- What does Cleareview need for a BlindPanel Review?
Cleareview needs the exam at issue, prior examinations used by the radiologist, as well as all clinical history given to the radiologist when they reviewed the original study. Please also send the original report and allegation being made against the radiologist.
- Who are the radiologists that perform the BlindPanel Review?
Cleareview has arranged with a large national radiology group to distribute each exam to ten randomly selected board certified radiologists. Their names are redacted prior to the reports being delivered to Cleareview, so we are blind to their specific identities.
- Can the blind panel radiologists be used as expert witnesses?
These radiologists are blinded as to the source of the exams, do not know that the exams are potential subjects of litigation, and are not available as expert witnesses. In addition, Cleareview is blind to who the radiologists are that performed the panel review, providing a true double blind analysis. Their service is to provide an unbiased interpretation of the exam to be used as a source of data.
- Can the blind panel results be used in court?
While the panel radiologists cannot be subpoenaed, an expert witness can review the panel’s results and arguably use the date to help form an expert opinion of the panel’s conclusions. This has not yet been tested in court.
- If I cannot take the results to court, what is the value of a BlindPanel Review?
Ten independent reviews of a problematic examination can provide considerable insight to either plaintiff or defense attorney as to the likelihood of a successful conclusion of the case. The more of the opinions that favor your side of the litigation, the stronger your case. Defense clients have used the data results to determine initial offers on settlement.
- Can mammography cases be submitted for BlindPanel Review?
Currently, mammography cases cannot be performed through a BlindPanel Review.
- Can the BlindPanel Review be combined with a BlindExpert Review?
Both services can be performed for the same case. While the BlindPanel Review will provide data for use in pre-trial decisions, the BlindExpert Review will provide you with an unbiased expert to use a trial. Ideally, a BlindPanel Review is first performed for pre-trial assessment, followed by a BlindExpert Review to provide an unbiased expert for use at trial. The combined service will establish a very high level of credibility.
- What does Cleareview need for a BlindExpert Review?
1. The exam of interest, and its accompanying report.
2. Lawsuit-related information.
3. Expert-related information.
1. We need the original imaging study at issue in DICOM format (the standard medical imaging format, which is included on almost every radiology CD), and the radiology report that went along with it (which may or may not be found on the same CD). If needed, a release of information form found here can be used to have imaging information sent directly from the hospital or imaging center to Cleareview, with the patient's permission
In order to present the patient in as natural a manner as possible, we need all other imaging (and reports) associated with the patient to create the patient imaging record. These studies are all completely de-identified, in compliance with federal HIPAA regulations.
2. Background information regarding the circumstances of the imaging study allow creation of a review set that most closely simulates the original setting.
3. A review set must be relevant to the reviewer as well as the original setting. For example, a head CT at issue can be embedded in a wide range of exams for review by a general radiologist, but that set would not be appropriate for review by a neuroradiologist, who would only be interested in neuro exams. In that circumstance, Cleareview would create a neuro-specific set in which to embed the head CT.
- Why does Cleareview need the patient's other imaging studies?
Cleareview tries to present a complete patient for review. Radiologists review prior exams whenever they are available, so all historical studies on every patient are included in the presentation, whether they are related to the target exam or not (an ankle x-ray, mammogram or whatever). This more complete picture of the patient makes the simulation more realistic.
- Does Cleareview supply the expert?
If an attorney does not have a suitable expert for the review, Cleareview can assist. Cleareview provides information about three experts to the client, who then selects the expert to do the review. This arrangement delivers the added blinding benefit of the expert being unaware of whether he is reviewing for a plaintiff or defense counsel.
- Who pays for the expert?
All expert witness services are in addition to Cleareview's management of the review set, and will be itemized separately on our invoice.
- Should I contact the expert?
If Cleareview is recruiting the expert, we ask that you do not contact the expert until after the review is complete so that the expert remains blinded to the side of litigation for which the review is being performed. If you are retaining your own expert, you certainly may contact him. Do not communicate any specifics about the case, to maintain the blind nature of the review.
- How does the expert review the exam?
Cleareview creates a unique review set of exams similar to the plaintiff’s exam of interest from our proprietary archive of patients’ examinations and then embeds the plaintiff’s exam of interest into the review set. All exams are de-identified, and have as complete imaging records up to the date of the exam to be evaluated as are available. (Note: Any exams performed after the exam presented in the review set are hidden from the reviewer. They do not appear on the exam list, and the reviewer has no way of knowing that they exist). Upon logging in to Cleareview’s PACS, the expert sees this review set which simulates a normal work environment.
Cleareview offers three ways for an expert to assess the review set.
1. Free-Text evaluation provides the expert with the opportunity to enter his or her impressions of each exam in the review set.
2. Standard of Care evaluation asks the reviewer to view the exam, then read the original radiologist’s report and decide whether or not that report met the standard of care. If not, the expert offers additional information to support this assessment.
3. Integrated evaluation combines the Free-Text and Standard of Care methods. The reviewer first reviews the exam, enters impressions, and only then can access the original report to make the standard of care judgment.
- How does Cleareview deal with procedures and other real-time events?
Cleareview can only deal with information that has been preserved- images that have been saved, and the associated radiology reports. Our services cannot be used to assess procedurally related issues such as consent, decision-making or complications that are not documented either in either of these two records.
- Can the blind expert results be used in court?
Cleareview’s BlindExpert Review has not yet been challenged in court, and may not for several years, since most malpractice lawsuits are dropped or settled. The company processes have been designed in anticipation of court challenge, and Cleareview is prepared to justify the entire system in open court.
- How am I informed of the results?
After the completion of either type of blind review, Cleareview will convey the results of the review by phone, and can prepare a written report if desired.
- Does Cleareview provide a true blind review?
The BlindPanel Review is truly blind. The exam at issue is entered into the radiologists’ daily work flow and is treated like any other exam in the work day.
The ClearExpert review is not quite as blind, as the expert has foreknowledge that he is involved in a legal action. The presence of the foil exams requires the expert to approach each case with a much more open mind than he uses in a traditional case review setting. By telling him that there is one or more litigation cases in the set, he can't play the game of "find the worst exam in the batch" and be done. The Cleareview process is designed to model everyday practice, but any situation in which an expert is retained is going to result in a higher level of scrutiny on the part of the expert.
- What is Cleareview?
Cleareview, Inc. was started by a radiologist to address the issue of bias in expert witness testimony. (Click here for a more complete discussion of bias). Our platform was designed for BlindExpert Reviews, but is also useful for quality assurance or peer review activities allowing de-identified exam material to be viewed remotely.
- What do I need to have to complete a BlindExpert Review?
In order to access the Cleareview website, you need an internet connection and a personal computer that runs current versions of either Chrome, Internet Explorer or Safari web browsers. Obviously your Internet connection speed will affect the responsiveness of the PACS. The type of computer you use will also affect performance: a PACS workstation will have better image quality and faster performance than a laptop. Cleareview’s zero-footprint PACS requires no downloaded to your computer or workstation, and once you close the web browser, leaves no patient data whatsoever on your computer.
- Can I access Cleareview from my tablet? Other mobile device?
While the Cleareview website can accessed from any device, the Clear Canvas PACS that we use is not supported by mobile operating systems (Android, iOS) so you will not be able to see PACS images on your phone or notepad. Windows-based tablets such as the Surface are supported, although the image quality may be suboptimal.
- What kind of technical support is available?
A technical support button is available on every page. You can fill out a brief form that goes to the top of the service queue and will be addressed within 24 hours, confirmed by e-mail. If there is a more time-critical issue, you leave a voicemail which will be returned as soon as possible.
- Where is the plaintiff's exam?
All the plaintiff’s exams have been de-identified and entered in the Cleareview PACS. We have created a worklist that includes the exam of interest, along with a series of other patients' de-identified exams, any of which may or may not also be litigation cases. You will not know which exam you are reading is the subject of the litigation.
- How do I report my findings?
All reporting is done on the Cleareview website. The attorney client has chosen one of three types of reviews for you to perform, which determines how you report your findings.
1. Free Text evaluation provides you with a text box in which you can report your findings. You may type or use your computer’s built-in voice recognition if it applies, but Cleareview does not offer VR at this time.
2. Standard of Care evaluation simply asks you to determine whether or not the original radiologists’ report met the standard of care with respect to the imaging study. If you believe it does not, a three-question form will allow you to elaborate on your reasoning.
3. Integrated evaluation combines the Free-Text and Standard of Care methods. First you enter your impressions of the exam, after which the original report will become available for you to read and assess.
- What happens after I finish the review?
Cleareview will contact the attorney who has retained you, and convey the results of your review verbally. We will also send you an e-mail containing the accession number of the exam of issue. When you log back in to Cleareview, all of the plaintiff’s exams will be available to you, even exams subsequent to the date of the exam of issue (if they have been given to Cleareview). The attorney will then contact you to discuss the results of your review.
Once you have discussed the results of your review with the attorney, send Cleareview the invoice for your time, and Cleareview will pay you, concluding the review.
- What about deposition or trial testimony?
Whether your involvement in the case advances to deposition depends on the client. You will discuss and negotiate your arrangements directly with the client.