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Almanaa M. Impact of Computerized Physician Order Entry (CPOE) Coupled With Clinical Decision Support (CDS) on Radiologic Services. Cureus 2024; 16:e69470. [PMID: 39411619 PMCID: PMC11479669 DOI: 10.7759/cureus.69470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2024] [Indexed: 10/19/2024] Open
Abstract
Medical imaging is an essential component of healthcare, enabling accurate diagnoses and facilitating effective treatment plans. However, the field is not without its challenges, including medical imaging errors, overutilization of procedures, and adverse reactions to contrast agents. This review explores the impact of computerized physician order entry (CPOE) systems coupled with clinical decision support (CDS) on radiologic services. By analyzing the findings from various studies, this paper highlights how CPOE coupled with CDS can significantly reduce inappropriate imaging, enhance adherence to clinical guidelines, and improve overall patient safety. The implementation of CPOE with CDS optimizes the utilization of radiologic procedures, thereby reducing healthcare costs and minimizing patients' exposure to unnecessary radiation. Despite its benefits, the adoption of CPOE with CDS encounters challenges such as high implementation costs, changes in workflow, and alert fatigue among healthcare providers. Addressing these challenges requires careful system design, including the customization of alerts to reduce override rates and improve the specificity of CDS recommendations. This review underscores the potential of CPOE with CDS to transform radiologic services, enhancing both the quality and safety of patient care. Further research is needed to explore the system's effectiveness in preventing adverse reactions to contrast media and to identify best practices for overcoming the barriers to its broader adoption.
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Affiliation(s)
- Mansour Almanaa
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, SAU
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Luxenburg O, Vaknin S, Wilf-Miron R, Saban M. Evaluating the Accuracy and Impact of the ESR-iGuide Decision Support Tool in Optimizing CT Imaging Referral Appropriateness. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01197-5. [PMID: 39028357 DOI: 10.1007/s10278-024-01197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024]
Abstract
Radiology referral quality impacts patient care, yet factors influencing quality are poorly understood. This study assessed the quality of computed tomography (CT) referrals, identified associated characteristics, and evaluated the ESR-iGuide clinical decision support tool's ability to optimize referrals. A retrospective review analyzed 300 consecutive CT referrals from an acute care hospital. Referral quality was evaluated on a 5-point scale by three expert reviewers (inter-rater reliability κ = 0.763-0.97). The ESR-iGuide tool provided appropriateness scores and estimated radiation exposure levels for the actual referred exams and recommended exams. Scores were compared between actual and recommended exams. Associations between ESR-iGuide scores and referral characteristics, including the specialty of the ordering physician (surgical vs. non-surgical), were explored. Of the referrals, 67.1% were rated as appropriate. The most common exams were head and abdomen/pelvis CTs. The ESR-iGuide deemed 70% of the actual referrals "usually appropriate" and found that the recommended exams had lower estimated radiation exposure compared to the actual exams. Logistic regression analysis showed that non-surgical physicians were more likely to order inappropriate exams compared to surgical physicians. Over one-third of the referrals showed suboptimal quality in the unstructured system. The ESR-iGuide clinical decision support tool identified opportunities to optimize appropriateness and reduce radiation exposure. Implementation of such a tool warrants consideration to improve communication and maximize patient care quality.
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Affiliation(s)
- Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Sharona Vaknin
- The Gertner Institute for Health Policy and Epidemiology, Ramat-Gan, Israel
| | - Rachel Wilf-Miron
- Department of Health Promotion, School of Public Health, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Mor Saban
- School of Health Professions, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv-Yafo, Israel.
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Coleman JJ, Atia J, Evison F, Wilson L, Gallier S, Sames R, Capewell A, Copley R, Gyves H, Ball S, Pankhurst T. Adoption by clinicians of electronic order communications in NHS secondary care: a descriptive account. BMJ Health Care Inform 2024; 31:e100850. [PMID: 38729772 PMCID: PMC11097811 DOI: 10.1136/bmjhci-2023-100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Due to the rapid advancement in information technology, changes to communication modalities are increasingly implemented in healthcare. One such modality is Computerised Provider Order Entry (CPOE) systems which replace paper, verbal or telephone orders with electronic booking of requests. We aimed to understand the uptake, and user acceptability, of CPOE in a large National Health Service hospital system. METHODS This retrospective single-centre study investigates the longitudinal uptake of communications through the Prescribing, Information and Communication System (PICS). The development and configuration of PICS are led by the doctors, nurses and allied health professionals that use it and requests for CPOE driven by clinical need have been described.Records of every request (imaging, specialty review, procedure, laboratory) made through PICS were collected between October 2008 and July 2019 and resulting counts were presented. An estimate of the proportion of completed requests made through the system has been provided for three example requests. User surveys were completed. RESULTS In the first 6 months of implementation, a total of 832 new request types (imaging types and specialty referrals) were added to the system. Subsequently, an average of 6.6 new request types were added monthly. In total, 8 035 132 orders were requested through PICS. In three example request types (imaging, endoscopy and full blood count), increases in the proportion of requests being made via PICS were seen. User feedback at 6 months reported improved communications using the electronic system. CONCLUSION CPOE was popular, rapidly adopted and diversified across specialties encompassing wide-ranging requests.
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Affiliation(s)
- Jamie J Coleman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Jolene Atia
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Felicity Evison
- Data Science Team, Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Suzy Gallier
- PIONEER Health Data Research Hub, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Sames
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Capewell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Copley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Gyves
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Ball
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tanya Pankhurst
- Digital Healthcare and Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Rahimi F, Rabiei R, Seddighi AS, Roshanpoor A, Seddighi A, Moghaddasi H. Features and functions of decision support systems for appropriate diagnostic imaging: a scoping review. Diagnosis (Berl) 2024; 11:4-16. [PMID: 37795534 DOI: 10.1515/dx-2023-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Diagnostic imaging decision support (DI-DS) systems could be effective tools for reducing inappropriate diagnostic imaging examinations. Since effective design and evaluation of these systems requires in-depth understanding of their features and functions, the present study aims to map the existing literature on DI-DS systems to identify features and functions of these systems. METHODS The search was performed using Scopus, Embase, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL) and was limited to 2000 to 2021. Analytical studies, descriptive studies, reviews and book chapters that explicitly addressed the functions or features of DI-DS systems were included. RESULTS A total of 6,046 studies were identified. Out of these, 55 studies met the inclusion criteria. From these, 22 functions and 22 features were identified. Some of the identified features were: visibility, content chunking/grouping, deployed as a multidisciplinary program, clinically valid and relevant feedback, embedding current evidence, and targeted recommendations. And, some of the identified functions were: displaying an appropriateness score, recommending alternative or more appropriate imaging examination(s), providing recommendations for next diagnostic steps, and providing safety alerts. CONCLUSIONS The set of features and functions obtained in the present study can provide a basis for developing well-designed DI-DS systems, which could help to improve adherence to diagnostic imaging guidelines, minimize unnecessary costs, and improve the outcome of care through appropriate diagnosis and on-time care delivery.
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Affiliation(s)
- Fatemeh Rahimi
- Department of Health Information Technology and Management, Medical Informatics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rabiei
- Department of Health Information Technology and Management, Medical Informatics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Saied Seddighi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Roshanpoor
- Department of computer, Yadegar-e-Imam Khomeini (RAH), Janat-abad Branch, Islamic Azad University, Tehran, Iran
| | - Afsoun Seddighi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Moghaddasi
- Department of Health Information Technology and Management, Health Information Management & Medical Informatics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Darband St., Tehran, Iran
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Singer C, Luxenburg O, Rosen S, Vaknin S, Saban M. Advancing acceptance: assessing acceptance of the ESR iGuide clinical decision support system for improved computed tomography test justification. Front Med (Lausanne) 2023; 10:1234597. [PMID: 38162879 PMCID: PMC10756707 DOI: 10.3389/fmed.2023.1234597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024] Open
Abstract
Background A clinical decision support system (CDSS), the European Society of Radiologists (ESR) iGuide, was developed to address gaps in the availability and use of effective imaging referral guidelines. Aim This study aimed to assess the appropriateness of computed tomography (CT) exams with and without ESR iGuide use, as well as the usability and acceptance of the physician systems. Methods A retrospective single-center study was conducted in which data from 278 consecutive CT tests referred by physicians were collected in the first phase (T1), and physicians used the ESR iGuide system for imaging referrals in the second phase (T2; n = 85). The appropriateness of imaging referrals in each phase was assessed by two experts, and physicians completed the System Usability Scale. Results The mean appropriateness level on a scale of 0-9 was 6.62 ± 2.69 at T1 and 7.88 ± 1.4 at T2. When using a binary variable (0-6 = non-appropriate; 7-9 = appropriate), 70.14% of cases were found appropriate at T1 and 96.47% at T2. Surgery physician specialty and post-intervention phase showed a higher likelihood of ordering an appropriate test (p = 0.0045 and p = 0.0003, respectively). However, the questionnaire results indicated low system trust and minimal clinical value, with all physicians indicating they would not recommend collegial use (100%). Conclusion The study suggests that ESR iGuide can effectively guide the selection of appropriate imaging tests. However, physicians showed low system trust and use, indicating a need for further understanding of CDSS acceptance properties. Maximizing CDSS potential could result in crucial decision-support compliance and promotion of appropriate imaging.
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Affiliation(s)
- Clara Singer
- Research Center for Medical Technology Policy and Innovation, The Gertner Institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Shani Rosen
- Research Center for Medical Technology Policy and Innovation, The Gertner Institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Sharona Vaknin
- Research Center for Medical Technology Policy and Innovation, The Gertner Institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Mor Saban
- Nursing Department, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Winchester DE, Keating FK, Patel KK, Shah NR. The Medicare Appropriate Use Criteria Program: A Review of Recommendations for Testing in Coronary Artery Disease. Ann Intern Med 2023; 176:1235-1239. [PMID: 37603865 DOI: 10.7326/m23-1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Congress established the Appropriate Use Criteria (AUC) Program to reduce unnecessary advanced imaging studies. Organizations that wish to develop AUC can apply to the Centers for Medicare & Medicaid Services (CMS) to qualify as provider-led entities (PLEs) under this program. Variable methods, content, and formatting of PLE-generated AUC could lead to clinician uncertainty about whether an advanced imaging test is appropriate or not. PURPOSE To review AUC published by CMS-qualified PLEs focused on advanced imaging tests for coronary artery disease (CAD), a "priority clinical area" identified by CMS. DATA SOURCES Publicly available data from the worldwide web searched on 29 August 2022. STUDY SELECTION Approved AUC with recommendations related to testing for CAD. DATA EXTRACTION Manual review of published AUC by all authors. DATA SYNTHESIS Among the 17 CMS-qualified PLEs, only 7 had published AUC related to CAD. Substantial variation in the methods and formatting of these AUCs was observed. The number of clinical scenarios covered ranged from 6 to 210, and the number of advanced imaging methods covered ranged from 1 to 25. When specifically applied to clinical scenarios, many AUC offered no guidance on appropriateness; those that did conflicted with respect to appropriateness. LIMITATION Other CMS-identified priority clinical areas were not evaluated. CONCLUSION CMS-qualified AUC for imaging of CAD are heterogeneous and sometimes discrepant, creating substantial potential for uncertainty among clinicians seeking to provide their patients with appropriate imaging tests. PRIMARY FUNDING SOURCE No funding was received for this study.
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Affiliation(s)
- David E Winchester
- Malcom Randall VAMC and University of Florida College of Medicine, Gainesville, Florida (D.E.W.)
| | - Friederike K Keating
- Division of Cardiology, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont (F.K.K.)
| | - Krishna K Patel
- Departments of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York (K.K.P.)
| | - Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, Rhode Island (N.R.S.)
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Kruse CS, Ehrbar N. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review. JMIR Med Inform 2020; 8:e17283. [PMID: 32780714 PMCID: PMC7448176 DOI: 10.2196/17283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/08/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. Objective The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried. Methods Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. Results Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs. Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Nolan Ehrbar
- School of Health Administration, Texas State University, San Marcos, TX, United States
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Hogan J, Frasso R, Hailu T, Tate A, Martin R, Sze R. Optimizing Imaging Clinical Decision Support: Perspectives of Pediatric Emergency Department Physicians. J Am Coll Radiol 2020; 17:262-267. [DOI: 10.1016/j.jacr.2019.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/14/2019] [Accepted: 08/25/2019] [Indexed: 11/25/2022]
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9
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Rehani MM, Melick ER, Alvi RM, Doda Khera R, Batool-Anwar S, Neilan TG, Bettmann M. Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness. Eur Radiol 2019; 30:1839-1846. [PMID: 31792584 DOI: 10.1007/s00330-019-06551-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness. METHODS From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1-3 (red) as "not usually appropriate," 4-6 (yellow) "may or may not be appropriate," and 7-9 (green) "usually appropriate." Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC). RESULTS 9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease. CONCLUSIONS We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria. KEY POINTS We are faced with a situation wherein patients in age group 0-40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years. More than half of CT exams were unrelated to follow-up of a primary chronic disease. Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.
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Affiliation(s)
- Madan M Rehani
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Emily R Melick
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Raza M Alvi
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ruhani Doda Khera
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Tomas G Neilan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michael Bettmann
- Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
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Kadom N, Zafar HM, Cook TS, Greene A, Durand DJ. Engaging Patients: Models for Patient- and Family-centered Care in Radiology. Radiographics 2018; 38:1866-1871. [DOI: 10.1148/rg.2018180018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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A Day in the Life of MRI: The Variety and Appropriateness of Exams Being Performed in Canada. Can Assoc Radiol J 2018; 69:151-161. [DOI: 10.1016/j.carj.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022] Open
Abstract
Purpose This study aimed to determine the volumes and types of magnetic resonance imaging exams being performed across Canada, common indications for the exams, and exam appropriateness using multiple evaluation tools. Methods Thirteen academic medical institutions across Canada participated. Data were obtained relating to a single common day, October 1, 2014. Patient demographics, type by anatomic region and indication for imaging were analysed. Each exam was assessed for appropriateness via the Canadian Association of Radiologists Referral Guidelines and the American College of Radiology Appropriateness Criteria. The Alberta and Saskatchewan spine screening forms and the Alberta knee screening form were also used where applicable. The proportion of exams that were unscorable, appropriate, and inappropriate was determined. Exam-level results were compared between the 2 main evaluation tools. Results Data were obtained for 1087 relevant exams. There were 591 women and 460 men. 36 requisitions did not indicate the patient's sex. Brain exams were the most common, comprising 32.5% of the sample. Cancer was the most common indication. Overall, 87.0%–87.4% of the MR exams performed were appropriate; 6.6%–12.6% were inappropriate, based on the 2 main evaluation tools. Results differed by anatomic region; spine exams had the highest proportion, with nearly one-third of exams deemed inappropriate. Conclusion Variations by anatomic region indicate that focused exam request evaluation or screening methods could substantially reduce inappropriate imaging.
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Moriarity AK, Green A, Klochko C, O'Brien M, Halabi S. Evaluating the Effect of Unstructured Clinical Information on Clinical Decision Support Appropriateness Ratings. J Am Coll Radiol 2017; 14:737-743. [PMID: 28434848 DOI: 10.1016/j.jacr.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the appropriateness rating (AR) of advanced inpatient imaging requests that were not rated by prospective, point-of-care clinical decision support (CDS) using computerized provider order entry. MATERIALS AND METHODS During 30-day baseline and intervention periods, CDS generated an AR for advanced inpatient imaging requests (nuclear medicine, CT, and MRI) using provider-selected structured indications from pull-down menus in the computerized provider order entry portal. The AR was only displayed during the intervention, and providers were required to acknowledge the AR to finalize the request. Subsequently, the unstructured free text information accompanying all requests was reviewed, and the AR was revised when possible. The percentage of unrated requests and the overall AR, before and after radiologist review, were compared between periods and by provider type. RESULTS CDS software prospectively generated an AR for only 25.4% and 28.4% of baseline and intervention imaging requests, respectively; however, radiologist review generated an AR for 82.4% and 93.6% of the same requests. During the respective periods, the percentage of baseline and intervention imaging requests considered appropriate was 18.7% and 22.9% by prospective CDS software rating and increased to 82.4% and 88.7% with radiologist review. CONCLUSION Despite limited effective use of CDS software, the percentage of requests containing additional, relevant clinical information increased, and the majority of requests had overall high appropriateness when reviewed by a radiologist. Additional work is needed to improve the amount and quality of clinical information available to CDS software and to facilitate the entry of this information by appropriate end users.
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Affiliation(s)
- Andrew K Moriarity
- Advanced Radiology Services, Grand Rapids, Michigan; Division of Radiology and Biomedical Imaging, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Aaron Green
- Wayne State University School of Medicine, Detroit, Michigan
| | - Chad Klochko
- Department of Diagnostic Radiology, Henry Ford Health System, Detroit, Michigan
| | - Matthew O'Brien
- Department of Diagnostic Radiology, Henry Ford Health System, Detroit, Michigan
| | - Safwan Halabi
- Department of Radiology, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California
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13
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Fritz JV, Myers B. Coding in Neuroimaging. Continuum (Minneap Minn) 2016; 22:e1-e25. [DOI: 10.1212/con.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jensen JD, Durand DJ. Partnering With Your Health System to Select and Implement Clinical Decision Support for Imaging. J Am Coll Radiol 2016; 14:262-268. [PMID: 27687751 DOI: 10.1016/j.jacr.2016.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022]
Abstract
Recent legislation mandates the documentation of appropriateness criteria consultation when ordering advanced imaging for Medicare patients to remain eligible for reimbursement. Implementation of imaging clinical decision support (CDS) is a solution adopted by many systems to automate compliance with the new requirements. This article is intended to help radiologists who are employed by, contracted with, or otherwise affiliated with systems planning to implement CDS in the near future and ensure that they are able to understand and contribute to the process wherever possible. It includes an in-depth discussion of the legislation, evidence for and against the efficacy of imaging CDS, considerations for selecting a CDS vendor, tips for configuring CDS in a fashion consistent with departmental goals, and pointers for implementation and change management.
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Affiliation(s)
- Jeff D Jensen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
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