Support Tests.

Andrew Olson olso5714 at UMN.EDU
Tue Jan 26 18:48:31 UTC 2016


I think there are clear technological solutions that would allow for
interaction between clinical and perceptual teams that don't involve the
proverbial trip to a different part of the hospital, thereby modernizing a
historical activity that was both inefficient and important.   It would be
relatively easy to have a "click to chat with the radiologist" box in an
EMR.

On Tue, Jan 26, 2016 at 11:53 AM, Follansbee, William <follansbeewp at upmc.edu
> wrote:

> I trained in those days as well, with similar experiences. Your question
> is an important one and the answer is simple. There are no films anymore.
> Everything is now digital and is available at the point of care. The
> workflow no longer involves a trip to the radiology department. Those days
> are gone forever. The challenge is how can those interactions be reproduced
> in today’s work flow? That is a difficult challenge. The only way that I
> could envision that happening would be for radiologists to leave their
> department and make rounds, going to different inpatient services and
> making radiology rounds with them on site. This, of course, would be a
> major time commitment for the radiologists and for that reason might not be
> possible. Short of that, however, it is difficult imagine how to recreate
> it.
>
>
>
> We also should not get too caught up in nostalgia. These interactions were
> quite valuable but they were also a highly inefficient use of time.
> Clinical teams would trek together to the radiology department, stand for
> what seemed like forever at the file room while clerks sorted through
> mountains of films trying to find the ones that were needed, which not
> infrequently weren’t even in the department, before those valuable
> interactions with the radiologists could occur. That is why when digital
> imaging came along, point of care availability of the images was
> immediately adopted.
>
>
>
> An important issue but also a difficult challenge.
>
>
>
> William P. Follansbee, M.D., FACC, FACP, FASNC, FAHA
>
> The Master Clinician Professor of Cardiovascular Medicine
>
> Director, The UPMC Clinical Center for Medical Decision Making
>
> Suite A429 UPMC Presbyterian
>
> 200 Lothrop Street
>
> Pittsburgh, PA 15213
>
> Phone: 412-647-3437
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> Email: follansbeewp at upmc.edu
>
>
>
>
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>
>
> *From:* Bob Latino [mailto:blatino at RELIABILITY.COM]
> *Sent:* Tuesday, January 26, 2016 11:55 AM
>
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Support Tests.
>
>
>
> If this practice was so effective in the 70's and 80's, why did it fade
> away?
>
>
>
> Why aren't such proven best practices maintained and sustained?
>
>
>
> *Robert J. Latino, CEO*
>
> Reliability Center, Inc.
>
> 1.800.457.0645
>
> blatino at reliability.com
>
> www.reliability.com
>
>
>
> *From:* Albert Wu [mailto:awu at JHU.EDU <awu at JHU.EDU>]
> *Sent:* Tuesday, January 26, 2016 11:05 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Support Tests.
>
>
>
> I recall doing precisely this while a med student and resident at New York
> Hospital, and Mt Sinai in NYC in the mid 80s
>
>
>
> albert
>
>
>
> *From: *Alan Morris <Alan.Morris at IMAIL.ORG>
> *Reply-To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Alan Morris <Alan.Morris at IMAIL.ORG>
> *Date: *Tuesday, January 26, 2016 at 10:19 AM
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *Re: [IMPROVEDX] Support Tests.
>
>
>
> You may be interested to know that in the 1979s and 1980s we made daily
> rounds with the radiologist and interpreted the films together.  This was
> unequivocally produced remarkable returns and was a good investment of time
> in a high-tech intensive care unit.  Better communication is always
> desirable.  I am reminded of a quote from George Bernard Shaw:
>
>
>
> “The single biggest problem in communication is the illusion that it has
> taken place."
>
>
>
> Alan H. Morris, M.D.
>
> Professor of Medicine
>
> Adjunct Prof. of Medical Informatics
>
> University of Utah
>
>
>
> Medical Director, Urban Central Region Pulmonary Function Laboratories
>
> Pulmonary/Critical Care Division
>
> Sorenson Heart & Lung Center - 6th Floor
>
> Intermountain Medical Center
>
> 5121 South Cottonwood Street
>
> Murray, Utah  84157-7000, USA
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> Office Phone: 801-507-4603
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> Mobile Phone: 801-718-1283
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>
>
>
>
> *From: *Leonard Berlin <lberlin at LIVE.COM>
> *Reply-To: *Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Leonard Berlin <lberlin at LIVE.COM>
> *Date: *Tuesday, January 26, 2016 at 05:56
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> *Subject: *Re: [IMPROVEDX] Support Tests.
>
>
>
> Without any doubt whatsoever, the radiology literature is replete  in
> confirming that the more clinical information  that is provided to
> radiologists.  the more accurate will be their reports.
>
> Will clinical info on occasion bias the radiologist?  Yes, but very
> rarely.  Any potential "harm" of providing  the radiologist with clinical
> info is far, far,  outweighed by the benefit.
>
> Lenny Berlin, MD
> Professor of Radiology,
> Rush University and
> Uiv. Ill, Chicago
>
>
>
> > Date: Tue, 26 Jan 2016 04:30:40 +0000
> > From: Joe.Grubenhoff at CHILDRENSCOLORADO.ORG
> > Subject: Re: [IMPROVEDX] Support Tests.
> > To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> >
> > Is there not data that indicated that giving more, not less, information
> to a radiologist in a requisition improves the accuracy and clinical
> utility of the interpretation? As an PEM physician I teach the residents
> that our radiology colleagues are consultants just like a cardiologist.
> Call them, ask what the most reliable study is for the clinical question.
> Saves time and money by avoiding unnecessary or inappropriate exams that
> don't resolve or often muddy the clinical picture.
> >
> > Sent from Skynet
> >
> > > On Jan 25, 2016, at 21:12, Elias Peter <pheski69 at GMAIL.COM> wrote:
> > >
> > > I addressed my concerns to the radiologists and pathologists, not the
> hospital. They agreed that changes were needed, did not always agree on
> what changes were needed, and most were willing to try things to see what
> did and didn’t help.
> > >
> > > The administrative structure was not impressed with the clinical
> request that we expend some of the institutions resources (time, IT work,
> communication system to discuss what we were doing) and the requests
> eventually died out.
> > >
> > > I understand the concern that clinical information might bias a
> radiologist’s reading. The same thing could be said about the patient
> history biasing my exam, test ordering, assessment or plan. The purpose of
> information is to point us in some direction. The solution to this is NOT
> to hide clinical information from the radiologist/pathologist (or the
> patient) but to make as much information available to as many people on the
> team as possible.
> > >
> > > Peter Elias
> > >
> > >
> > >> On 2016.01.25, at 9:08 PM, Stefanie Lee <stefanieylee at GMAIL.COM>
> wrote:
> > >>
> > >> Part of the issue is framing (addressed in the recent IOM report) -
> > >> the view of the diagnostic specialties as provider of test results,
> > >> which are then used by the primary physician to diagnose the patient -
> > >> versus the pathologist or radiologist as being integrated into the
> > >> ongoing discussion and diagnostic process.
> > >>
> > >> Communication is essential to safe patient care. As more than one
> > >> scenario can have the same imaging appearance, it is the clinical
> > >> information that allows the radiologist to form an educated opinion as
> > >> to what the significance of the finding is (and avoid the dreaded
> > >> 'cannot exclude'!)
> > >>
> > >> Rim-enhancing collection with gas bubbles in the surgical bed - an
> > >> abscess that needs to be drained, right? Not if Surgicel had been used
> > >> during the operation (a hemostatic agent that has a very similar
> > >> imaging appearance).
> > >>
> > >> Given a CT or MRI which may have numerous abnormal findings in its
> > >> hundreds/thousands of images, the diagnostic process of putting all
> > >> the findings together to form an interpretation / hypothesis about
> > >> what is going on is not really all that different from other fields in
> > >> medicine.
> > >>
> > >> Sometimes referring physicians are concerned about 'biasing' the
> > >> radiologist with clinical information, but providing less information
> > >> is unlikely to help improve accuracy - better communication will. If
> > >> anything in the report doesn't fit - pick up the phone or send an
> > >> email/fax for a second look!
> > >>
> > >> As another example, consolidation on a chest radiograph is a
> > >> nonspecific finding that very frequently represents pneumonia and is
> > >> reported as such, but if this is a chronic process (especially if the
> > >> patient has weight loss without signs of infection), it could very
> > >> well be cancer.
> > >>
> > >> Agree that providing patients access to test reports will help reduce
> > >> findings falling through the cracks. I read about patient portals on a
> > >> regular basis - how commonly are they used today?
> > >> http://meetinglibrary.asco.org/content/120470-140
> > >>
> > >> Another area for improvement is to improve the ease/frequency with
> > >> which diagnostic specialists and office-based physicians communicate
> > >> with each other (e.g. direct phone lines).
> > >>
> > >> Multidisciplinary rounds and discussions with referring physicians who
> > >> drop by the reading room are very helpful in clearing up diagnostic
> > >> conundrums - however, this mostly happens in the hospital setting.
> > >>
> > >> (cannot tell from Dr. Elias' post if he conveyed his concerns about
> > >> the reports to the hospital or spoke with the radiologist directly - I
> > >> hope improving communication would be a goal of all involved in
> > >> patient care, for many obvious reasons)
> > >>
> > >>
> > >> On 24 January 2016 at 16:55, robert bell
> > >> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
> > >>> I have suggested that at the same time, or even before we tackle
> Errors in
> > >>> Diagnosis, we see that all our support diagnostic tests (Lab, X-ray,
> etc.)
> > >>> are in good order so as to help make the correct diagnoses more
> often.
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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