NEWS & EVENTS | Innovation Spotlight

The Center for Innovation (CFI) comes to life through examples of its work.

In collaboration with Mayo Clinic's Department of Radiology and GE Healthcare, the center engaged in a 20-week project to explore communication in radiology imaging and identify opportunities for innovation. The project included 10 weeks of internal and external field research involving 275 patient observations, 16 physician interviews in 21 areas around Mayo Clinic, and 30 at-home interviews with patients.

Terri Vrtiska, M.D., a consultant in the Department of Radiology, led the project for her department as part of her Mayo Clinic Career and Leadership Development (CALD) Program experience. The project was dubbed iViz — Innovations in Medical Visualization.

Medical imaging is one of the most common health care experiences. Eighty percent of Mayo patients have some type of imaging performed during their visits. But, little information is communicated to the public about the imaging experience. Similarly, the frequent isolation of radiologists from direct patient care distances them from the effect of the imaging experience on patients and also distances referring physicians from access to imaging information.

Understanding that capturing and reading images requires input from providers across specialties, the Center for Innovation research team observed interactions between patients, ordering physicians and radiologists, with a focus on discussions about the imaging studies and the imaging experience. External research focused on understanding how other individuals and industries communicate complex and technical information to peers and to the public.

Learning Points and Insights

"We wanted to learn what the imaging experience feels like for patients, ordering physicians, radiologists and the radiology care team," says Maggie Breslin, a designer in the Center for Innovation. The observational research identified insights that summarize key learning points for the Department of Radiology, including:

• When patients understand the image capture process, they take a more active role and often help expedite the event. Patients' desire to have a role in the experience is evidenced by their attempts to exert some control, even in small ways — bringing music, creating covers for their eyes and asking for blankets.
• The image capture experience is often isolating and lonely for patients who are left alone for long periods in antiseptic places with little human contact.
• A single imaging report is expected to satisfy multiple audiences (ordering physicians, patients, insurance companies), which creates difficulty in addressing the unique needs of any one group. If a goal is for patients to learn from their health care experiences, particularly in ways that make it more likely they will take an active role in their health care, a priority should be to talk to them in a language they understand.
• The complexity of reading images is rarely communicated to patients and, as a result, patients believe the information contained in images is clear-cut and that all physicians are equally skilled at reading all images. This can make some physicians uncomfortable with sharing images. Yet patients are more likely to ask questions, offer additional information and verbalize understanding when images are used during consultation.
• Patients have no benchmark for what "normal" is — no sense of how they compare relative to a normal state; thus, they have difficulty understanding how suggested treatments or procedures are likely to affect their condition.
• The image capture system has few feedback loops. Not between physicians and radiologists about usefulness. Not between radiologists and physicians about appropriateness. Not between providers and patients about the experience. Improving this communication will require understanding where and how to focus efforts.

Center for Innovation recommendations for the Department of Radiology include moving toward greater balance between data and understanding, between standardization and individualization, and between comfort and functionality. "We have prioritized the information from the Center for Innovation and have a team working on implementation," says Dr. Vrtiska. "We continue to collaborate with the Center for Innovation and integrate findings into our daily practice."

The Department of Radiology's goals for 2009 include:

• Provide physicians with tools to assist them in determining appropriate imaging orders.
• Create tools that allow physicians to order virtual consultations to discuss appropriate imaging orders and unique patient needs.
• Provide patients with takeaway materials from the image capture process, including an explanation of next steps or a card introducing the patient's radiologist and his or her role.
• Package critical images together to support the physicians in sharing images with patients.
• Create a library of "normal" images for physicians to use when orienting patients to their images.
• Develop opportunities for patients, physicians and radiologists to meet on demand, including instant messaging, webcam or podcasts.