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Computerized Physician Order Entry System with Clinical Decision Support Reduces Inappropriate Imaging

By MedImaging International staff writers
Posted on 13 Feb 2012

In an effort to reduce the inappropriate use of medical imaging and improve quality of care, a large, tertiary-care hospital has effectively implemented a computerized physician order entry (CPOE) system with clinical decision support for radiology.

The report’s findings were published in the February 2012 issue of the Journal of the American College of Radiology. Significant increases in meaningful use (for electronically created studies, from 0.4%-61.9%; for electronically signed studies, from 0.4%-92.2%) and the adoption of CPOE (from 0.5%-94.6%) were observed.

The meaningful use (MU) of healthcare information technology (IT) can improve patient safety, effectiveness, and the quality of care. Initial studies have showed that with decision support, the percentage of low-utility imaging studies may decrease by as much as 57%.

The study was performed in a healthcare delivery network with Brigham and Women's Hospital (Boston, MA, USA). After early testing and user feedback, a Web-enabled CPOE system with embedded imaging decision support was incorporated into clinical use between 2000 and 2010 across outpatient, emergency department, and in-patient settings.

A total of 4.1 million imaging studies were performed during the study period. The utilization of electronically created studies was greatest in the emergency department and in-patient settings. MU varied across specialties; surgical subspecialties had the lowest rates of electronically created studies.

“Our study shows that an imaging CPOE system with embedded decision support that is integrated into the healthcare enterprise IT infrastructure and the relevant electronic medical record platform and optimized within the clinicians’ workflow can be successfully and broadly accepted clinically,” said Ivan K. Ip, MD, MPH, lead author of the study. “Such an imaging CPOE system, if adopted and meaningfully used, could create an excellent platform for delivering real-time decision support to reduce inappropriate use of imaging, improve quality and reduce waste.”

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70 (466.10832214355): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (466.10832214355): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (88.930130004883): 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 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (391.96014404297): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 3576.9939422607): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (51.021575927734): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739257 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 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4229.0687561035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

105 (119.20928955078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

106 (62.942504882812): 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=294739257 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (66.995620727539): 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=294739257 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

109 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

110 (48.87580871582): 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=294739257 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (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_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=294739257 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (581.97975158691): 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 (417.94776916504): 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 (76.770782470703): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

115 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

116 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

117 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

118 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

119 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

120 (278.94973754883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 37908.07723999): 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

122 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

123 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

124 (407.93418884277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739257 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739257 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 845684.05151367): ( 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 (159.97886657715): ( 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 (58.889389038086): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (37.193298339844): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (56.982040405273): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (428.91502380371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (385.99967956543): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=216

136 (26.941299438477): SELECT name FROM jos_deeppockets WHERE id=216

137 (508.06999206543): 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 '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (483.03604125977): 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 '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

140 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

141 (!!!!! 14538.049697876): TRUNCATE TABLE jos_trademed_module

142 (360.96572875977): 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=294739257 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (602.96058654785): 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=294739257 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (545.02487182617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

147 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

148 (!!!!! 1387.8345489502): 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

149 (140.90538024902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

150 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

151 (!!!!! 2037.0483398438): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739257 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739257 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (105.85784912109): 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=216 or channel_id is null)

153 (61.988830566406): 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=216 or channel_id is null)

154 (81.062316894531): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (198.8410949707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

156 (116.82510375977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739257 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739257 AND published='1' LIMIT 1

157 (125.88500976562): select jos_twitters.link from jos_twitters where cat=10

158 (76.055526733398): select jos_facebook.link from jos_facebook where cat=10

159 (61.988830566406): select jos_google_plus.link from jos_google_plus where cat=10

160 (236.98806762695): select jos_linkedin.link from jos_linkedin where cat=10

161 (361.91940307617): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 3524.0650177002): insert into jos_banners_delta values (14615,'2025-06-19 08:14:48','216.73.216.120','view'),(14202,'2025-06-19 08:14:48','216.73.216.120','view'),(14203,'2025-06-19 08:14:48','216.73.216.120','view')

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