“Worrying About Being Sued” – A Call to Action

Radiology scan of human brain in a neurology clinic

Like many of you, I read Medscape’s annual Physician Compensation Report and the breakout report covering radiology to get a take on radiologists’ perceptions of issues and trends in payment models, job satisfaction and other areas. One data point in the 2021 report was especially notable. For the first time, “Worrying about being sued” is at the top of the list of the greatest job challenges for radiologists.

About 21% of radiologists surveyed placed medico-legal liability ahead of “Having to work long hours” (20%) and “Having so many rules and regulations” (19%). Dealing with payers was fourth at 15%, with concerns about COVID-19 (4%), working with EHR systems (3%), and other matters well down the list.

That it’s now at the top of the list raises three important questions:

Why?

The percentage of radiologists most concerned about malpractice actions has actually remained fairly steady for the past 5 years and ranged between 14% and 20%. But “being sued” has consistently been third on their list of concerns after “long hours” and “rules and regulations.” In comparison, worry about legal action among all physicians is much lower at 7% and is sixth on their list of challenges. So, what’s different for radiologists now?

It’s hard to pinpoint why without more data, but we can make educated guesses at possible factors. One could be the decline in reporting workloads because of COVID-19 as patients deferred regular screening or did not seek diagnostic imaging for injuries and other conditions. Another could be that steps to address physician burnout, including increased use of AI-powered tools for workflow optimization and report automation, are making a difference.

A more direct factor may be awareness of legislation  – Act 112 in Pennsylvania, for example — holding radiologists responsible for adverse outcomes related to failed follow-ups on incidental findings. Medical malpractice attorneys may also be hunting for errors related to the increased use of advanced imaging modalities like CT and MRI. Results of a study publish in the Journal of the American College of Radiology (JACR) in August 2020 found an association between paid medical malpractice claims and physician use of advanced medical imaging as a defensive strategy.

No matter the causes, it prompts the second question:

Why, especially when reporting solutions exist to overcome those challenges?

The Nuance Diagnostic Imaging division has long been dedicated to innovation in radiology. It’s a passion that drives our business. We mean “innovation” in the same way that Johns Hopkins University radiology leaders Jenny Hoang and Andrew Menard defined it in a JACR opinion article published in October 2020: “Innovation involves systematically looking at the doing something a new and different way to solve a problem or meet an identified need.”

That straightforward description describes the process that we use to create and continuously enhance our portfolio of radiology reporting solutions including cloud-based PowerScribe One with workflow-integrated AI, real-time clinical decision support (CDS) and EHR integration. The PowerShare image-sharing network serves multiple functions, including linking PowerScribe and our other tools such Follow-Up Manager, and the AI Marketplace for Diagnostic Imaging into a comprehensive patient-centered reporting environment. Their capabilities together directly address the multiple challenges facing radiologists, including those on the Medscape list.

For example, PowerScribe One supports structured reporting powered by natural language processing, workflow-integrated CDS, Common Data Elements for reporting consistency and analytics, and quality checks for complete and accurate reports. It also incorporates diagnostic models from the AI Marketplace, provides radiologists with relevant patient history and strengthens coordination with referring providers. Follow-up Manager automates tracking of follow-up imaging recommendations to ensure completion.

Those capabilities are available today. In fact, there are no fewer than 20 articles published in the JACR in the past three years that report how physicians are using structured reporting, NLP, CDS and other tools to improve diagnosis and treatment and reduce errors. Many of the technologies are described in a July 2019 article co-authored by seven radiology leaders and titled “Bending the Artificial Intelligence Curve for Radiology: Informatics Tools From ACR and RSNA.”

That compels the third question:

If not now, when? A call to action

We have the technology and tools to overcome current challenges and advance the state of the art of radiology. So why not now? Yes, there are practical, financial and organizational hurdles to clear, not the least of which is the continuing recovery from a global pandemic. But it’s worth noting that collectively we have demonstrated the ability to respond decisively and effectively in response to one of the most urgent medical challenges we have ever faced.

By working together, radiology leaders, health systems, radiology professional organizations and IT vendors can drive adoption of technologies and solutions that address radiology’s greatest challenges. By doing so, we can have a lasting positive impact on the most rewarding parts of a radiologist’s job listed in the Medscape report: “Being very good at what I do/Finding answers and diagnosis,” “Knowing that I’m making the world a better place” by helping others, and “Making good money at a job that I like.”

In the end, it’s about issues that affect all of us – healthcare outcomes, access to care, physician and patient satisfaction, and the long-term financial viability of our healthcare system.

The time to act is now.

Karen Holzberger

About Karen Holzberger

Karen Holzberger is the senior vice president and general manager of Nuance’s Healthcare’s diagnostic solutions business. Karen joined Nuance in 2014 with more than 15 years of experience in the Healthcare industry. Prior to Nuance, she was the vice president and general manager of Global Radiology Workflow at GE Healthcare where she managed service, implementation, product management and development for mission critical healthcare IT software. Karen attended Stevens Institute of Technology where she earned a B.S in Mechanical Engineering.