Improving Cost-Efficiency, Safety in Hospitals via Imaging Clinical Decision Support

Imaging in hospitals can be very costly, both in terms of economic losses and patient safety risks. A study in the Journal of the American College of Radiology found that overall, imaging utilization in emergency departments increased 60 percent from 2000-2008. This growth in imaging increases not only the costs for the hospital but also the amount of radiation patients receive. In fact, in August The Joint Commission released a Sentinel Event Alert warning healthcare providers of the risk to patients of repeated diagnostic radiation doses. Steven Gerst, MD, vice president of medical affairs for MedCurrent, says decision support systems can help reduce unnecessary imaging, thereby improving hospitals' cost-efficiency and patient safety.

Physicians who refer patients to a hospital for imaging tests sometimes order tests that are duplicative or not the most appropriate based on American College of Radiology criteria, according to Dr. Gerst. The radiologist at the hospital would then have to speak with the physician to determine a more appropriate test. "What we tend to find is either because of traditional practice patterns or for medico legal purposes, many physicians go through a set of their own protocols [when ordering imaging tests], such that they may order a CT scan , when in fact, looking at the medical history, the best test may be an MRI," Dr. Gerst says.

Imaging clinical decision support would prevent inappropriate orders by providing referring physicians with evidence at the point of order, which is when the physician places an order within the electronic medical record. Physicians could place imaging orders in the computerized physician order entry platform based on evidence from the clinical decision support system. The CDS could use ACR, as well as criteria created by the organization within the CDS toolset, to guide physicians to the most cost-efficient and effective imaging test for each patient.

Physicians' imaging orders are not always based on clinical evidence, however. Oftentimes, physicians may order a slew of tests to protect themselves from lawsuits. CDS can mitigate this tendency because it documents physicians' orders and the accompanying evidence, creating a defense against potential legal issues. "From a medical/legal standpoint, the system should be able to track and provide an audit trail for all orders from [a] physician and should match up with the American College of Radiology criteria whenever possible," Dr. Gerst says. Furthermore, reducing the amount of imaging tests for each patient can lower the risk of accumulated radiation doses.

Learn more about MedCurrent.


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