Structured reporting: patient care enhancement or productivity nightmare?

David L. Weiss, MD Curtis P. Langlotz, MD, PhD The man we now know as St Lawrence lived his life as Lawrence of Rome and served as a deacon in the 3rd century Roman Empire. In 258 AD he was executed during the persecution of Christians by the Emperor Valerian. Historians detail his martyrdom as being grilled alive. Many scholars consider this account well documented while others have cast some doubt on its accuracy. They point out that as a Roman citizen under a sentence of death Lawrence would likely have been afforded the “privilege” of being beheaded. Some believe the discrepancy can be traced to the error of an early scribe. The Latin “passus est” (he died) may have been incorrectly transcribed as “assus est” (he was roasted) (1). That a seemingly trivial transcription error could have such profound historical and ecclesiastic consequences should not be surprising to a radiologist. Our specialty is rife with anecdotes of the trivial typographical error that is perhaps not quite as gruesome, but potentially life-threatening if left uncorrected. Although the first radiology report was generated over a century ago, the process of radiology reporting has changed very little until the past decade. The use of speech-to-text software has been available for some time (2), but speech recognition use did not become widespread until hardware and software matured in the late 1990s. The use of speech recognition in radiology reporting has resulted in improved turnaround time and reported cost savings (3,4), metrics that delight hospital and department administrators. Radiologists, however, have found that the software tends to decrease productivity and has the potential to cause distraction during image interpretation (5,6). In the past several decades, structured reporting systems have become available, first as research systems (7,8), then as production systems, particularly in mammography and ultrasonography (9). As with speech recognition software, current structured reporting systems are more sophisticated and acceptable as a result of advances in hardware, software, and workflow design (10). Will these new systems result in improved workflow or are these reports merely administrative agitprop designed to convince radiologists to adopt one more reporting system that may ultimately have negative consequences for the user? In the sections that follow, we will discuss these issues in a classic dialogue format, alternatively presenting the pros (C.P.L.) and cons (D.L.W) of structured reporting from two radiologists’ points of view.