CDS prompts appropriate advanced imaging orders

Using clinical decision-support (CDS) software in clinical practice improves the appropriateness scores of advanced imaging orders, according to a study published online July 16 in the American Journal of Roentgenology.

Although the improvement is moderate, it represents progress, according to a team led by Dr. Ted Palen of Kaiser Permanente Colorado in Denver.

"CDS systems hold promise to improve the quality of image ordering in clinical practice and may have impacts on patient outcomes and organizational efficiency that deserve further investigation," the group wrote.

Costs for healthcare services continue to rise, and advanced imaging exams have often been blamed for the increase, Palen and colleagues noted. The American College of Radiology (ACR) has developed appropriateness criteria in an attempt to mitigate the problem of unnecessary or inappropriate imaging, and CDS software is increasingly being used in clinical practice to assess the need for advanced imaging studies, the authors noted.

"To address the rising rate of imaging and the concomitant rise in unnecessary or inappropriate imaging studies, clinical decision-support (CDS) tools are being incorporated into electronic medical record (EMR) systems to provide clinicians with evidence-based decision support at the time of ordering imaging studies," they wrote.

Palen's team sought to assess whether the use of CDS software (ACR Select, version 10, National Decision Support Company) improved the appropriateness scores of orders for advanced imaging in clinical practice, using data from 22,279 CT or MRI studies ordered between October 2015 and February 2016 by 941 physicians at Kaiser Permanente Colorado. Clinicians entered indications for each order, which were then scored against an appropriateness criteria scale of 1 to 9; scores of 7 or higher were considered appropriate.

The team evaluated "best practice alerts" that were triggered by orders with low or marginal appropriateness scores and sent to the ordering physician. The group also evaluated the rate per month of orders for advanced imaging and the proportion of orders for which the radiology department requested changes, Palen and colleagues wrote.

The researchers found that the CDS software did improve the mean proportion of appropriate orders. They noted no significant change in the rate of orders per month for advanced imaging, although the proportion of order changes requested by the radiology department did decrease, from 5.7% before the tool was put into practice to 5.3% after (p < 0.001).

Applying appropriateness criteria through CDS software and using best practice alerts resulted in a modest but statistically significant improvement in appropriateness scores and has potential for further improvements for both patients and radiology departments, Palen and colleagues concluded.