Clinical decision support in EHR helps reduce low-value imaging

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The use of clinical decision support software can help young physicians more appropriately order imaging studies, reducing the number of studies they order that have minimal benefit to the treatment process.

In a recently published study, medical residents and fellows benefitted the most from the use of clinical decision support in ordering imaging examinations, said researchers from the University of Virginia.

Providers who followed the criteria on the appropriateness of imaging requests—guidance on which was integrated into the organization’s electronic health records system—ordered 50 percent fewer “low utility” studies that would not aid clinicians in diagnosing conditions. On the plus side, the rate of ordering appropriate imaging studies rose to more than 80 percent. Results of the study were published in the May 25 online version of the Journal of the American College of Radiology.

The findings are important for organizations that increasingly will be pressured by value-based care initiatives to reduce the number of unnecessary imaging exams. In addition to direct financial costs, inappropriate studies are expected to come under increasing pressure from federal payers—for example, the Centers for Medicare and Medicaid Services expects to start a program in 2020 that would require physicians to use “appropriate use” criteria to order certain kinds of advanced diagnostic imaging. Under the program CMS will review adherence to defined priority clinical areas—eight of which have been finalized—to identify outliers. The intent of the initiative is to aim to reduce diagnostic imaging expenditures by using industry-developed criteria to order studies.

For the University of Virginia study, it adopted in 2014 a version of the ACR’s CDS platform and integrated it into its Epic electronic health record software. After a transition period, referring providers began receiving feedback when entering orders, and that resulted in the reduction of low-value studies, while the number of CDS-indicated studies rose.

“The goal of this study was to determine the impact of commercially available CDS on the ordering habits of inpatient and emergency providers,” wrote Timothy Huber, MD, in the published study. “After implementation of a commercially available decision support tool integrated into the electronic health record, there was a significant improvement in imaging study appropriateness scores, (which was) more pronounced in studies ordered by trainees.”

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