RSNA: Rads are sitting targets in Washington

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CHICAGO—Radiology's implementation of IT solutions to improve appropriateness is essential to reduce wasteful imaging and rescue radiologists from being sitting targets in Washington, D.C., according to a presentation given Dec. 1 at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

"In two years, these [IT solutions and performance metrics] will all be common in radiology, or I won't be speaking here," predicted Ramin Khorasani, MD, of Brigham and Women's Hospital (BWH) and Harvard Medical School in Boston. Khorasani called on radiologists to increasingly turn digital, by way of clinical decision support, exam entry and performance measurement.

Electronic order entry meliorates radiologists' accountability and improves the quality of their work, according to Khorasani. At BWH, imaging orders are placed online and provide radiologists with immediate evidence-based decision support for cases. "If it's [the evidence is] not actionable, don't put it up there," commanded Khorasani. While physicians are not prohibited from ordering repeated exams or studies not typically indicated for a patient's given condition, the physicians are notified of their irregular orders and must respond to several questions as to why they are requisitioning the studies.

Khorasani also implored radiologists to go paperless. "Why stop using paper?" asked Khorasani, "because paper doesn't check the radiologist's work." Sticking to paper for ordering exams and other workflow also dramatically increases the potential points of failure. Whether it be miswritten patient information, accurate but illegibly penned requisitions (orders may pass through more than a dozen medical workers' hands) or errors transcribing the information into RIS, paper is less efficient and less safe, apprised Khorasani.

He tied these recommendations together by expressing urgency and confidence in the application of these technologies and the implementation of metrics to monitor them. Tagging many imaging orders as wasteful and unnecessary and calling on radiologists to cut the 40 percent of imaging orders placed by non-radiologists down to 20 percent, Khorasani tweaked the common managerial adage, saying "You can't improve what you can't measure."

With radiology imaging under stricter scrutiny, these IT solutions are more pressing, and more effective, than ever. Otherwise, radiologists will continue to be "just a cost and a radiation target in Washington."