Structured reporting in radiology can improve accuracy and consistency, which could lead to enhanced patient care, improved efficiency, increased reimbursement, and more accessible and actionable data.
Nevertheless, it has yet to become mainstream in radiology. But it will.
So, what is structured reporting? Definitions abound, but Melanie Wilson, a senior clinical sales specialist with GE HealthCare, points out that most people agree: Structured reporting involves using IT to automatically populate and arrange medical data into a template—this could include data that comes from the sonographer as well as the information added by the radiologist. As one group of imaging experts put it, "Structured reporting is the use of an IT-based means of importing and arranging medical content in the radiological report."1
Early Adopters of Structured Reporting
Radiology organizations have largely embraced the concept of structured reporting, and sonographers themselves like it, says Wilson, a longtime sonographer. Many radiologists remain reluctant, however, so radiology lags behind several other specialties.
Early adopters include neurology, oncology, maternal fetal medicine, and invasive cardiology.2 Mammography and point-of-care ultrasound also lend themselves to structured reporting, Wilson says.
Academic institutions are often ahead of the curve—"Change is constant for them," Wilson notes—but there's a good reason they're among the earliest adopters. Structured reporting helps with training, whether that's giving students more independence or onboarding new hires.
Value Propositions Driving Structured Reporting
A main advantage of structured reporting is that it removes potential subjectivity, increasing the consistency and accuracy of results.3 They can be less ambiguous and more comprehensive than the conventional report—and the standardized data may help support artificial intelligence (AI) training. Plus, there are potential financial savings by avoiding costly delays.
Enhanced Readability and Clarity
Structured reporting can be a big help for referring clinicians. Currently, Wilson says, they often have to figure out what each radiologist is trying to say. In some situations, a doctor may end up having to reach out to the radiologist for help deciphering the notations or possibly unnecessarily ordering another exam. "Standardization makes it easier for them to understand the meat of things," she says.
More Accurate Reports
Often, it's not just a matter of interpretation; it's a matter of accuracy. Roughly 20 percent of radiology reports include at least one mistake.3 The process leaves considerable room for error, Wilson points out. Radiologists typically dictate measurements from a handwritten sonographer worksheet that was scanned into the picture archive and communications system (PACS).
"Sometimes the radiologists can't read what the sonographer wrote, or you may have a less-experienced sonographer. Maybe one wrote a book and the other didn't include enough information," Wilson explains. "Removing that variation can improve accuracy and consistency, which leads to better reimbursement and better patient care."
Structured reporting supports data mining in clinical, business, and research settings, which is becoming increasingly important as digitization, interoperability, and AI play larger roles. It makes it easier to aggregate, search, analyze, and compare data. This aggregated data can yield fresh business and clinical insights. Because structured reports provide standardized, discrete data elements, healthcare organizations can mine the data for population health trends, decision support, precision medicine insights, clinical research, and much more.2
Standardized, aggregate data supports AI model training. In fact, the adoption of AI and the adoption of structured reporting are linked. Advances in AI and the push for data-readable assets can help drive the move to structured reporting. "However," Wilson warns, "failure to adopt structured reporting could delay AI development. It will take longer to develop AI tools, and it will take longer for people to adopt them."
From an operations and business perspective, the clarity and comprehensiveness of structured reporting could eliminate costly delays. Plus, incomplete reports can have financial implications, including billing opportunities lost due to poor documentation or lost revenue from procedures.2
Radiology's Slowness to Update
Despite the benefits of structured reporting, free-form text reports remain the norm in radiology. There are myriad reasons, not the least of which is a lack of national standards for how radiologists should report. But that doesn't explain the pushback. Wilson offers some speculation on possible reasons:
- Reporting culture. Individual physicians often have their own approach that they may have used for decades, Wilson explains. They simply prefer doing it the way they always have. One set of researchers suggests that there's a tradeoff where structured reporting is perceived as threatening radiologist individuality.4
- Concerns about errors. Wilson emphasizes that most radiologists aren't just being intransigent. They recognize that any change can introduce errors—at least initially.
- Integration challenges. Sometimes, Wilson says, an IT department needs additional tools or training to make seamless transitions when integrating structured reporting and bringing radiologists up to speed. It takes work from both the IT professionals and the radiologists to bridge that gap.
- The hassle factor. Some users think structured reporting will create more work and take longer to complete than traditional free-form reports, and that's not a completely unfounded opinion. The current workflow of many structured reporting tools can be clunky and time-consuming.2 But as vendors introduce tools integrating voice commands, pre-population of AI-generated findings, and more, it will become less of a heavy lift. Still, moving to structured reporting does require an investment in time, something radiology departments and IT teams need to prepare for.
However, the right training, technology, and guidance can overcome these barriers, Wilson says.
Looking Toward Mainstream Adoption
Structured reporting can unleash the power of data to support clinician collaboration, patient health, business efficiency, AI tools, and even clinical research. But for a variety of reasons, it hasn't yet been widely adopted in radiology. But it is coming: Mainstream adoption of structured reporting in radiology is expected to happen within five to seven years.2
Now is the time for healthcare organizations, radiology teams, and health IT departments to prepare.
"Structured reporting is here to stay. It's not going anywhere, but it's still in the early stages," Wilson says. "Embrace it, get involved, and provide feedback." Radiologists who adopt structured reporting early will likely have more say in its implementation.
"Instead of jumping back," she says, "be the first one to jump in."
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1. Nobel JM, Kok EM, Robben SGF. Redefining the structure of structured reporting in radiology. Insights Into Imaging. February 2020;11:10. doi: 10.1186/s13244-019-0831-6.
2. Structured reporting adoption in imaging IT—world—2021. Signify Research. Published October 2021. https://www.signifyresearch.net/reports/structured-reporting-adoption-imaging-2/.
3. Viewpoint™ 6 Direct Connect Ultrasound IT Reporting Solution 1188879c5dae414882e179716eefeba6.pdf (gehealthcare.com)
4. Granata V, De Muzio F, Cutolo C, et al. Structured reporting in radiological settings: Pitfalls and perspectives. Journal of Personalized Medicine. August 2022;12(8):1344. doi: 10.3390/jpm12081344.
GE is a trademark of General Electric Company used under trademark license.