1
|
Haddad L, Saleme H, Howarth N, Tack D. Reject Analysis in Digital Radiography and Computed Tomography: A Belgian Imaging Department Case Study. J Belg Soc Radiol 2023; 107:100. [PMID: 38144871 PMCID: PMC10742225 DOI: 10.5334/jbsr.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/25/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Reject analysis is usually performed in digital radiography (DR) for quality assurance. Data for computed tomography (CT) rejects remains sparse. The aim of this study is to help provide a straightforward benchmark for reject analysis of both DR and CT. Materials and methods This retrospective observational study included 107,277 DR and 20,659 CT during 18 months in a tertiary care center. Rejected acquisitions were retrieved by Dose Archiving and Communication System (DACS). The DR and CT reject analysis included reject rates, reasons for rejection and supplementary radiation dose associated with these rejects. Results 8,904 rejected DR and 514 rejected CT were retrieved. The DR reject rate was 8.3% whereas the CT reject rate was 2.5%. The cumulative effective dose (ED) of DR rejects was 377.3 mSv while the cumulative ED of CT rejects was 1267.4 mSv. The major reason for rejects was positioning for both DR (61%) and CT (44%). Conclusion This study helps constitute a simple reproducible method to analyze both DR and CT rejects simultaneously. Although CT rejects are less often monitored than DR rejects, the radiation dose associated with CT rejects is much higher, which emphasizes the need to systematically monitor both DR and CT rejects. Investigating the reasons and the most frequently rejected examinations gives an opportunity for improvement of imaging techniques in cooperation with technologists.
Collapse
Affiliation(s)
| | - Hanna Saleme
- Department of Radiology, Epicura La Madeleine, Rue Maria Thomée, 1, 7800 Ath, Belgium
| | - Nigel Howarth
- Department of Radiology, Hislanden –Clinique des Grangettes, 7 Chemin des Grangettes, 1224 Chênes-Bougeries, Switzerland
| | - Denis Tack
- Department of Radiology, Epicura La Madeleine, Rue Maria Thomée, 1, 7800 Ath, Belgium
| |
Collapse
|
2
|
Karimian S, Rahimi B. A systematic review of effects of exchanging and sharing medical images systems in a sociotechnical context: Evaluation perspectives. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
|
3
|
Rose S, Viggiano B, Bour R, Bartels C, Kanne JP, Szczykutowicz TP. Applying a New CT Quality Metric in Radiology: How CT Pulmonary Angiography Repeat Rates Compare Across Institutions. J Am Coll Radiol 2021; 18:962-968. [PMID: 33741373 DOI: 10.1016/j.jacr.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify overall CT repeat and reject rates at five institutions and investigate repeat and reject rates for CT pulmonary angiography (CTPA). METHODS In this retrospective study, we apply an automated repeat rate analysis algorithm to 103,752 patient examinations performed at five institutions from July 2017 to August 2019. The algorithm identifies repeated scans for specific scanner and protocol combinations. For each institution, we compared repeat rates for CTPA to all other CT protocols. We used logistic regression and analysis of deviance to compare CTPA repeat rates across institutions and size-based protocols. RESULTS Of 103,752 examinations, 1,447 contained repeated helical scans (1.4%). Overall repeat rates differed across institutions (P < .001) ranging from 0.8% to 1.8%. Large-patient CTPA repeat rates ranged from 3.0% to 11.2% with the odds (95% confidence intervals) of a repeat being 4.8 (3.5-6.6) times higher for large- relative to medium-patient CTPA protocols. CTPA repeat rates were elevated relative to all other CT protocols at four of five institutions, with strong evidence of an effect at two institutions (P < .001 for each; odds ratios: 2.0 [1.6-2.6] and 6.2 [4.4-8.9]) and somewhat weaker evidence at the others (P = .005 and P = 0.011; odds ratios: 2.2 [1.3-3.8] and 3.7 [1.5-9.1], respectively). Accounting for size-based protocols, CTPA repeat rates differed across institutions (P < .001). DISCUSSION The results indicate low overall repeat rates (<2%) with CTPA rates elevated relative to other protocols. Large-patient CTPA rates were highest (eg, 11.2% at one institution). Differences in repeat rates across institutions suggest the potential for quality improvement.
Collapse
Affiliation(s)
- Sean Rose
- Department of Medical Physics, University of Wisconsin Madison, Madison, Wisconsin
| | - Ben Viggiano
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin
| | - Robert Bour
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin
| | - Carrie Bartels
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin
| | - Jeffery P Kanne
- Vice Chair of Quality and Safety, Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Timothy P Szczykutowicz
- Department of Medical Physics, University of Wisconsin Madison, Madison, Wisconsin; Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin Madison, Madison, Wisconsin.
| |
Collapse
|
4
|
Abstract
OBJECTIVE. Repeated imaging is an unnecessary source of patient radiation exposure, a detriment to patient satisfaction, and a waste of time and money. Although analysis of rates of repeated and rejected images is mandated in mammography and recommended in radiography, the available data on these rates for CT are limited. MATERIALS AND METHODS. In this retrospective study, an automated repeat-reject rate analysis algorithm was used to quantify repeat rates from 61,102 patient examinations obtained between 2015 and 2018. The algorithm used DICOM metadata to identify repeat acquisitions. We quantified rates for one academic site and one rural site. The method allows scanner-, technologist-, protocol-, and indication-specific rates to be determined. Positive predictive values and sensitivity were estimated for correctly identifying and classifying repeat acquisitions. Repeat rates were compared between sites to identify areas for targeted technologist training. RESULTS. Of 61,102 examinations, 4676 instances of repeat scanning contributed excess radiation dose to patients. Estimated helical overlap repeat rates were 1.4% (95% CI, 1.2-1.6%) for the rural site and 1.1% (95% CI, 1.0-1.2%) for the academic site. Significant differences in rates of repeat imaging required because of bolus tracking (11.6% vs 4.3%; p < 0.001) and helical extension (3.3% vs 1.8%; p < 0.001) were observed between sites. Positive predictive values ranged from 91% to 99% depending on the reason for repeat imaging and site location. Sensitivity of the algorithm was 92% (95% CI, 87-96%). Rates tended to be highest for emergent imaging procedures and exceeded 9% for certain protocols. CONCLUSION. Our multiinstitutional automated quantification of repeat rates for CT provided a useful metric for unnecessary radiation exposure and identification of technologists in need of training.
Collapse
|
5
|
Wickerson L, Fujioka JK, Kishimoto V, Jamieson T, Fine B, Bhatia RS, Desveaux L. Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study. JMIR Form Res 2020; 4:e17220. [PMID: 32459644 PMCID: PMC7418016 DOI: 10.2196/17220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Timely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province. Objective The aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption. Methods This multimethod study included semistructured interviews with physicians and administrative stakeholders and descriptive analysis of the
current DICS usage data. Results In this study, 41 participants were interviewed, that is, 34 physicians and 7 administrative stakeholders. The following 4 key themes emerged: (1) utilization of the DICS depended on the awareness of the technology and the preferred channels for accessing images, which varied widely, (2) clinical responsibilities and available institutional resources were the drivers of utilization (or lack thereof), (3) centralized image repositories were perceived to offer value at the patient, clinician, and health care system levels, and (4) the enabling factors to realize value included aspects of technology infrastructure (ie, available functionality) alongside policy supports. High-volume DICS usage was not evenly distributed throughout the province. Conclusions Suboptimal adoption of the DICS was driven by poor awareness and variations in the clinical workflow. Alignment with physician workflow, policy supports, and investment in key technological features and infrastructure would improve functionality and data comprehensiveness, thereby optimizing health system performance, patient and provider experience, population health, and health care costs.
Collapse
Affiliation(s)
- Lisa Wickerson
- University Health Network, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Jamie K Fujioka
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vanessa Kishimoto
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Trevor Jamieson
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ben Fine
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Effect of intravenous contrast for CT abdomen and pelvis on detection of urgent and non-urgent pathology: can repeat CT within 72 hours be avoided? Emerg Radiol 2019; 26:601-608. [PMID: 31332644 DOI: 10.1007/s10140-019-01704-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/14/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine if administering IV contrast for CT abdomen and pelvis improves detection of urgent and clinically important non-urgent pathology in patients with urgent clinical symptoms compared to patients not receiving IV contrast, and in turn to determine whether repeat CT exams on the same patient within 72 h were of low diagnostic benefit if the first CT was performed with IV contrast. METHODS We evaluated 400 consecutive patients who had CT abdomen and pelvis (CT AP) examinations repeated within 72 h. For each patient, demographic data, reason for examination, examination time stamps, and examination technique were documented. CT AP radiology reports were reviewed and both urgent and non-urgent pathology was extracted. RESULTS Of 400 patients, 63% had their initial CT AP without contrast. Administration of IV contrast for the first CT AP was associated with increased detection of urgent findings compared with non-contrast CT (p = 0.004) and a contrast-enhanced CT AP following an initial non-contrast CT AP examination better characterized both urgent (p = 0.002) and non-urgent findings (p < 0.001). Adherence to ACR appropriateness criteria for IV contrast administration was associated with increased detection of urgent pathology on the first CT (p = 0.02), and the second CT was more likely to be performed with IV contrast if recommended by the radiologist reading the first CT (p = 0.0006). CONCLUSION In the absence of contraindications, encouraging urgent care physicians to preferentially order IV contrast-enhanced CT AP examinations in adherence with ACR appropriateness criteria may increase detection of urgent pathology and avoid short-term repeat CT AP.
Collapse
|
7
|
Hallet J, Coburn NG, Alberga A, Fu L, Tharmalingam S, Beyfuss K, Milot L, Law CHL. Reducing repeat imaging in hepato-pancreatico-biliary surgical cancer care through shared diagnostic imaging repositories. HPB (Oxford) 2019; 21:96-106. [PMID: 30297304 DOI: 10.1016/j.hpb.2018.06.1807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/29/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND With regionalization of care, patients often undergo treatment in institutions other than where the initial investigation is conducted. This study assessed the impact of a shared diagnostic imaging repository (SDIR) on processes of care and outcomes in hepato-pancreatico-biliary (HPB) cancer surgery. METHODS Provincial administrative datasets were linked to study HPB cancer patients operated at a regional cancer centre (2003-2014). SDIR and non-SDIR groups were based on where initial imaging (CT or MRI) was conducted. Outcomes were repeat imaging before surgery and wait times for surgery from initial imaging and surgical consultation. RESULTS Of 839 patients, 474 were from SDIR institutions. Fewer SDIR patients underwent any repeat imaging (55.9% vs. 75.3%; p < 0.01) and repeat imaging with same modality and protocol (24.7% vs. 43.0%; p < 0.01). Median wait time to surgery from initial imaging (64 Vs. 79 days; p < 0.01) and surgical consultation (39 Vs. 45 days; p = 0.046) was shorter with SDIR. SDIR patients had lower adjusted odds of any repeat imaging (OR 0.20 [0.14-0.30]), and repeat imaging with same modality and protocol (OR 0.58 [0.41-0.80]). CONCLUSION Radiology sharing with SDIR reduced repeat imaging for HPB cancer surgery, including potentially redundant repeat imaging with same protocol, and shortened wait time to surgical care.
Collapse
Affiliation(s)
- Julie Hallet
- Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Natalie G Coburn
- Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amanda Alberga
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sukirtha Tharmalingam
- Canada Health Infoway - Inforoute Santé du Canada, Toronto, Ontario, Canada; Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kaitlyn Beyfuss
- Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurent Milot
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Calvin H L Law
- Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Jung HY, Vest JR, Unruh MA, Kern LM, Kaushal R. Use of Health Information Exchange and Repeat Imaging Costs. J Am Coll Radiol 2016; 12:1364-70. [PMID: 26614881 DOI: 10.1016/j.jacr.2015.09.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to quantify the association between health information exchange (HIE) use and cost savings attributable to repeat imaging. METHODS Imaging procedures associated with HIE were compared with concurrent controls on the basis of propensity score matching over the period from 2009 to 2010 in a longitudinal cohort study. The study sample (n = 12,620) included patients ages 18 years and older enrolled in the two largest commercial health plans in a 13-county region of western New York State served by the Rochester Regional Health Information Organization. The primary outcome was a continuous measure of costs associated with repeat imaging. The determinant of interest, HIE use, was defined as system access after the initial imaging procedure and before repeat imaging. RESULTS HIE use was associated with an overall estimated annual savings of $32,460 in avoided repeat imaging, or $2.57 per patient. Basic imaging (radiography, ultrasound, and mammography) accounted for 85% of the estimated avoided cases of repeat imaging. Advanced imaging (CT and MRI) accounted for 13% of avoided procedures but constituted half of the estimated savings (50%). CONCLUSIONS HIE systems may reduce costs associated with repeat imaging. Although inexpensive imaging procedures constituted the largest proportion of avoided repeat imaging in our study, most of the estimated cost savings were due to small reductions in repeated advanced imaging procedures. HIE systems will need to be leveraged in ways that facilitate greater reductions in advanced imaging to achieve appreciable cost savings.
Collapse
Affiliation(s)
- Hye-Young Jung
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York.
| | - Joshua R Vest
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York
| | - Mark A Unruh
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York
| | - Lisa M Kern
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Rainu Kaushal
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York; Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, New York, New York
| | | |
Collapse
|
9
|
Vest JR, Jung HY, Ostrovsky A, Das LT, McGinty GB. Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis. J Am Coll Radiol 2015; 12:1371-1379.e3. [PMID: 26614882 PMCID: PMC4730956 DOI: 10.1016/j.jacr.2015.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. METHODS Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004-2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. RESULTS A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = -0.17; 95% confidence interval [CI] = [-0.25, -0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. CONCLUSIONS Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings.
Collapse
Affiliation(s)
- Joshua R Vest
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
| | - Hye-Young Jung
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Aaron Ostrovsky
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Lala Tanmoy Das
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York; Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Geraldine B McGinty
- Department of Radiology, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, New York, New York
| |
Collapse
|
10
|
Journal club: Requiring clinical justification to override repeat imaging decision support: impact on CT use. AJR Am J Roentgenol 2015; 203:W482-90. [PMID: 25341162 DOI: 10.2214/ajr.14.13017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the impact of requiring clinical justification to override decision support alerts on repeat use of CT. SUBJECTS AND METHODS This before and after intervention study was conducted at a 793-bed tertiary hospital with computerized physician order entry and clinical decision support systems. When a CT order is placed, decision support alerts the orderer if the patient's same body part has undergone CT within the past 90 days. The study cohort included all 28,420 CT orders triggering a repeat alert in 2010. The intervention required clinical justification, selected from a predetermined menu, to override repeat CT decision support alerts to place a CT order; otherwise the order could not be placed and was dropped. The primary outcome, dropped repeat CT orders, was analyzed using three methods: chi-square tests to compare proportions dropped before and after intervention; multiple logistic regression tests to control for orderer, care setting, and patient factors; and statistical process control for temporal trends. RESULTS The repeat CT order drop rate had an absolute increase of 1.4%; 6.1% (682/11,230) before to 7.5% (1290/17,190) after intervention, which was a 23% relative change (7.5 - 6.1)/6.1 × 100 = 23%; p < 0.0001). Orders were dropped more often after intervention (odds ratio, 1.3; 95% CI, 1.1-1.4; p < 0.0001). Statistical control analysis supported the association between the increase in the drop rate with intervention rather than underlying trends. CONCLUSION Adding a requirement for clinical justification to override alerts modestly but significantly improves the impact of repeat CT decision support (23% relative change), with the overall effect of preventing one in 13 repeat CT orders.
Collapse
|
11
|
Vest JR, Grinspan ZM, Kern LM, Campion TR, Kaushal R. Using a health information exchange system for imaging information: patterns and predictors. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2013; 2013:1402-1411. [PMID: 24551416 PMCID: PMC3900154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Health information exchange (HIE) systems may address the challenges that prevent easy access to patients' existing radiological information at the point of care. However, little is known about the factors associated with usage of HIE for radiology reports, nor about how reports are shared with an exchange network. We analyzed the system log files from a regional health information organization in upstate New York matched with insurance claims files using network analysis and regression modeling. The exchange network was dominated by a few key information sources. Outpatient users overall accessed 17 times more radiology reports than inpatient and ED users combined. Additionally, as the number of exchange partners increased per organization, the average number of reports exchanged by that organization also increased. Radiology reports were most likely to be accessed by physicians and other clinical users. These findings have implications for those operating and fostering exchange activity.
Collapse
Affiliation(s)
- Joshua R Vest
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY
| | - Zachary M Grinspan
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Pediatrics, Weill Cornell Medical College, New York, NY; ; New York Presbyterian Hospital, New York, NY
| | - Lisa M Kern
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Thomas R Campion
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Rainu Kaushal
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Pediatrics, Weill Cornell Medical College, New York, NY; ; New York Presbyterian Hospital, New York, NY; ; Department of Medicine, Weill Cornell Medical College, New York, NY
| |
Collapse
|
12
|
Physicians' views and assessments on picture archiving and communication systems (PACS) in two Turkish public hospitals. J Med Syst 2012; 36:3555-62. [PMID: 22392563 DOI: 10.1007/s10916-012-9831-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/05/2012] [Indexed: 10/28/2022]
Abstract
A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of and convenient access to images from multiple modalities (source machine types). PACS have been widely introduced as a credible alternative to the traditional film-based radiological service. This study was planned and conducted to determine the physicians' views and assessments on PACS in two public hospitals in Turkey. A questionnaire was prepared by viewing the literature related to PACS. The questionnaires were distributed several times to a total of 150 physicians two public hospitals in Ankara, Turkey. The overall response rate is 46%. Some questions required a graduated score in response and others an open ended response. The majority of physicians judged PACS to be a major advance for their hospitals with less frustration than using film high quality images and an improvement in their working lives and patient care. They reported that PACS gave them to radiology reports in short time. Also physicians believed that PACS has improved their consultations. Open ended questions were prepared with concerning the benefits and disadvantages of PACS. The assessments of the physicians demonstrated many more benefits than disadvantages of PACS in their hospitals. PACS has been accepted well by a wide percentage of hospital physicians. PACS evolves over time components are frequently replaced and so the users must expect continuous learning about new updates and improved functionality. The implementation of the PACS clearly contributes to an increase in the productivity of health professionals and physicians.
Collapse
|
13
|
Ip IK, Mortele KJ, Prevedello LM, Khorasani R. Repeat abdominal imaging examinations in a tertiary care hospital. Am J Med 2012; 125:155-61. [PMID: 22269618 PMCID: PMC4447187 DOI: 10.1016/j.amjmed.2011.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reducing unnecessary repeat imaging may reduce waste and costs, and improve health care quality. We aimed to quantify repeat imaging rates in patients with abdominal imaging examinations, and identify factors associated with repeat imaging. METHODS We retrospectively analyzed all diagnostic abdominal computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), fluoroscopy, and radiograph reports performed at our institution between January 1, 2000 and December 31, 2009. Primary outcome measure was the rate of repeat abdominal imaging (RAI) examinations, defined as any imaging examination of the abdomen on the same patient within 0-90 days of the first (enrollment) examination. We used natural language processing tools to extract recommendations for follow-up imaging from radiology reports. Univariate and multivariate logistic regressions were fitted to determine the effect of patient age, sex, study modality, care setting, follow-up recommendations, and history of neoplasm on the primary outcome over time. RESULTS Over 10 years, 245,184 abdominal imaging examinations were performed (43.2% CT, 20.6% US, 16.6% radiograph, 13.9% fluoroscopy, 5.7% MRI). The RAI rate remained unchanged (41.2% to 41.7%); unadjusted RAI volume increased from 6596 to 12,218 (P <.01). Most repeat studies (88.2%) were not preceded by a radiologist's recommendation. Practice setting, study modality, patient age, sex, underlying health condition, and radiologist's recommendations were associated with higher rate of repeat abdominal imaging examinations. CONCLUSIONS A large proportion of abdominal imaging examinations result in a repeat study. Many factors contribute to repeat imaging, including patient age, sex, underlying disease, initial study modality, practice setting, and radiologist's recommendation.
Collapse
Affiliation(s)
- Ivan K Ip
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | |
Collapse
|