Radiologists can help pediatric physicians optimize clinical decision support tools

By now radiologists should know that on Jan. 1, 2020, the Protecting Access to Medicare Act of 2014 will require that physicians consult appropriate use criteria (AUC) for ordering advanced imaging studies, or face reimbursement penalties.

James Hogan, MD, with the Children’s Hospital of Philadelphia’s Department of Radiology and colleagues, transcribed 30 interviews conducted with pediatric ED physicians to understand their experience with clinical decision support (CDS) tools and how such tools may help improve appropriate imaging orders.

Below are three takeaways from the study, published Wednesday, Oct. 16, in the Journal of the American College of Radiology, and how radiologists can use them to improve patient care:

1. Imaging decisions are complex

Patient factors, physician’s individual experiences and a specialist’s perspective all inform the complex imaging decision process. A patient’s presentation, stability and differential diagnoses are always the top consideration, pediatric physicians said.

Physicians also said their personal experience impacts how they think about imaging decisions and whether they opt for consultation.

“I think with more experience you know what you don’t know and you’re not afraid to say that,” one respondent said.

And while pediatric physicians value recommendations from subspecialists, they reported challenges in the communication and coordination of care across ED physicians, subspecialists and radiologists.

2. Radiology consultations are helpful, but can be challenging

Pediatric ED physicians said radiologist consultations are “helpful” for complex patients who may not fall under an algorithm’s predetermined imaging decision.

Respondents also acknowledged that it can take a long time to find the appropriate radiologist for such a consultation. Large workloads for both clinicians also inhibit physicians from interrupting a radiologist's workflow.

Expanding departments, advances in technology, heavier workloads and increased physical distance between departments are all barriers that inhibit communication between physicians and radiologists.

3. Physicians see opportunities with CDS tools

CDS software should always be up to date and contain evidence-based recommendations that are reviewed and approved, the physicians explained.

Additionally, respondents want CDS tools to increase interaction between themselves and radiologists. Interactive features such as a chat tool could help facilitate direct communication to discuss imaging tests and findings.

The “optimal” CDS platform could also recommend radiologist consultation when necessary, the respondents said.

What can radiologists do?

Prior research has proven that imaging decision-support tools are most effective when located in areas that can improve workflow for patients and clinicians. Radiologists should think about a satellite reading room situated near patient care areas to encourage in-person interaction, the authors wrote.

Radiologists should also brainstorm methods to ensure their consultation questions are welcomed. Placing an expert reader on a dedicated consultation service with fewer clinical responsibilities could help, Hogan et al. explained, as could a reading room with a dedicated consultation space.

“…our results highlight the limitations of purely evidence-based AUC and the irreplaceable function of radiologists as the thinking, understanding, creative human counterbalance to the standardized uniformity of CDSMs,” the authors concluded. “Through efforts such as those discussed here, radiologists have an opportunity to promote value-based imaging care, which may potentially contribute to improved health outcomes.”