A recent article on the JAMA website is causing waves as it at calls for less medical imaging in the United States. The authors of the article, physicians from the Mayo Clinic and Stanford Health, note that imaging rates in the United States are much higher than in comparable health care systems around the globe with no great increase in overall health benefits. This isn’t the first time we’ve heard of a push for a reduction in medical imaging exams. On January 1, 2020, PAMA (the protecting access to medicare act) will require physicians to review appropriate use criteria before ordering any advanced imaging services like CT or MRI for Medicare patients. The goal of the initiative is to reduce unnecessary exams and lower healthcare costs.
Medical imaging that is unnecessary presents a few key concerns including overexposure to radiation, a topic area of particular concern in pediatrics. Children are considered more at risk than adults since exposure levels are higher, making dose management even more important. Imaging exams can also cause patients large amounts of stress, whether due to high cost, fear of the procedure itself, or waiting for the results. Frequently and fortunately, the results of imaging exams are often normal but with the occasional incidental finding. Incidental findings present their own set of challenges with the jargon of radiology reports alarming patients more than necessary or the findings being ignored entirely in referring physician communications.
However, it cannot be ignored that medical imaging has been strongly linked to a greater life expectancy, reduced cancer risk, and overall improved quality of life. The 2018 Cancer Facts & Figures Report by the American Cancer Society notes a 39% reduction in breast cancer deaths since the 1980s due to earlier detection and diagnosis. Screening with low-dose spiral computed tomography (LDCT) has also been shown to reduce lung cancer mortality by about 20% compared to standard chest x-ray among current or former heavy smokers 55 to 74 years of age. Other cancers, such as ovarian cancer, are difficult to detect and often found at a late stage due to a lack of preventive screening exams. Research is being conducted on how medical imaging tools, like ultrasound, could be best used to diagnosis it at a much earlier point, particularly in high-risk women.
It’s clear that medical imaging exams have the ability to do far more good than harm and there are a few key tools facilities and patients alike can use to prevent unnecessary exams.
Medical imaging exams are often still shared on CDs which can be lost, broken, or incompatible with a system upon upload. This is particularly critical with screening tests such as mammography that are dependent on looking at the imaging history of the patient. A patient who has moved states and does not have access to prior imaging often loses the ability to have priors reviewed. At best, if anything in the imaging is of concern, the prior images are able to be mailed on CD within a few days to the new physician. However, these are still a few days of additional worry and concern for a patient. And at worst, the patient may face further imaging or unnecessary biopsies if priors can’t be accessed.
Secure, electronic sharing of images provides a simple alternative to image distribution via CD. Cloud technology can allow medical images to be transferred through the web allowing for faster turnaround time on reads, speedier diagnosis, and improved overall time to care delivery. Cloud archiving capabilities take this a step further and allow the secure storage of patient data in one unified location.
Many physicians fear that reviewing appropriate use criteria will add yet another wrench in their already burdensome workflows. Facilities should consider deploying a cloud management system that image-enables the EHR, providing a single-sign-on experience and holistic patient record. Additionally, clinical decision support tools are using AI algorithms to act as a digital assistant to physicians when reviewing appropriate use criteria. HealthIT can be the answer to improve complex care workflows.
According to a study we conducted of over 1,100 patients, only 17% of patients are able to easily access radiology reports and imaging. However, our study found that 80% of respondents said they would like to have access to their imaging alongside their imaging results. An image-enabled patient portal offers the opportunity for patients to access imaging exams and reports and be the owners of their healthcare data.
A patient should always receive a thorough explanation of imaging results from their referring physician. Facilities can also offer the contact information of the radiologist who read the exam or that of the appropriate administrator so that patients may reach out with any specific questions following their exam or understand why additional tests are being ordered. These simple steps can a long way in ensuring that patients feel in control of their medical imaging records.