Radiology E-Consults: Reinterpretation of Outside CT and MRI Exams to Improve Quality, Reduce Unneeded Imaging, and Lower Costs

Advanced imaging examinations commonly uncover incidental findings. Without access to prior imaging that is external to their healthcare system, radiologists may struggle to assess the significance of these findings. This can lead to unnecessary imaging follow-up recommendations and management uncertainty. We created a program to facilitate outside advanced imaging reinterpretation in the context of both internal and external prior imaging, resulting in more complete and accurate follow-up recommendations. Our value-based care organization created a program to facilitate outside advanced imaging reinterpretation, including importing the outside examinations and reports into our PACS/RIS platform. A total of 222 of these reinterpretations were performed between November 2020 and June 2022. In each case, a radiologist reinterpreted the entire examination and placed an official report into the electronic medical record, comparing their conclusions and recommendations with those of the outside imaging report. The reinterpretation report included a trackable code for future data mining purposes. These E-consults seamlessly fitted into a radiologist's normal workflow and resulted in revenue generation as well as wRVU credit. The E-consults resulted in a change in management recommendations for approximately 46% of the overall number of cases. Approximately 37% of all examinations resulted in a recommendation of no further imaging required, or adjustment of the imaging modality/interval. An official radiology E-consult program can synthesize disparate sources of imaging data, transforming it into clear and documented recommendations which providers can use to improve patient safety and reduce unnecessary imaging and costs.