Late last year, the Journal of the American College of Radiology published a study confirming what many have been talking about regarding physician peer review. A whopping 86% of respondents said peer review is important for improving patient care. An even higher number (92%) said they believe physician peer review should be anonymous.
The authors, including Dr. Michael Loreto of the Department of Medical Imaging, Health Sciences North, Ontario, Canada, concluded that, “the incorporation of a non-anonymous peer review system generates anxiety and uncertainty within a radiology department.”
As always, the devil is in the details. Setting up a true blind-review system can be complicated, especially for facilities using older PACS. Virtually none of these systems can be easily modified to remove the name of the reading radiologist and create a smooth, randomized workflow for blind review.
“Random sampling is the least biased way to choose peer review cases, so you shouldn’t look at the case before deciding whether to review it,” said Dr. Robert Pyatt, chair of the American College of Radiology RADPEER committee. “Some make it the first two cases after lunch,” he said in an interview with Diagnostic Imaging.
Newer systems simplify the task for all involved, integrating with an existing PACS to create an automated workflow while ensuring ACR and JACHO regulations are adhered to. Highly sophisticated systems take the solution to the next level, allowing not only completely blind physician peer review at an enterprise level with multiple PACS, but also the ability for the reviewing radiologist to chat anonymously with the original radiologist in real-time before submitting a score.
Although supporting data does not yet exist, common sense tells us incorporating blind reviews into radiologists’ daily workflow helps take the sting out of adding this task to their work week.
Other incentives for participation include a token financial incentive (Hershey Medical Center gives radiologists who meet their quota a few hundred dollars twice a year) or disincentive (doctors lose a percentage of their bonus if they don’t perform the minimum number of reviews). And finally, some radiologists may be incentivized by prospective-review programs in countries like Canada, where results are checked before going to the ordering physician.