RSNA: Decision support can help curb unnecessary exams
CHICAGO—The implementation of clinical decision support (CDS) resulted in a marked, positive change in the utilization pattern for breast MRI, according to a study presented Nov. 30 at the Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).
The value of breast MRI as an adjunct to mammography has attracted the attention of the medical community in the last decade, leading to rapid growth in use. Guidelines for appropriate use of the modality have recently become available.
“There is an ongoing debate about how to control the rising cost of healthcare, and the negation of unnecessary imaging exams is a potential attractive strategy,” said the study’s lead investigator, Vartan M. Vartanians, MD, from the department of radiology at Massachusetts General Hospital in Boston.
For this study, Vartanians and his colleagues sought to determine whether the addition of a CDS to their computer physician order entry (CPOE) system would improve or guide the utilization of breast MRI.
“Breast MRI has been available on our outpatient radiology order entry system for 11 years without decision support,” Vartanians explained. “Decision support was introduced in April 2007, following the publication of American Cancer Society [ACS] guidelines.” The guidelines rank an exam on a one-to-nine basis, with nine being the most appropriate.
“If a physician wants to order a breast MRI, they have to check the indications that would designate the exam as appropriate. Also, the decision support system navigates the user to the National Cancer Institute’s website to calculate the lifetime risk of breast for each patient that the study is ordered for, which is an advantage of an electronic order entry system,” he said.
In this study, the researchers analyzed 10 years of data to determine number of breast MRI exams done monthly, both before and after the introduction of CDS. To control for changes in MRI availability during this period, they also examined the percentage of outpatient MRI that was represented by breast exams. They used linear regression to evaluate the significance of the effect of the decision support intervention on the outcome of ordering events.
For 88 months prior to the introduction of decision support the frequency of orders grew rapidly (slope +2.3), reaching a peak in mid-2008, around the time of introduction of decision support. During the subsequent 32 months after the ACS guidelines were introduced into the decision-support intervention, the rate declined with a slope of -2.16.
A similar effect was observed on the percentage of total outpatient MRI, indicating that the growth in use and subsequent decline was not due to changing availability, Vartanians said.
“There has been huge debate over whether electronic health records and order entry systems with decision support can beneficially affect practice," he concluded. "Our results provide evidence that decision support can be effective."
The value of breast MRI as an adjunct to mammography has attracted the attention of the medical community in the last decade, leading to rapid growth in use. Guidelines for appropriate use of the modality have recently become available.
“There is an ongoing debate about how to control the rising cost of healthcare, and the negation of unnecessary imaging exams is a potential attractive strategy,” said the study’s lead investigator, Vartan M. Vartanians, MD, from the department of radiology at Massachusetts General Hospital in Boston.
For this study, Vartanians and his colleagues sought to determine whether the addition of a CDS to their computer physician order entry (CPOE) system would improve or guide the utilization of breast MRI.
“Breast MRI has been available on our outpatient radiology order entry system for 11 years without decision support,” Vartanians explained. “Decision support was introduced in April 2007, following the publication of American Cancer Society [ACS] guidelines.” The guidelines rank an exam on a one-to-nine basis, with nine being the most appropriate.
“If a physician wants to order a breast MRI, they have to check the indications that would designate the exam as appropriate. Also, the decision support system navigates the user to the National Cancer Institute’s website to calculate the lifetime risk of breast for each patient that the study is ordered for, which is an advantage of an electronic order entry system,” he said.
In this study, the researchers analyzed 10 years of data to determine number of breast MRI exams done monthly, both before and after the introduction of CDS. To control for changes in MRI availability during this period, they also examined the percentage of outpatient MRI that was represented by breast exams. They used linear regression to evaluate the significance of the effect of the decision support intervention on the outcome of ordering events.
For 88 months prior to the introduction of decision support the frequency of orders grew rapidly (slope +2.3), reaching a peak in mid-2008, around the time of introduction of decision support. During the subsequent 32 months after the ACS guidelines were introduced into the decision-support intervention, the rate declined with a slope of -2.16.
A similar effect was observed on the percentage of total outpatient MRI, indicating that the growth in use and subsequent decline was not due to changing availability, Vartanians said.
“There has been huge debate over whether electronic health records and order entry systems with decision support can beneficially affect practice," he concluded. "Our results provide evidence that decision support can be effective."