Effect of Computerized Physician Order Entry on Imaging Study Indication

Abstract

The effect of computerized physician order entry (CPOE) on imaging indication quality had only been measured in one institution’s emergency department using a homegrown electronic health record with faculty physicians, and only with one instrument. To better understand how many US hospitals’ recent CPOE implementations had affected indication quality, we measured its effect in a generalizable inpatient setting, using one existing and one novel instrument. We retrospectively analyzed the indications for 100 randomly selected inpatient abdominal computed tomography studies during two calendar months immediately prior to a 3/3/2012 CPOE implementation (1/1/2012–2/29/2012) and during two subsequent calendar months (5/1/2012–6/30/2012). We excluded two intervening months to avoid behaviors associated with adoption. We measured indication quality using a published 8-point explicit scoring scale and our own, novel, implicit 7-point Likert scale. Explicit scores increased 93% from a pre-CPOE mean ±95% CI of 1.4 ±0.2 to a CPOE mean of 2.7 ±0.3 (p<0.01). Implicit scores increased 26% from a pre-CPOE mean of 4.3 ±0.3 to a CPOE mean of 5.4 ±0.2 (p < 0.05). When presented with a statement that an indication was “extremely helpful,” and choices ranging from “strongly disagree” = 1 to “strongly agree” = 7, implicit scores of 4 and 5 signified “undecided” and “somewhat agree,” respectively. In an inpatient setting with strong external validity to other US hospitals, CPOE implementation increased indication quality, as measured by two independent scoring systems (one pre-existing explicit system and one novel, intuitive implicit system). CPOE thus appears to enhance communication from ordering clinicians to radiologists.

Evaluation of computerized provider order entry systems: assessing the usability of systems for electronic prescription

“…This is supported by Pevnick et al who reported the improved data exchange between the radiology information system and the CPOE system studied (28). According to findings of the current study and studies noted above, paying attention to the decision support aspect of the CPOE systems, when designing or improving the systems, can help to minimize medication errors and improve patient safety.…”

Evaluating the Effect of Unstructured Clinical Information on Clinical Decision Support Appropriateness Ratings

“…The use of CPOE has been reported to enhance communication of such information in imaging requests [19], and although additional unstructured free text clinical data were available in our initial implementation of CDS, it was not usable by the software in over 75% of all requests [6]. After review of the unstructured free text data accompanying requests, the percentage of requests with insufficient information to determine the AR fell to 6.4%.…”

Impact of clinical history on choice of abdominal/pelvic CT protocol in the Emergency Department

“…It is not expected that clinicians will provide an exhaustive history, but rather, key points which may help radiologists choose imaging as effectively as possible. With increasing access to electronic medical records, radiologists may have increasing access to patient history, however, the acute clinical interaction at the time of the ED visit may still provide additional information required by the radiologist [ 11 , 12 ].…”

“…This subjectivity is a limitation of our current study. However, at present, there are no available gold standards for determining history quality and different authors have used different techniques and statistical analyses to evaluate quality of history in a few previously published manuscripts [ 11 , 12 ]. As the imaging requisition is a medical document included in the patient encounter, the grading system utilized in this study was based on criteria described in guidelines for documentation of patient encounters and subsequent papers regarding the guidelines’ clinical application [ 24 , 25 ].…”

“…Much of this research has focused on accuracy and efficiency of communication from the radiologist reporting a final imaging interpretation [ 4 – 7 ]. However, the importance of the initial interaction and quality of history provided to the radiologists prior to imaging, particularly with abdominal imaging, has only been discussed in a few publications, with mixed results [ 8 – 12 ].…”