JACR: CDS can help control inappropriate medical imaging
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“Clinical decision support systems are point-of-order decision aids, usually through computer order entry systems, that provide real-time feedback to providers ordering imaging tests, including information on test appropriateness for specific indications,” wrote the study's lead author C. Craig Blackmore, MD, professor of radiology and adjunct professor of health studies at the University of Washington and associate director of radiology at Harborview Medical Center in Seattle.
"However, data on the effectiveness of clinical decision support is limited. Prior investigation has focused on the use of a global system encompassing virtually all CT and MRI studies and indications and has demonstrated only a relative attenuation in the rate of increase in imaging utilization. However, in the prior report, actual imaging utilization of both CT and MRI continued to grow," Blackmore stated.
The researchers at Virginia Mason performed a retrospective cohort study of staged implementation of evidence-based CDS built into ordering systems for selected high-volume imaging procedures: lumbar MRI, brain MRI and sinus CT. Imaging utilization rates and overall imaging utilization before and after the intervention were determined.
Results showed that the rates of imaging after intervention were 23.4 percent lower for low back pain lumbar MRI, 23.2 percent lower for headache head MRI, and 26.8 percent lower for sinusitis sinus CT.
“Clinical decision support is potentially an ideal method for improving the evidence-based use of imaging. Clinical decision support systems have the desired properties of being educational, transparent, efficient, practical and consistent,” Blackmore wrote. “As our study suggests, the use of such systems can aid the elimination of unnecessary imaging, increasing both patient safety and quality and decreasing healthcare costs.
The report detailed a significant, sustained decrease in the utilization of targeted advanced imaging studies through the use of CDS based on a simple set of locally derived evidence-based imaging guidelines, according to Blackmore.
"Our approach has several important innovations from other reports of imaging clinical decision support systems that may have contributed to success. We targeted areas of high and potentially inappropriate utilization, concentrating effort where there is potential for benefit rather than globally applying computer decision support to all higher imaging," Blackmore wrote.
"Also, we incorporated denial of imaging for inappropriate indications, preventing orders that did not meet evidence-based indications from proceeding in the computer order entry system. Finally, we offered the provision of alternate resources, in the form of prompt specialist consultation or therapy, where indicated."