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Decision-Support System Results in Fewer Unnecessary Imaging Exams for Patients

By MedImaging International staff writers
Posted on 23 Jun 2010

A new rule preventing medical support staff from completing orders for outpatient imaging exams that were likely to be negative resulted in a noticeable decrease in low-yield exams for patients.

Many medical institutions request and schedule outpatient diagnostic imaging exams through use of web-based radiology order entry systems. Some systems offer real-time feedback, called decision support, on the appropriateness of the exams being ordered. When entering the desired examination into the system, the physician or support staff must also enter clinical information justifying the order. Based on that information, the decision-support system provides a yield score ranging from one to nine. The score indicates the probability that the selected exam will yield valuable diagnostic or positive results for this set of clinical circumstances.

Following American College of Radiology (Reston, VA, USA) appropriateness criteria, a score of one to three is considered low yield. The user is then given the opportunity to cancel the order or select a different examination. However, because medical support staff do not make clinical decisions, they are less likely to cancel or revise an order without additional clarification from the physician.

To address this problem, Massachusetts General Hospital (MGH; Boston, MA, USA) instituted a rule preventing medical support staff from completing computerized orders for outpatient computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine examinations that received low-yield decision support scores.

"We developed this strategy to encourage more clinician ‘hands-on' use of the system,” said Vartan M. Vartanians, M.D., clinical research associate in the department of radiology at Massachusetts General Hospital. "With greater physician involvement, fewer low-yield exams are ordered.”

After the change, the proportion of total examination requests by physicians directly logging into the system more than doubled from 26-54% of the total number of requests, while the percentage of low-yield exams requested decreased from 5.4% of total number of requests to 1.9% of total requests.

"Physicians need to use the decision-support system for it to be effective, but getting them to do so can be difficult,” Dr. Vartanians said. "Our work demonstrates that a minimally disruptive alteration in the radiology order entry system can encourage direct physician involvement, and improve patient care by reducing the number of low-yield examinations.”

The study was published June 2010 issue of the journal Radiology.

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66 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

67 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

68 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE id=294729936 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294729936 AND published='1' LIMIT 1

69 (32.901763916016): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

70 (184.05914306641): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (139.95170593262): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (956.05850219727): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (35.04753112793): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (50.783157348633): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

105 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

106 (454.90264892578): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294729936 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (318.76564025879): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294729936 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

109 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

110 (265.12145996094): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294729936 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (325.20294189453): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294729936 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (555.99212646484): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 2526.0448455811): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (185.01281738281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

115 (99.18212890625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

116 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

117 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

118 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

119 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

120 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

121 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

122 (207.90100097656): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 37303.20930481): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 3892.8985595703): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729936 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729936 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 15928.030014038): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 1947.1645355225): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (229.1202545166): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (!!!!! 3628.0155181885): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (232.93495178223): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (84.161758422852): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (128.03077697754): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (34.809112548828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (111.10305786133): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (272.98927307129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (391.00646972656): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (118.97087097168): SELECT name FROM jos_deeppockets WHERE id=215

138 (91.075897216797): SELECT name FROM jos_deeppockets WHERE id=215

139 (539.06440734863): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (514.98413085938): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (256.06155395508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

142 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

143 (!!!!! 3028.8696289062): TRUNCATE TABLE jos_trademed_module

144 (398.87428283691): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294729936 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (138.99803161621): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294729936 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (370.02563476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1145.1244354248): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

149 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

150 (!!!!! 1236.9155883789): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

152 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

153 (32.186508178711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729936 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729936 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (29.087066650391): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

155 (27.179718017578): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

156 (37.908554077148): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

158 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729936 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729936 AND published='1' LIMIT 1

159 (122.0703125): select jos_twitters.link from jos_twitters where cat=10

160 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

161 (25.98762512207): select jos_google_plus.link from jos_google_plus where cat=10

162 (26.941299438477): select jos_linkedin.link from jos_linkedin where cat=10

163 (321.86508178711): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

164 (!!!!! 5186.7961883545): insert into jos_banners_delta values (14202,'2025-06-21 01:02:48','216.73.216.120','view'),(14203,'2025-06-21 01:02:48','216.73.216.120','view')

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