Using Digital Health to Support Best Practices: Impact of MRI Ordering Guidelines Embedded Within an Electronic Referral Solution.

BACKGROUND

Between 2003 and 2012, the number of MRIs performed in Canada more than doubled to 1.7 million [1]. According to a 2010 Health Council of Canada report nearly 30% of MRIs were inappropriately ordered [2]. The use of diagnostic imaging referral guidelines has been shown to improve the appropriateness of imaging orders [3, 4].

OBJECTIVES

To identify the number of unnecessary pre-consult MRIs ordered for patients with knee pain. As well, the impact that new evidence-based clinical decision support (DS) guidelines embedded within the referral form has had on the number of unnecessary MRIs was investigated.

METHODS

This study employed a retrospective design approach. Charts of all knee pain patients over the age of 55 who were referred for consultation to the 5 participating orthopedic surgeons during the study period were reviewed by three medical students.

RESULTS

270 patient charts were included in this study. MRI was ordered for 60 patients with only 56.7% having had a prior X-ray. Of the 60 ordered MRIs, 50 (84%) were considered inappropriate, while only 10 (16%) were appropriate. Our results were compared to previous results of a quality improvement study implemented at the same clinic. A substantial reduction of 12% in the number of pre-consult MRIs and a 5% increase in the number of ordered X-rays before consultation was demonstrated.

CONCLUSION

This work highlights the impact of including DS tools within an electronic referral form to support clinical best practices.