In diagnostic radiology, information is the currency. Although the clinical knowledge in diagnostic radiology is the most salient component, information in radiology comes in many forms. What is the most appropriate next step in diagnosis? What is the most appropriate way to explain the clinical impact of this incidentally noted, indeterminate adrenal nodule? How to describe this finding in the most understandable way now that our patients are reading our reports?
If information is the currency, then communication is the most important transaction in radiology.
What makes communication complex is not its difficulty, but that the written word, the spoken dialogue, and even medical images themselves are but a vehicle to a higher purpose – meaningful guidance for patient care. The American College of Radiology pushes its Imaging 3.0 initiative precisely for the goal of positioning radiologists as expert consultants to the clinical staff. At each step in the radiology value stream, from decision-to-image to imaging to reporting and back to clinical decision-making, radiologists need better communication tools.
I am a senior resident in my third year of training, and despite spending every day immersed in clinical communication, I find it more difficult than the science of imaging itself. In a 2014 issue of American Journal of Roentgenology, David Larson and his colleagues agree, eloquently outlining the various ways that challenges and complexity of communication in radiology “often fall far short of what is possible… in many other domains of modern life.”
At the center of Larson et al.’s article sits the Media Richness Theory, which the authors describe as “the ability of information to change understanding within a time interval.” In this paradigm, in-person communication is the richest – we have visual, verbal, and body language, and even opportunities to annotate images in real time. But modern life and medical practice has shown that in-person communication is not always possible, and the balance between accessibility and richness may determine the best means of information exchange.
Larson uses “media synchronicity theory” to describe this new way to think about communication, which hypothesizes that although communication is one word, it comes in two forms: conveyance and convergence (fancy words to mean sending and receiving). While each successful episode of communication needs both, they need not occur simultaneously. Good examples of asynchronous communication include email and text message.
Making this transition from synchronous to asynchronous communication in radiology causes an inadvertent loss in convergence in some cases, but it is important to know that important exceptions exist in modern life. An innovative use of media synchronicity theory comes in Uber, the $50 billion dollar tech blockbuster. Traditionally, hailing a taxicab required the synchronous exchange of information: you raised your hand or whistled loudly at the same time a cab driver saw or heard your request. Uber innovated on the ability to disaggregate conveyance (“I need a ride”, “I can take a passenger”) and convergence (“let’s get you to your destination”) with the use of a mobile application, such that a rich communication occurs regardless of the physical distance separating the two individuals.
The question then becomes, “can we improve the richness of asynchronous communication without necessarily decreasing accessibility?” The Society of Imaging Informatics in Medicine (SIIM) has a long history of tackling rich, powerful asynchronous communication. In 2003, an SIIM grant funded the work of Wyatt Tellis for the proposal titled “Improving ED and Radiology Interdepartmental Communications Through the Application of Mobile Computing Technologies.” More recently, a 2015 SIIM roundtable discussion titled “Veering into Uber’s Lane: Imaging Reports for Patients and Families” considered the importance of leveraging technology to provide a richer experience for our patients. In an oral presentation, Jason Balkman presented his work in “An Audio/Video Reporting Workflow to Supplement Standardized Radiology Reports,” providing additional media where simple text in diagnostic reports would not suffice.
These projects approach the problem of communication complexity in several important ways detailed in Larson’s AJR article. For instance, they aim to streamline the “Primary Workflow of Imaging,” and they place a unique emphasis on standardization of workflow to reduce error while enriching the process of information exchange.
As radiology moves towards the visions of “Imaging 3.0,” the expert radiologist will be the one who knows how to enrich his or her communication with the ordering clinicians. An exceedingly complex topic, the science of communication has given rise to entire disciplines of research and blockbuster business models. Radiology has just begun to scratch the surface.
This post originally appeared in the Society of Imaging Informatics in Medicine blog.