Curry L, Reed MH. "Electronic decision support for diagnostic imaging in a primary care setting."
Reference
Curry L, Reed MH. Electronic decision support for diagnostic imaging in a primary care setting. J Am Med Inform Assoc 2011 May-Jun; 18(3): 267–70.
Abstract
METHODS: Clinical guideline adherence for diagnostic imaging and acceptance of electronic decision support in a rural community family practice clinic was assessed over 36 weeks. Physicians wrote 904 diagnostic imaging orders, 58% of which were addressed by the Canadian Association of Radiologists guidelines. RESULTS: Of those orders with guidelines, 76% were ordered correctly; 24% were inappropriate or unnecessary resulting in a prompt from clinical decision support. Physicians followed suggestions from decision support to improve their diagnostic imaging order on 25% of the initially inappropriate orders. The use of decision support was not mandatory, and there were significant variations in use rate. Initially, 40% reported decision support disruptive in their workflow, which dropped to 16% as physicians gained experience with the software. CONCLUSIONS: Physicians supported the concept of clinical decision support but were reluctant to change clinical habits to incorporate decision support into routine workflow.
Objective
To use mixed methods approach to assess electronic decision support in diagnostic imaging in a rural community family practice. Specifically, will physicians incorporate decision-support technology into their clinical routines? And will physicians follow clinical advice when provided?
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
Small and/or medium
Geography
Rural
Other Information
Situated in rural Manitoba with 15-19 physicians; majority were family medicine doctors, 2 were surgeons.
Type of Health IT
Computerized provider order entry (CPOE)
Type of Health IT Functions
Two software systems: the CPOE and decision support system that incorporates the Canadian Association of Radiologists (CAR) Diagnostic Imaging Referral Guidelines were utilized. A project server on-site enabled decision support to interact with the clinic's EMR. Decision support communicated with the EMR and diagnostic imaging order entry via web-based handoffs among servers. The electronic interaction was almost instantaneous and eliminated the necessity of any patient data entry for decision support or diagnostic imaging order creation.
Context or other IT in place
EMR
Workflow-Related Findings
Physician workflow with electronic decision support and CPOE was documented - decision support would query all diagnostic imaging orders that contravened guidelines; each query routes would take time for the physician to read, consider and respond.
The largest challenge identified was perceived interference with usual workflows, specifically the interactivity between EMR and the CPOE decision support system. This interaction was perceived to be too slow, although it clocked at 1s. The time required to interact with decision support was also perceived to be too long. Initially 40% reported decision support disruptive in their workflow, which dropped to 16% as physicians gained experience with the software.
Study Design
Pre-postintervention (no control group)
Study Participants
Physicians practicing at the Steinbach Family Medicine Clinic - 16 physicians who used the CPOE and decision support at least once during the study period of 36 weeks.