Patient Photograph Association with Radiologist Recommendations for Additional Imaging

Abstract

ObjectiveAssess whether display of a patient photograph in the electronic health record (EHR) alongside head and neck CT or MRI radiology examinations is associated with recommendations for additional imaging (RAI) and whether self-reported race modifies that association. MethodsThis multi-institution healthcare system retrospective observational study from 6/1/2021-5/31/2022 included all patients with a head/neck CT or MRI report. We investigated association of photograph with RAI using mixed effects models adjusting for age, sex, complexity score, race, and area deprivation index while conditioning on patient and radiologist. Race was subsequently included as an interaction term. Multiple imputation was used as sensitivity analysis to address missing race data. Results60,543 reports were included from 48,143 patients (55.6% female; median age 58 years, IQR 40-70). The EHR included a photograph at the time 18.2% (11,048/60,543) of reports were signed. 7.5% (4,522/60,543) of reports contained RAI. Reports signed when a photograph was displayed had lower estimated odds of containing RAI (OR: 0.85, 95%CI: 0.77-0.93, p<0.001), consistent in sensitivity analysis, with no clear interaction between race and photograph (OR: 0.99, 95% CI: 0.69-1.46, p=0.97). DiscussionPatients with a photograph in the EHR had a lower probability of receiving RAI and this difference did not appear to be the result of implicit racial bias but may be due to personalization of the encounter. This effect may influence radiology reporting for millions of patients per year. Further research is needed to determine if the association has a positive or negative impact on care quality and outcomes.