How one health system improved the quality of patient imaging history

When radiologists have complete imaging histories of their patients, they are more likely to provide better interpretations, but such information is often incomplete and inconsistent.

Authors of a new study outlined how Kaiser Permanente Colorado undertook a multidisciplinary project to improve the quality of patient imaging history in radiology, sharing their process in the American Journal of Roentgenology.

“Radiologists are more likely to provide high-value imaging interpretations when ordering providers submit high-quality imaging histories at order entry,” wrote Daniel S. Bor, with Kaiser Permanente Colorado’s Department of Medical Imaging, and colleagues.

In the first phase of the project, a multidisciplinary team, consisting of physicians, primary care clinicians, medical imaging providers, information technology professionals and practice improvement employees, defined the components of a complete imaging history. They came up with four topics: what happened, when it happened, where the patient was experiencing pain and the ordering provider’s concern.

These four criteria were put in the electronic physician order entry process to automatically include the multipart prompt. With the push of one key, ordering providers could move to the free-text entry box and were prompted to answer the four questions.

"Before this intervention, ordering providers in the institution were provided a single free-text box to enter whatever history information they felt to be relevant," Bor et al. added. "Our medical imaging team identified that frequently these unguided histories were incomplete, inconsistent, and of variable quality."

Providers placed a total of 10,236 order during the study period spanning March 13, 2017, to Dec. 16, 2018. At baseline, 16% of orders contained all four of the components the team defined as a complete imaging history; that jumped to 52% over the duration of the study, the authors noted.

Additionally, the mean number of characters providers entered in the imaging histories also increased—a secondary goal of the project—from 45.4 per order at baseline to 75.4 after the intervention.

“The frequency of more complete histories submitted after intervention increased by 225.0%, and the improvement was sustained for 18 months,” the researchers wrote. “This intervention was also associated with a sustained increase in the character count of the histories submitted by ordering providers, further supporting the conclusion that history completeness improved.”

According to Bor, the results are likely generalizable to other private practices and academic settings, but would require facilities connected across a health system’s EMR to modify their order entry process—a potential challenge for systems with “disparate” technology systems.

The intervention, at least anecdotally, Bor wrote, has already made an impact with radiologists.

“Radiologists have attributed the ability to make difficult diagnoses, such as subtle stress fractures, to having access to more complete imaging histories from ordering providers,” Bor noted. “We have also noticed that increased clinical information results in radiologists feeling less of a need to recommend additional downstream or repeat imaging.”