Effect of Computerized Order Entry with Integrated Decision Support on the Growth of Outpatient Procedure Volumes: Seven-year Time Series Analysis

Sistrom, Chris L.; Dang, Pragya A.; Weilburg, Jeffrey B.; Dreyer, Keith J.; Rosenthal, Daniel I.; Thrall, James H.

doi:10.1148/radiol.2511081174

Cited by 247 publications

(106 citation statements)

References 12 publications

(16 reference statements)

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“…In some studies, guideline implementation with an educational message or with lectures and feedback have reduced general practitioners' spine radiography referrals by about 20%, and in one study even by about 80% (28)(29)(30)(31). There have also been studies assessing the impact of the computerized physician order entry system with decision support on medical imaging services (32). Such systems are not in use in Finland.…”

Section: Discussionmentioning

confidence: 99%

Justification and active guideline implementation for spine radiography referrals in primary care

et al. 2016

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Background: Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose: To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods: Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results: After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% (P < 0.001), thoracic spine by 53% (P < 0.001), and lumbar spine by 47% (P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified (P ¼ 0.005). Conclusion: Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

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Section: Discussionmentioning

confidence: 99%

Justification and active guideline implementation for spine radiography referrals in primary care

et al. 2016

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“…Studies on clinical decision support for ordering physicians have shown this solution reduces inappropriate utilization [18,19], which promotes patient safety and should limit over-diagnosis and potential unnecessary workup of benign incidental findings. In contrast to the binary systems of prior-authorization programs used by most radiology benefit management companies, clinical decision support solutions improve the efficiency of referring physicians and can suggest a more appropriate alternative examination if the one initially considered is not the most appropriate [20] likely improving disease detection and early diagnosis.…”

Section: Decision To Image Imaging Examination Selection and Patientmentioning

confidence: 99%

Improving diagnosis in health care: perspectives from the American College of Radiology

et al. 2017

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Abstract:In September of 2014, the American College of Radiology joined a number of other organizations in sponsoring the 2015 National Academy of Medicine report, Improving Diagnosis In Health Care. Our presentation to the Academy emphasized that although diagnostic errors in imaging are commonly considered to result only from failures in disease detection or misinterpretation of a perceived abnormality, most errors in diagnosis result from failures in information gathering, aggregation, dissemination and ultimately integration of that information into our patients' clinical problems. Diagnostic errors can occur at any point on the continuum of imaging care from when imaging is first considered until results and recommendations are fully understood by our referring physicians and patients. We used the concept of the Imaging Value Chain and the ACR's Imaging 3.0 initiative to illustrate how better information gathering and integration at each step in imaging care can mitigate many of the causes of diagnostic errors. Radiologists are in a unique position to be the aggregators, brokers and disseminators of information critical to making an informed diagnosis, and if radiologists were empowered to use our expertise and informatics tools to manage the entire imaging chain, diagnostic errors would be reduced and patient outcomes improved. Heath care teams should take advantage of radiologists' ability to fully manage information related to medical imaging, and simultaneously, radiologists must be ready to meet these new challenges as health care evolves. The radiology community stands ready work with all stakeholders to design and implement solutions that minimize diagnostic errors.

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“…Improper utilization leads to poor resource allocation, wasted medical dollars, needless radiation exposure to patients, and countless hours of lost physician time trying to contact ordering physicians and correct errors during exam protocoling. Indeed, the medical literature has documented the extent of this problem, and technological solutions are being developed, including electronic physician order entry systems for radiologic exams with integrated clinical decision support [9,10]. The need for these electronic resources speaks to the complexity and clinical sophistication often needed in determining the best imaging exam in any given clinical scenario.…”

Section: Focus On Indications Not Interpretationmentioning

confidence: 99%

Strategies for Incorporating Radiology into Early Medical School Curricula

Naeger

Webb

Zimmerman

et al. 2014

Journal of the American College of Radiology

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Clinically oriented material is being incorporated increasingly early into medical school curricula. Traditional models of incorporating radiology early on, mainly as an adjunct to pathology or anatomy instruction, are not focused on learning important aspects of clinical radiology. Medical students can be better served by an integrated curriculum that focuses on appropriate ordering of radiology studies, an intuitive understanding of imaging modalities, and understanding the patient experience.

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Effect of Computerized Order Entry with Integrated Decision Support on the Growth of Outpatient Procedure Volumes: Seven-year Time Series Analysis

Cited by 247 publications

References 12 publications

Justification and active guideline implementation for spine radiography referrals in primary care

Justification and active guideline implementation for spine radiography referrals in primary care

Improving diagnosis in health care: perspectives from the American College of Radiology

Strategies for Incorporating Radiology into Early Medical School Curricula

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