Daniel Ira Rosenthal MD, Presenter: Nothing to Disclose

Jeffrey B Weilburg MD, Abstract Co-Author: Nothing to Disclose

Thomas Schultz, Abstract Co-Author: Nothing to Disclose

Keith J. Dreyer DO, Abstract Co-Author: Nothing to Disclose

James Hunter Thrall MD, Abstract Co-Author: Nothing to Disclose

Increased use of high-tech, high-cost imaging modalities has prompted payers to attempt to control costs. Prior approval programs and “pay for performance” targets for imaging use are increasingly common in managed care programs. We have attempted to decrease inapproprate use of imaging by providing decision support that indicates the comparative utility of various imaging modalities based upon the information provided at the time of ordering

We have created a web-based “decision support” system that indicates the probable utility (appropriateness) of each requested imaging test, based upon the indication provided. Comparative scores are provided for the requested examination and also for possible alternative approaches (e.g. CT vs. MRI). Starting with the ACR “appropriateness criteria”, the numerical scores have been modified by our radiologists and clinicians and are continuously updated in response to feedback from users. A composite score for each clinician’s use of each modality is kept. The effect is similar to creation of a “Credit rating” for each clinician. Clinicians who consistently receive low scores are called by medical leadership and asked to justify or modify their practices. Changes to orders in response to decision support are tracked. Opportunities are provided for feedback.

Early results indicate a high rate of acceptance from clinicians. Since 11/2004, 827 physicians have ordered 26,460 exams. 84% of the examinations were judged to have a high likelihood of adding diagnostic value 5% were judged to be of low utility, and 12% were intermediate. Overall use, as well as percentages of low utility examinations are reported for orders created by individual physicians, administrative staff and practice type. Frequency of changed orders in response to decision support, and changes in rates of “inappropriate orders” are also reported.

A carefully designed, minimally intrusive decision support system can find widespread acceptance from requesting physicians and radiologists

Rosenthal, D, Weilburg, J, Schultz, T, Dreyer, K, Thrall, J, Radiology Order Entry with Decision Support.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4405786.html