Moriarity Andrew K, Green Aaron, Klochko Chad, O'Brien Matthew, Halabi Safwan
Advanced Radiology Services, Grand Rapids, Michigan; Division of Radiology and Biomedical Imaging, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Wayne State University School of Medicine, Detroit, Michigan.
J Am Coll Radiol. 2017 Jun;14(6):737-743. doi: 10.1016/j.jacr.2017.02.003. Epub 2017 Apr 21.
To determine the appropriateness rating (AR) of advanced inpatient imaging requests that were not rated by prospective, point-of-care clinical decision support (CDS) using computerized provider order entry.
During 30-day baseline and intervention periods, CDS generated an AR for advanced inpatient imaging requests (nuclear medicine, CT, and MRI) using provider-selected structured indications from pull-down menus in the computerized provider order entry portal. The AR was only displayed during the intervention, and providers were required to acknowledge the AR to finalize the request. Subsequently, the unstructured free text information accompanying all requests was reviewed, and the AR was revised when possible. The percentage of unrated requests and the overall AR, before and after radiologist review, were compared between periods and by provider type.
CDS software prospectively generated an AR for only 25.4% and 28.4% of baseline and intervention imaging requests, respectively; however, radiologist review generated an AR for 82.4% and 93.6% of the same requests. During the respective periods, the percentage of baseline and intervention imaging requests considered appropriate was 18.7% and 22.9% by prospective CDS software rating and increased to 82.4% and 88.7% with radiologist review.
Despite limited effective use of CDS software, the percentage of requests containing additional, relevant clinical information increased, and the majority of requests had overall high appropriateness when reviewed by a radiologist. Additional work is needed to improve the amount and quality of clinical information available to CDS software and to facilitate the entry of this information by appropriate end users.
确定使用计算机化医嘱录入系统的前瞻性即时临床决策支持（CDS）未评级的住院患者高级影像检查申请的适宜性评级（AR）。
在为期30天的基线期和干预期内，CDS使用计算机化医嘱录入门户下拉菜单中提供者选择的结构化指征，为住院患者高级影像检查申请（核医学、CT和MRI）生成AR。AR仅在干预期间显示，提供者需要确认AR才能完成申请。随后，对所有申请附带的非结构化自由文本信息进行审查，并在可能的情况下修订AR。比较不同时期和不同提供者类型在放射科医生审查前后未评级申请的百分比和总体AR。
CDS软件分别仅对25.4%和28.4%的基线期和干预期影像检查申请前瞻性地生成了AR；然而，放射科医生审查为相同申请中的82.4%和93.6%生成了AR。在各时期，前瞻性CDS软件评级认为合适的基线期和干预期影像检查申请的百分比分别为18.7%和22.9%，经放射科医生审查后分别增至82.4%和88.7%。
尽管CDS软件的有效使用率有限，但包含额外相关临床信息的申请百分比有所增加，并且放射科医生审查时大多数申请的总体适宜性较高。需要开展更多工作来改善CDS软件可用临床信息的数量和质量，并促进合适的最终用户录入这些信息。
