The Impact of a Single CDS Tool

It just takes one to make a difference. That is, a single clinical decision support (CDS) rule that can make an impact on patient safety, radiology department operational efficiency, and – oh, yes – ordering physicians’ and hospital administration’s perception of the value of having a radiology CDS.

Just ask Dr. Daniel R. Karolyi, a vice chairman of radiology at the seven hospital enterprise Carillion Clinic headquartered in Roanoke, Va. The schedulers of MRI exams were not identifying in advance all of the patients with pacemakers or implanted defibrillators. Safety wasn’t the biggest concern, because the MRI technologists were intervening. But patients were getting peeved because they would arrive for their scheduled exam, only to be turned away because the necessary personnel (an electrophysiologist and a device representative) hadn’t been notified and weren’t on site. The delays to reschedule patients were annoying referring physicians and potentially compromising timely treatment planning for these patients. And in every such incident, a time slot to perform a MRI scan would be wasted, impacting the efficiency of the radiology department. The situation dissatisfied everyone.

The problem was accelerating because the number of patients with MR-conditional pacemakers was increasing. The department decided to create a CDS code that would alert ordering physicians about the need to contact the radiology department when they wished to order a MRI exam. The hospital wrote the software for the rule, which was integrated with its electronic medical record system.

When a physician ordered a MRI scan for any patient, the tool triggered an automated search of the patient’s records for any one of 295 diagnostic codes related to implanted pacemakers and defibrillators. If one was identified, a warning message would display advising the physician to call a specific telephone number manned by a MRI technologist. At that point, a radiologist could discuss other imaging options with the ordering physician. Or, if the physician still wanted to schedule the exam, the additional individuals who needed to be present could also be scheduled.

The hospital launched the rule in July 2014. Dr. Karolyi presented the results of comparing the prior six months of ordering patterns with the first six months of deployment of the CDS tool at the recent 2015 American College of Radiology (ACR) seminar. In this short time, the rule proved to be very effective. CLICK HERE to read the findings that Dr. Karolyi presented and to see a screen shot of the warning notice, published online by Applied Radiology.

This example shows how the implementation of one well-thought out rule provides a tangible beneficial impact to multiple entities, in this case, the hospital, the patient, the referring physician, and the radiology department in multiple ways -- safety, goodwill, and operational efficiencies. It serves as an example of how other rules are intended to work when formal implementation of a CDS system becomes mandatory in January 2017.