data collection, bill pay, lay-language summary delivery, clinical report delivery, image access, live chats, and professional telemedicine consultations Uploading outside examinations for second opinions or comparison Imaging screening needs assessment Follow-up tracking, outcome tracking, and patient satisfaction assessment
The method of communication may also be subcategorized: n
n
n
Relatively static content, such as a website or links to other websites that post information Asynchronous structured information exchange, such as patient scheduling, preregistration, bill pay, results delivery, appointment notifications, follow-up prompts, and image access Asynchronous unstructured information exchange, such as secure two-way electronic messaging via e-mail-like or text communication, or secure social network messaging (such as sending a monthly post to a subgroup of patients, perhaps smoking patients, women, or seniors) 1605
n
n
Real-time communication such as live chats or telemedicine consultation Face-to-face consultation
Selecting the proper vendor or vendors can be challenging. Many radiologists who practice within large health care organizations believe that vendor selection is outside of their control; patient communication technology and policies are selected at a higher organizational level. Others, especially radiologists involved in imaging centers, may view patient communication technology as a component of their radiology information systems. Some considerations with regard to vendor selection are as follows: n
n n
n
n
Consider whether vendors conform to the requirements of Direct messaging. Look for ONC certification. If you are a radiology group independent contractor, even if your hospital or imaging center already provides a portal, consider whether you want to provide an independent means for patients to communicate with you and your professional organization. Learn about upcoming federal regulations that provide incentives for patient engagement. Before assuming that your patient engagement solution is just a component of a larger system, learn about specialized patient engagement solutions that may interact with your existing technology via Direct messaging or other interfaces.
CONCLUSIONS Communicating with patients is good medicine and serves the enlightened economic interests of imaging professionals as well. Although face-to-face communication creates a memorable and valuable service event, various web approaches to direct patient communication can also offer benefits, such a higher patient satisfaction, improved compliance with screening procedures, lower operational costs, and greater patient health literacy. If you do not communicate with your patients via the web, someone else will. TAKE-HOME POINTS -
Growing health care consumerism raises the need for imaging providers to satisfy patients with web conveniences such as report delivery, image delivery, and preregistration services.
1606
-
-
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Communication between imaging professionals and patients can improve patient understanding of imaging-related diagnostic and treatment options and improve adherence to appropriate imagingbased screening. The Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians’ quality ratings, which are in part dependent on patient engagement. Electronic communication concordant with patient expectation may engender greater patient loyalty and provide a competitive edge to an imaging practice.
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Journal of the American College of Radiology Lewis, Reicher n Web Apps for Patients
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