Computerized order entry helps radiologists see the big picture

Structured order entry systems for physicians ordering trauma CT scans not only improved communication with radiologists, they’ve also improved billing efficiency and reimbursement rates, according to a recent study in the American Journal of Roentgenology.

Led by Jeremy R. Wortman, MD, of Brigham and Women’s Hospital, the research team measured the effectiveness of physicians using a structured order entry system when ordering CT on trauma patients.

Wortman and colleagues noted the importance of communication between referring physicians and radiologists, especially when it comes to patients’ medical histories, and said incomplete medical history is a common problem faced by radiologists, leading to “decreased accuracy in the interpretation of studies, wasted time spent searching through medical records, and billing delays and rejections.”

Researchers set out to study one intervention system built to bridge the gap in communication between the referring doctor and the radiologists—computerized physician order entry.

“We hypothesized that improvement in the physician order entry system would increase the likelihood that clinical information would be provided to the radiologist and would promote more accurate and detailed coding of examinations,” the authors wrote.

For the study, the team compared a number of factors both before and after the study’s level 1 trauma center implemented its structured order entry system on March 29, 2012. These factors included:

  • Communication of clinical signs and symptoms and mechanism of injury;
  • Primary International Classification of Diseases;
  • Clinical Modification code category;
  • Success of reimbursement; and
  • Time required for successful reimbursement.

During the study period (2011 to 2013), a total of 457 patients underwent pan-scan CT in 2,736 examinations. After the order entry system’s implementation, there was a 62 percent increase in requisitions containing clinical signs or symptoms and a 99 percent increase in orders providing the mechanism of injury.

Additionally, the order entry system resulted in a 7 percent increase in reimbursement success for claims submitted to insurance companies, and for those reimbursed there was a 14.7 day reduction in billing cycle time.

For the authors, the results supported the assertion that structured order entry can be adopted for trauma patients and can persuade ordering doctors to provide necessary clinical information when ordering trauma CT.

“Our study showed substantial problems with the clinical information provided in radiology requisitions before the intervention,” Wortman and colleagues wrote. “With the default trauma ordering system, 99.6 [percent] of trauma pan-scan CT orders were devoid of any clinical information beyond an autopopulated history of multiple trauma. Our remedy of redesigning the trauma [structured order entry] system was readily implemented and widely accepted into clinical practice in a busy emergency department."