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  • February 2009

    Benefits of ROE and DS System on Outpatient Imaging

    Radiology | Christopher L. Sistrom, MD, MPH


    Effect of Computerized Order Entry with Integrated Decision Support on the Growth of Outpatient Procedure Volume: Seven-Year Time Series Analysis


    Christopher L. Sistrom, MD, MPH; Pragya A. Dang, MD; Jeffrey B. Weilburg, MD; Keith J. Dreyer, DO, PhD; Daniel I. Rosenthal, MD; James H. Thrall, MD


    Radiology 2009 – Published online before print, February 12, 2009


    In 2008, researchers from the University of Florida Health Center and Massachusetts General Hospital sought to determine the effect certain appropriateness criteria measures – specifically a computerized radiology entry (ROE) and decision support (DS) system – might have on the growth rates of outpatient CT, magnetic resonance (MR) imaging, and ultrasonography (US) procedures over time. Initially introduced in late 2001, the computerized ROE system was designed to assist physicians in making their decisions ordering high-cost imaging tests. Three years later, in 2004, DS was integrated into the original ROE system, providing physicians with a 1-9 appropriateness score for their diagnostic recommendation after clinical indications for the patient had been provided. Appropriateness scores were based on the existing American College of Radiology Appropriateness Criteria, supplemented with locally developed indication and procedure pairs when necessary. These additions were agreed upon by consensus panels of radiologists, primary care physicians and clinicians. Relevant data in the study included outpatient MR imaging, CT and US studies conducted from October 1, 2000, to December 31, 2007, as well as the total number of outpatient visits to the researchers’ facility over the same period of time. Statistical analysis was performed using SAS software.

    Statistical analysis showed significant benefits in controlling high-cost imaging growth rates with the implementation of a computerized ROE and DS system. The most noticeable procedural decrease was in annual outpatient CT growth (from 12% to 1%), followed by MR imaging (12% to 7%) and US (9% to 4%). These decreases occurred even as the growth rate of outpatient visits to the same facility increased steadily at compound annual growth rate of just under 5%. This study demonstrates the clear and immediate impact appropriateness measures can have on patient care, ensuring patients are receiving the right scan at the right time.

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