CDS improves the appropriateness of advanced inpatient imaging

The addition of point-of-care clinical decision support (CDS) software can increase the overall appropriateness of advanced imaging tests ordered by physicians, according to study results published in the April issue of the Journal of the American College of Radiology.

Due to the rapid expansion of medical imaging use and recent updates to healthcare policy aimed at reducing waste within the medical industry, providers will soon be required to meet certain criteria for appropriateness when ordering imaging procedures for Medicare beneficiaries. One such system is the American College of Radiology Appropriateness Criteria (ACR AC), which draws upon evidence-based guidelines and can be integrated with CDS to help doctors decide when and how to image. But not everyone is convinced, according to Andrew Moriarity, MD, and his colleagues at the Henry Ford Health System in Detroit.

“Studies have shown low utilization of the ACR AC by clinical providers in determining what is appropriate image utilization, limited ability of medical house staff to choose appropriate imaging examinations, and a general reluctance of providers to accept changes suggested by CDS systems,” wrote Moriarity, et al. “Others have reported that, when properly integrated, CDS can have wide acceptance, improve workflow efficiency and increase adherence to expert guidelines.”

Moriarity and his team set out to determine what effect CDS could have on imaging appropriateness when integrated with computerized physician ordering entry (CPOE). To do so, the researchers used CDS to generate appropriateness scores for all inpatient CPOE imaging requests for nuclear medicine, CT and MRI at their medical facility over the course of 12 months. Appropriateness scores were only displayed to physicians on CPOE for the second six month period, and acknowledgement was required to complete the request for imaging. Scores and requests were compared among specialists and primary care providers.

Their results showed that the addition of CDS proved successful in positively impacting the appropriateness of physicians’ imaging orders, especially with regard to primary care doctors. “Integrating CDS into inpatient CPOE slightly increased the overall AC score of advanced imaging requests as well as the provision of sufficient structured data to automatically generate AC scores,” the researchers wrote. “Both effects were more pronounced in [primary care providers] compared with specialists.”

Moriarity and his team concluded that further study is needed to determine whether factors such as physician age, years in practice and computer literacy have on the adoption of CDS software, as well as the financial impact of adopting CDS and other emerging medical technologies on providers and facilities.