Vartan Vartanians MD, Presenter: Nothing to Disclose

Daniel Ira Rosenthal MD, Abstract Co-Author: Nothing to Disclose

James H. Thrall MD, Abstract Co-Author: Stockholder, Apple Inc Stockholder, Achillion Pharmaceuticals, Inc Stockholder, RPC Inc

To determine the effectiveness of Computerized Radiology Order Entry (ROE) System on ordering behavior of physicians for outpatient spine and head MRI exams.

We have used an electronic order entry system for outpatient imaging for approximately 10 years. During the first four years no Decision Support (DS) was offered. Decision support was introduced in 2004 and subsequently 2 modifications were made to limit perceived overuse of spine and head imaging. In 2007 an administrative change was made to prevent ordering of low utility examinations by support staff (so-called “hard stop” or HS), and in 2008 more stringent criteria for Head and Spine exams were introduced (revised DS or rDS) We analyzed the patterns of outpatient MRI imaging both before and after these changes. To account for changes in hardware availability we evaluated the percentage of total MRI represented by head and spine imaging, rather than absolute numbers.  

In the years prior to introduction of DS intervention; spine examinations comprised a stable 25% of annual MRIs. With the first implementation of DS, the percentage dropped from 24.96% to 23.1 (P<0.001). HS was followed by a further decrease to 22.38% (P=0.0061). The revised, more stringent criteria did not result in further change in spine imaging. (22.40%, P=0.53). Head imaging was also a stable percentage of the total prior to DS. Following DS it decreased from 36.46% to 35.5 (P=0.0037) and after HS it decreased further to 34.48% (P<000.1). After rDS this proportion decreased even more to 32.9% (P<0.001).

Attempts to manage utilization of spine and head MRI by Decision Support appear to have met with some success

There is an ongoing debate about whether DS systems are an effective means of influencing clinical practice. Our data suggest that the changes in utilization are real, and not the result of "gaming"

Vartanians, V, Rosenthal, D, Thrall, J, Effectiveness of Computerized Radiology Order Entry (ROE) System on Ordering Behavior of Physicians for Outpatient Spine and Head MRI Exams in Last Decade.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034380.html