News | May 25, 2010

Low-Yield Exams Drop 3.5 Percent Using Decision Support

May 25, 2010 - May 25, 2010 - Radiologists using decision support helped decrease the percentage of low-yield exams from 5.4 percent of total number of requests to 1.9 percent of total requests, according to a study appearing in the June issue of Radiology.

The study, “Increasing the Appropriateness of Outpatient Imaging: Effects of a Barrier to Ordering Low-Yield Examinations," measured how a new rule preventing medical support staff from completing orders for outpatient imaging exams that were likely to be negative resulted in a marked decrease in low-yield exams for patients.

Many medical institutions request and schedule outpatient diagnostic imaging exams through use of web-based radiology order entry systems. Some systems offer real-time feedback, called decision support, on the appropriateness of the exams being ordered. When entering the desired examination into the system, the physician or support staff must also enter clinical information justifying the order. Based on that information, the decision-support system provides a yield score ranging from one to nine. The score indicates the likelihood that the selected exam will yield valuable diagnostic or positive results for this set of clinical circumstances.

Following American College of Radiology appropriateness criteria, a score of one to three is considered low yield. The user is then given the opportunity to cancel the order or select a different examination. However, because medical support staff do not make clinical decisions, they are less likely to cancel or revise an order without additional clarification from the physician.

To address this problem, Massachusetts General Hospital instituted a rule preventing medical support staff from completing computerized orders for outpatient CT, MRI and nuclear medicine examinations that received low-yield decision support scores.

“We developed this strategy to encourage more clinician ‘hands-on’ use of the system,” said Vartan M. Vartanians, M.D., clinical research associate in the Department of Radiology at Massachusetts General Hospital in Boston. “With greater physician involvement, fewer low-yield exams are ordered.”

After the change, the proportion of total examination requests by physicians directly logging into the system more than doubled from 26 percent to 54 percent of the total number of requests, while the percentage of low-yield exams requested decreased from 5.4 percent of total number of requests to 1.9 percent of total requests.

“Physicians need to use the decision support system for it to be effective, but getting them to do so can be difficult,” Dr. Vartanians said. “Our work demonstrates that a minimally disruptive alteration in the radiology order entry system can encourage direct physician involvement, and improve patient care by reducing the number of low-yield examinations.”

Reference: “Increasing the Appropriateness of Outpatient Imaging: Effects of a Barrier to Ordering Low-Yield Examinations.” Collaborating on this paper with Dr. Vartanians were Christopher L. Sistrom, M.D., M.P.H., Jeffrey B. Weilburg, M.D., Daniel I. Rosenthal, M.D., and James H. Thrall, M.D. Radiology.

For more information: www.rsna.org

Related Content

LVivo EF Cardiac Tool Now Available for GE Vscan Extend Handheld Mobile Ultrasound
Technology | Cardiovascular Ultrasound | September 19, 2018
DiA Imaging Analysis Ltd. (DiA), a provider of artificial intelligence (AI)-powered ultrasound analysis tools,...
HealthMyne QIDS Platform Adds Cancer Screening Module
Technology | Clinical Decision Support | August 21, 2018
HealthMyne announced the release of Quantitative Imaging Decision Support (QIDS) 5 featuring a new, automated Cancer...
ACR LI-RADS Steering Committee Releases New Version of CT/MRI LI-RADS
News | Clinical Decision Support | August 13, 2018
August 13, 2018 — The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) steering commit
Aidoc Receives FDA Clearance for AI Detection of Acute Intracranial Hemorrhage
Technology | Clinical Decision Support | August 08, 2018
Aidoc announced that it was granted U.S. Food and Drug Administration (FDA) clearance for the first product of its...
Videos | Clinical Decision Support | August 03, 2018
Sheila Sferrella, president of Regents Health Resources and Bill Finerfrock, president of Capitol Associates, discuss
CT Decision Instrument Reliably Guides Pediatric Blunt Trauma imaging Decisions

This is a four-site prospective observational cohort. Image courtesy of Kirsty Challen, B.Sc., MBCHB, MRES, Ph.D., Lancashire Teaching Hospitals, United Kingdom.

News | Clinical Decision Support | July 18, 2018
A new study finds The Pediatric NEXUS Head Computed Tomography (CT) Decision Instrument (DI) reliably identifies blunt...
2019 Proposed Physician Fee Schedule Appropriate Use Criteria Summary
Feature | Clinical Decision Support | July 13, 2018 | Nathan Baugh
On July 12, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the 2019 Physician Fe
Guerbet, IBM Watson Health Partner on Artificial Intelligence for Liver Imaging
News | Clinical Decision Support | July 10, 2018
Guerbet announced it has signed an exclusive joint development agreement with IBM Watson Health to develop an...
Videos | Clinical Decision Support | March 22, 2018
Jonathan Teich, M.D., chief medical information officer for InterSystems, discusses the growth of clinical decision s
Siemens Healthineers Launches New Partners for Digital Ecosystem at HIMSS 2018
News | PACS Accessories | March 12, 2018
At the 2018 Healthcare Information and Management Systems Society (HIMSS) Annual Conference and Exhibition, March 5-9...