Radiologists Generate Fewer High-Cost Follow-Up Orders


radiology informationThe beauty of radiology information studies, or any controlled study for that matter, is that researchers start with one premise and, based on their findings, often arrive at unexpected or opposite conclusions. The title of the article published in the online journal, Radiology, “When Does a Radiologist’s Recommendation for Follow-up Result in High-cost Imaging?” gives the reader the impression that radiologists are the reason for high costs when, in fact, radiologists generate few high-cost follow-up orders.

We do not know the researchers’ intent, or if they were conducting the research with bias.  However, in the abstract we read that Susanna I. Lee, M.D., PhD of Massachusetts General Hospital, Department of Radiology along with others intended originally to measure simply the proportion of high-cost medical imaging generated by a radiologist’s recommendation which we learn was small (5.3%).

While we think that summarizing their findings will help to clarify the article’s title, we also pose a few solutions that could turn around this low figure.

Lacking Guidelines, Radiologists Err on the Side of Caution

Thanks to data gleaned from radiology information systems, we know that the largest percentage of follow-up recommendations came as a result of pulmonary nodules. While most lung nodules are noncancerous, according to the Mayo Clinic, some may represent early-stage lung cancer. Hence, radiologists tend to be proactive in this area.

In addition, the National Lung Screening Trial and the Fleischner Society both offer guidelines for the treatment of small pulmonary nodules.

“It is possible that the higher proportion of recommendations for chest CT resulted from our radiologists’ adherence to these nationally recognized guidelines, which, in the context of early lung cancer detection, can be considered medically indicated,” wrote Lee,

The areas that radiologists struggle with particularly, adenopathy and renal lesions, lack criterion to distinguish benign from malignant findings. This fact supports our theory that it may be the lack of guidelines that prevent radiologists from recommending follow ups rather than their inability to optimize financial performance. Unfortunately, data from radiology information systems are unable to shed light on the topic as that information is not tracked.

Knowledge Gap Between Physicians and Radiologists

The authors suggested a knowledge gap regarding appropriate studies among referring physicians and noted that one of radiologists’ roles is to consult on the choice of medical imaging. This suggests a “disconnect” between the attending physician and the imaging expert, i.e. the radiologist. Is it possible for radiology information to be disseminated to referring physicians? Would a proactive stance generate more high-cost follow-up orders improving the bottom line?

Maybe it’s time for a new study.

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