Alexander Goehler1, Christopher Moore2, Jennifer M Manne-Goehler3, Jennifer Arango4, Linda D'Amato5, Howard P Forman4, Jeffrey Weinreb4. 1. Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; Harvard Medical School, 25 Shattuck St, Boston, MA 02115; Alfried Krupp von Bohlen und Halbach Foundation Chair for Health Systems Management, University of Duisburg-Essen, Essen, Germany. Electronic address: agoehler@post.harvard.edu. 2. Yale University, Yale New Haven Hospital, Department of Emergency Medicine, 464 Congress Ave #260, New Haven, CT 06450. 3. Harvard Medical School, 25 Shattuck St, Boston, MA 02115; Harvard University, Beth-Israel Medical Center, Department of Medicine, 330 Brookline Ave, Boston, MA 02215. 4. Yale University, Yale New Haven Hospital, Department of Radiology, 20 York St # 2, New Haven, CT 06510. 5. Yale New Haven Hospital, Information Technology Services, 789 Howard Ave, New Haven, CT 06519.
Abstract
PURPOSE: To determine the feasibility and impact of Clinical Decision Support for imaging ordering. METHODS: A survey of 231 emergency providers identified Computed tomography angiography (CTA)-Pulmonary embolism (PE) as an overutilized study. We developed an algorithm that combined established risk scores to stratify patients for PE work-up (recommendations: CTA, D-dimer or no further testing); the algorithm was integrated into the Epic Radiology Information Ordering System. RESULTS: Among 872 studies requested, 479 (55%) received a recommendation to change their order: 6 (1.3%) were cancelled; 13 (2.7%) changed to a D-dimer, and 460 (96%) proceeded with CTA. Of the 853 studies conducted, 8.2% were positive for PE. The algorithm had good discriminatory power with positivity rates of 12.0% (CT), 10.0% (D-dimer), and 2.6% (no further testing). Compliance with the recommendation ranged from 12%-68% (mean 45%) with 10% correlation between compliance and positivity rates. CONCLUSION: While the CDS algorithm was accurate, it had only a minimal impact on ordering practices, in part due to heterogeneity in physician adherence.
PURPOSE: To determine the feasibility and impact of Clinical Decision Support for imaging ordering. METHODS: A survey of 231 emergency providers identified Computed tomography angiography (CTA)-Pulmonary embolism (PE) as an overutilized study. We developed an algorithm that combined established risk scores to stratify patients for PE work-up (recommendations: CTA, D-dimer or no further testing); the algorithm was integrated into the Epic Radiology Information Ordering System. RESULTS: Among 872 studies requested, 479 (55%) received a recommendation to change their order: 6 (1.3%) were cancelled; 13 (2.7%) changed to a D-dimer, and 460 (96%) proceeded with CTA. Of the 853 studies conducted, 8.2% were positive for PE. The algorithm had good discriminatory power with positivity rates of 12.0% (CT), 10.0% (D-dimer), and 2.6% (no further testing). Compliance with the recommendation ranged from 12%-68% (mean 45%) with 10% correlation between compliance and positivity rates. CONCLUSION: While the CDS algorithm was accurate, it had only a minimal impact on ordering practices, in part due to heterogeneity in physician adherence.
Authors: Michael C Brunner; Scott E Sheehan; Eric M Yanke; Dean F Sittig; Nasia Safdar; Barbara Hill; Kenneth S Lee; John F Orwin; David J Vanness; Christopher J Hildebrand; Michael A Bruno; Timothy J Erickson; Ryan Zea; D Paul Moberg Journal: Appl Clin Inform Date: 2020-02-19 Impact factor: 2.342
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