How better patient and provider communications can increase follow-up care
Whitepaper | Spencer Cross, MBA | Ty Williams
Mr. Cross leads product strategy and development for Change Healthcare’s Digital Experience business.
Mr. Williams is an agile product designer and user experience researcher with a background in product design and business development management for tech startups.
As the name suggests, “incidental findings” are medical findings that are unintentionally discovered during radiological evaluation for an unrelated medical condition. For decades, radiologists reported incidental findings to the patient’s referring physician, who then made the decision as to whether the patient required notification or additional care.
This communication flow has always been problematic, in part because it was never intended to be a closed-loop process. Radiologists are not typically aware of whether follow-up care or patient notification has occurred. In addition, most referring physicians struggle with an overwhelming caseload, which increases the likelihood that test results can be inadvertently overlooked.
Recently, jurisdictions have implemented new regulations requiring radiologists to directly notify patients about their incidental findings. For example, Act 112 in Pennsylvania requires outpatient diagnostic imaging services to notify patients and referring physicians about any significant abnormality within a 20-day time frame.
In reaction to these new laws, some physician groups have expressed concerns that patients might not understand or may misinterpret test results they receive directly. They argue that misinterpreted results will increase patient anxiety and lead to unnecessary testing, further straining an overloaded healthcare system. Despite these fears, legislation centered on improving transparency is on the rise. Proponents believe that patients have the right to know their own medical information, and that giving patients access to this information will help them advocate for better care.
Uncovering Workflow Pain Points
To understand how incidental findings can best be addressed, managed, and communicated to referring physicians and their patients, Change Healthcare conducted multiple rounds of primary research involving empathy interviewing and prototype testing. The research centered on a medium-sized radiology practice’s interaction and communication with referring physicians and patients. Our user experience researchers conducted 60 interview and prototype testing sessions with radiologists, referring physicians, administrators, and patients. The team assessed each group’s pain points and communication needs for incidental findings management.
Radiologists Want to Protect Their Physician Relationships
We found that radiologists are primarily concerned with protecting their relationships with referring physicians. They worry that communicating with patients directly will negatively impact their valuable relationships, chiefly due to timing issues. The radiologists believed that referring physicians would not want them to notify patients about any incidental findings, as patients might besiege their doctor’s office with questions before the physician had fully digested the report.
As a result, radiologists favor a communication flow that allows the referring physician ample time to review the radiology report before patients are notified. Radiologists also believe that physician notifications are more effective if they are sent with or linked to the original report. Urgent significant findings should be communicated by phone, but others can wait for email delivery.
Physicians Want Contextualized Results Within Their Workflow
As the radiologists expected, our research reveals that referring physicians do feel they are operating over capacity. As a result, however, referring physicians are far more appreciative of direct patient communication than radiologists tend to believe. They are appreciative of the idea of radiologists notifying patients in the case of non-urgent incidental findings. They also support patients becoming more proactive in pursuing follow-up care.
Referring physicians want fast, seamless access to a patient’s personal health information (PHI) within the notification of incidental findings. As radiology centers and provider practices often use different patient identification frameworks, quick patient identification is of primary importance.
The ability to conveniently receive, interpret, and assess reports is critical for referring physicians. In the case of incidental findings, they want to be able to understand the seriousness of the radiologist’s recommendation and the associated protocol for patient follow-up—without needing to call for clarification.
Notably, many referring physicians say that integration within their existing system is a prerequisite for active engagement with a new system. Provider offices are wary about adopting a separate alert system for incidental findings, as physicians already face cluttered inboxes. They are sensitive to any administrative processes that can contribute to physician burnout.
Up to two-thirds of patients whose radiology reports advise follow-up care for incidental imaging findings do not receive care.1