CDS tools can reduce ordering of imaging tests

Clinical decision support in electronic health records can cut down the amount of diagnostic radiologic imaging ordered, according to a new study in the Annals of Internal Medicine.

Over-testing increases healthcare costs, and in some cases provides no value to the patient or even causes harm. The study, funded in part by the Department of Veterans Affairs, conducted a review of 23 studies on the effect of clinical decision support (CDS) on diagnostic radiology test ordering in adults.

Of the 23 studies, 21 provided moderate quality evidence that EHR-based interventions can improve the appropriate use of diagnostic testing and reduce overall use by a small amount. There also was "low quality" evidence that interventions that include a "hard stop--prohibiting the ordering in certain instances and ordering in an integrated care delivery setting--may be particularly effective. Auditing and feedback may also help, but the studies did not provide sufficient data for that conclusion.

Other studies have found that CDS can be effective in reducing tests, lowering costs and improving patient care. However, these benefits don't necessarily occur in a vacuum, and redesign or other simple workflow changes can make a big difference in utilization and effectiveness.

The researchers also expressed concern at the limitations of the study. Not much has been published on this topic and what existed may have possible publication bias, they said. They also decried the lack of information on the harms of CDS and on the context and implementation of the studies.

"This lack of reporting of context and implementation, which is common to many studies of health IT, limits readers' ability to draw conclusions about effectiveness and may perpetuate the belief that these kinds of interventions can be developed separate from the workflow of practicing clinicians and then simply "turned on" with the expectation that clinicians will know how to use the intervention and use it correctly," they warned.

To learn more:
- read the study abstract