Radiologists' use of online decision-support tools increases significantly if they can access them from within their PACS environment, but it's critical that they receive this integrated access upon system deployment, according to a study in the July issue of the Journal of the American College of Radiology.
In a study involving 48 radiology residents, researchers found that those with integrated access used decision-support tools three times as frequently as those with only Web-based access. When the groups swapped access methods, however, the group that initially had integrated access experienced a significant drop-off in usage. And, interestingly, the group that gained integrated access continued to lag behind in utilization.
"Decision-support tools that are embedded into the clinical workflow have the best chance of improving quality of care, and, in the current climate of radiology outsourcing, may also help preserve radiologists' added value," wrote the research team led by Dr. Matthew Morgan of the University of Utah School of Medicine (JACR, July 2011, Vol. 8:7, pp. 497-500).
The study team randomly divided the participants into two groups: One group had access to the StatDx online radiology decision-support tool (Amirsys) via a PACS-integrated portal that launched directly from within the institution's PACS environment with automated login and authentication. The second group had Web-based access to StatDx, which required minimizing the PACS interface and logging into the system from a Web browser.
After five months, the groups switched access methods for the second half of the study.
Logins per month to clinical decision-support tool
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When PACS-integrated access was switched between the groups after the fifth month, average use of decision support dropped 52%, from 604 to an average of 289 sessions per month in the remaining five months of the study. Meanwhile, the group that gained PACS-integrated access increased 20% from 229 to an average of 274 sessions per month in the final five months.
Both gains were statistically significant. Further analysis shows, however, that while the residents who gained integrated access in the second part of the study initially increased their use of decision support by about 35%, utilization subsequently fell back to the preintegration baseline, according to the researchers.
"Reasons for this behavior are not completely clear but may have to do with the difficulty of overcoming formed behaviors," the authors wrote. "Once introduced to one method of accomplishing a task, individuals tend to repeat that method because it is familiar or habitual. In fact, physicians may be more prone to this tendency given the importance of methodic analysis in their daily work."
