Digital imaging, archiving, and structured reporting in pediatric echocardiography: impact on laboratory efficiency...

Digital structured reporting (DSR) is an emerging technology in medical information management. In November of 2006, the pediatric echocardiography laboratory at Children's Hospital of Wisconsin transitioned from transcription-based reporting of results to DSR.

Transthoracic echocardiograms were reviewed for the study duration and time to report completion for October of 2006 (the last month of phone-based transcription) and January of 2007 (the third month of DSR). For both months, the 5 cardiologists responsible for echocardiography reporting were evaluated for report generation time and the 5 sonographers were evaluated for study duration. Data for physicians and sonographers were analyzed individually, as a group between months, between examination types (brief vs comprehensive), and diagnoses (normal vs abnormal findings).

The time to generate a final report to the electronic medical record/auto-fax to the referring physician for all examination types between months decreased significantly from the transcription month to the DSR month (median 23.8 vs 1.2 hours; P =.001). This decrease was consistent among physicians and occurred despite an increase in monthly echocardiography volume of 12% between the study periods. No difference was noted in report generation times between brief and comprehensive transthoracic echocardiography for transcription (P =.220) or DSR (P =.185). Analysis of diagnoses after instituting DSR revealed significantly shorter report generation time for normal examination findings versus abnormal examination findings (0.97 vs 1.5 hours; P =.001). Study duration decreased significantly from the transcription month to the DSR month for all examination types (32 vs 27 minutes; P =.001). For both months, the study duration was longer for abnormal versus normal transthoracic echocardiography findings (transcription: 37 vs 27 minutes; DSR: 32 vs 23 minutes).

DSR is a superior technology for pediatric echocardiography reporting and an important next step to increase efficiency and customer satisfaction. Although congenital heart disease increases DSR study report time, the value of digitally scripted, database-compatible, complete segmental analysis of the heart and vascular structures with direct transfer of quantitative data from the ultrasound machine to the report without the need for a transcription interface justifies the time expense. DSR should be a goal for all pediatric echocardiography laboratories to decrease consumer wait time, increase laboratory efficiency, and improve compliance with Intersocietal Commission for the Accreditation of Echocardiography Laboratories standards.