Patient access to imaging results brings awkward challenges

2014 01 10 12 25 04 287 Doctor Wheeling Patient 200

Providing patients with Web-based access to their radiology reports offers benefits, but also raises some difficult issues. For example, an Israeli hospital recently found a discouraging number of patients did not return to their referring physician, despite having online access to their abnormal findings.

In a presentation at last month's RSNA 2013 meeting in Chicago, Dr. Nogah Shabshin of Assuta Medical Center Network in Tel Aviv reported that almost 30% of patients who could access their radiology reports via an Internet portal didn't come back to their referring physician even though the results were abnormal.

"These results are really disturbing," she noted.

In recent years, there's been increasing use of Internet portals to directly provide radiology reports to patients, but these portals come with both positives and negatives, Shabshin said. On the bright side, portals support patient rights and enable patients to become more involved and take more responsibility for their medical condition, she said. They also can provide speedier access to results and a faster workup.

"Actually, the patients encourage their doctors to continue with the treatment," she said.

However, patients can also potentially misunderstand reports with bad news after Googling the results, Shabshin said.

"The misunderstanding can be disastrous," she said. "Actually in Israel there was a patient who received a pathology report that was benign but he misunderstood it as malignant and committed suicide and the hospital was sued for that."

Misunderstandings can also lead to patient delays, and it's also known that even negative results may have clinical significance, she said.

Assuta's experience

Assuta Medical Center in Israel has been delivering radiology reports to patients via a portal for about five years. When it launched, the service was very attractive to the hospital, HMOs, and some patients, Shabshin said.

It was viewed as advanced, technological, new, and innovative, and considered to be an excellent service for patients, she said. It was also seen as the most confidential and fastest way to get results.

Patients were encouraged to use the portal to get the reports, and were given passwords even if they preferred to receive the results in another way such as fax, mail, courier, or by returning to the site. Even after five years however, only 30% of patients log in to the portal, she said.

In essence, this group of patients had the capability to access their radiology reports within 72 hours, most likely before the doctor received the report and before seeing their doctor, and yet chose not to use it, she said.

In a descriptive study, the researchers sought to assess the proportion of patients with abnormal studies who didn't access the reports online and did not receive the results at all, and the proportion of those who received the results in a different way but did not return to the referring physician.

The study included 1,594 patients who received a CT or MRI from April to October 2012. These patients received a password and did not log in to the portal and had reports that were classified as abnormal by the reading radiologist.

A telephone survey was performed to ask the patients if they received the report and if they returned to their referring physicians after receiving the report.

Of the 1,594, 220 (14%) did not receive the results although they were available to them in at least one way. Of the remaining 1,374 patients who received the results, 190 (14%) did not return to their referring physician.

The researchers further analyzed the results by body part imaged and by patient age.

Results by body part
  Didn't receive results Received the results but didn't
return to referring physician
Spine and joint 129 100 229
Body 56 48 104
Head 36 41 77
Results by patient age
Age Didn't receive results Received the results but didn't
return to referring physician
< 18 4 0 4
18-45 89 81 170
> 46 127 109 236

There was very little difference by gender, Shabshin said.

Although the researchers didn't specifically assess the reasons for these patients' decisions, they believe they can be explained by anxiety and denial, as well as an assumption that the doctor will call if the results are abnormal, she said. In addition, patients may also misunderstand the report.

"Last month, we presented another study in which we asked patients with abnormal results whether their reports were normal or abnormal, 30% of those patients perceived the reports as normal, which showed they did not understand the reports correctly," she said.

Learning to cope

Shabshin noted though patients are receiving reports directly now and have easy access to sources of medical information on the Internet.

"We need to learn how to cope with this," she said.

In the future, the researchers would like to systematically evaluate the potential causes for failing to return to the referring physician despite having access to their abnormal imaging results, and to study different ages as well as socioeconomic groups, she said.

Based on the current study's finding, Shabshin recommends that imaging departments should make every effort they can to ensure that results are sent to and received by the referring physician. This process should be documented.

"The radiologist, when reporting a significant and abnormal finding, should keep in mind that almost 30% of the patients will not do anything with the report after having their study done," Shabshin said.

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