Computerized Physician Order Entry System with Clinical Decision Support Reduces Inappropriate Imaging

In an effort to reduce the inappropriate use of medical imaging and improve quality of care, a large, tertiary-care hospital has effectively implemented a computerized physician order entry (CPOE) system with clinical decision support for radiology.

The report’s findings were published in the February 2012 issue of the Journal of the American College of Radiology. Significant increases in meaningful use (for electronically created studies, from 0.4%-61.9%; for electronically signed studies, from 0.4%-92.2%) and the adoption of CPOE (from 0.5%-94.6%) were observed.

The meaningful use (MU) of healthcare information technology (IT) can improve patient safety, effectiveness, and the quality of care. Initial studies have showed that with decision support, the percentage of low-utility imaging studies may decrease by as much as 57%.

The study was performed in a healthcare delivery network with Brigham and Women's Hospital (Boston, MA, USA). After early testing and user feedback, a Web-enabled CPOE system with embedded imaging decision support was incorporated into clinical use between 2000 and 2010 across outpatient, emergency department, and in-patient settings.

A total of 4.1 million imaging studies were performed during the study period. The utilization of electronically created studies was greatest in the emergency department and in-patient settings. MU varied across specialties; surgical subspecialties had the lowest rates of electronically created studies.

“Our study shows that an imaging CPOE system with embedded decision support that is integrated into the healthcare enterprise IT infrastructure and the relevant electronic medical record platform and optimized within the clinicians’ workflow can be successfully and broadly accepted clinically,” said Ivan K. Ip, MD, MPH, lead author of the study. “Such an imaging CPOE system, if adopted and meaningfully used, could create an excellent platform for delivering real-time decision support to reduce inappropriate use of imaging, improve quality and reduce waste.”

Related Links:
Brigham and Women’s Hospital