A Radiologist’s Playbook for Care Coordination

Digital imaging, changing physical location, new networking and telehealth help radiologists care for patients

Radiologists play an important role in the healthcare system. In the outpatient setting, doctors refer patients to radiology departments for evaluation and diagnosis of illness. In the acute realm, imaging services are an important part of the care process.

It has been estimated that CT and MRI utilization in the emergency department increased by 159% and 264%, respectively, between 2002 and 2012, with nearly 50% of emergency room visits involving imaging. Given this increase, it’s important for radiologists not only to be involved in the interpretation of imaging, but also be a critical member of the healthcare team. Part of that responsibility involves coordinating care with other physicians and ancillary personnel.

Care coordination has been defined as the “deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services.” To that end, radiologists have multiple opportunities to coordinate care. They may be included in multidisciplinary tumor boards, change their physical setting, network with other physicians electronically, or simply answer a phone call.

Digital Imaging

Digital imaging, picture archiving and communications systems, and electronic medical records have changed workflow within the radiology department. In the past, referring physicians had to physically visit the radiology department to view images. Now, they can receive images remotely. Though convenient, this has decreased visits by referring physicians. Therefore, radiologists must be proactive to be more visible in care coordination.

Multidisciplinary tumor boards are one example of increased visibility, and an important aspect of care coordination. Tumor boards bring together radiologists, oncologists (radiation, medical, surgical, and interventional), and pathologists, among others. As they collaborate, treatment options and plans are often changed. When this happens, radiologists play an important role in diagnosis and treatment determination. Radiologists should be prepared for tumor boards, reviewing imaging and pathology and occasionally discussing cases beforehand.

Change in Physical Location

Another way radiologists have increased care coordination is by changing their actual location. It would appear, at least initially with the implementation of digital imaging and network connectivity, that changing location is not necessary. However, as mentioned before, this has decreased interaction between radiologist and referring physician. Often, not just viewing the images is necessary, but also having a conversation about the images in real-time is necessary. Changing the physical location of radiologists to integrate them with their referrers helps accomplish this.

Breast imaging was an early adopter. Breast imagers are often integrated with comprehensive breast care centers and associate closely with breast surgeons and oncologists. Similarly, a number of radiology departments have shifted some radiologists into the emergency department, allowing emergency medicine physicians quick access to a radiologist when needed. More recently, similar initiatives have occurred with integrating musculoskeletal radiologists with orthopedic surgeons. While changing locations is noble, it may not be available in all settings nor be justified if a single location doesn’t have sufficient volume.

Online Networks

New technology and social media offer other opportunities for radiologists to coordinate care. I use Doximity, an online network for physicians and other healthcare professionals, to coordinate care for  specific patients. Doximity was especially useful, for instance, when a person who was moving to my area needed an imaging study that was only available at our institution. I used Doximity to coordinate a referral from the physician, who was 600 miles away.

Through online networks, referring physicians and other healthcare professionals can securely communicate with and refer patients to radiologists. New technology also enables physicians to review images and imaging studies in real-time, despite geographic limitations. In one example, researchers at Johns Hopkins University created an iPad-based application, called REACH, that allows for real-time image review, annotation, and teleconsultation. Apps like REACH remove distance barriers and provide the opportunity for face-to-face collaboration.

While new technology gives us new ways to collaborate, a simple phone call can go a long way to improve care coordination. There’s still a place for the telephone. It’s quick, relatively cheap, and remains a mainstay at many institutions.

Multidisciplinary tumor boards, change in physical location, new networking and teleconsultation apps, and the telephone are ways radiologists coordinate care for patients. As medicine becomes more and more integrated — and particularly with the increase in capitated payment models — it’s critical for radiologists to integrate themselves into the healthcare process and take more proactive and visible steps for the ultimate goal: improving our patients’ health.

Tirath Patel, MD, contributed this article. Patel completed his medical education at the University of Cincinnati in Cincinnati, Ohio, and is a resident in radiology at the University of Toledo Medical Center in Toledo, Ohio. Patel has an interest in radiology economics and policy.

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