Abstract Details

Title Does the Ability To Incorporate Images from External Radiology Studies into an Electronic Health Record (HER) Change the Ordering Practices of Academic Neurologists and Neurosurgeons?

Topic Neurologic ��ɫ��

Presentation(s) S27 - (-)

Poster/Presentation
Number 005

Objective

Background Decreased ordering of diagnostic testing, with resultant increased patient satisfaction and reduced healthcare costs, has been put forth as a potential advantage of EHRs. One proposed mechanism for this is the capability to integrate external medical records, including radiology images, into EHRs. This is of particular importance for academic neurologists and neurosurgeons, as patients frequently present with external studies. In July 2011, we implemented external image integration into our EHR and trained clinicians in using this functionality.

Design/Methods We retrospectively analyzed all outpatient visits to our neurology and neurosurgery departments from June 2011 to July 2012 (37,758 visits). We determined the number of associated CT and MRI orders, normalized to the number of visits each month. We compared the rates of CT and MRI ordering before and after implementing external image integration into the EHR.

Results In the month pre-intervention, our clinicians ordered 1.39 CTs and 11.68 MRIs per 100 visits. Post-intervention, the average values increased substantially to 3.02±0.65 and 18.47±1.99 respectively. Among neurologists, there were increased CT orders (0.48 to 1.14±0.31) and MRI orders (11.48 to 15.63±1.19). Among neurosurgeons, CTs were unchanged (8.84 to 9.59±2.17) while MRIs increased (13.26 to 28.42±6.03). These trends were maintained throughout the year for both departments.

Conclusions Our results appear to contradict the conventional belief that clinicians with the ability to incorporate external images into their EHR order fewer diagnostic studies. Although not assessed, higher costs of care may have resulted from this increase in orders. The limited pre-intervention data is a potential source of bias; computerized order entry was implemented in these practices in May 2011 and data prior to that time would have been confounded by this different ordering method.

Authors/Disclosures
Jonathan Cheponis, MD (Lehigh Valley Health Network) PRESENTER	Dr. Cheponis has nothing to disclose.
Jun Sone, MD, PhD, FAAN (Aichi Medical University)	No disclosure on file
Allison L. Weathers, MD, FAAN (Cleveland Clinic)	Dr. Weathers has received personal compensation in the range of $500-$4,999 for serving as a CME question writer, interviewer, presenter with ��ɫ��. Dr. Weathers has a non-compensated relationship as a Chair, Neurology Adult Steering Board with Epic that is relevant to AAN interests or activities. Dr. Weathers has a non-compensated relationship as a Member, Quality Informatics Subcommittee with ��ɫ�� that is relevant to AAN interests or activities. Dr. Weathers has a non-compensated relationship as a Member of the NCP Editorial Board with ��ɫ�� that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
	No disclosure on file

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