SOAP Notes for Appropriate Imaging

Subjective

Currently the ordering process for medical imaging provides no support for decision-making, which results in over utilization and inappropriate ordering of diagnostic imaging procedures.

This adds unnecessary overhead on the Healthcare delivery system and adds direct imaging related costs and wasted time for all those involved in the care continuum.  This is especially undesirable in risk bearing models such as inpatients and ACO’s.

Inappropriate and unnecessary imaging results in misdiagnosis and/or delayed diagnosis.  This creates less favorable patient outcomes and patients may be exposed to unnecessary radiation and contrast.

Existing CPOE platforms do not allow for adequate data analysis.

Objective

As medical imaging has advanced, the complexity and number of imaging studies has grown exponentially.

Computer Physician Order Entry (CPOE) and system automation has become commonplace.

Direct consultation with radiologists is not routinely performed, yet it is unreasonable to expect providers to be familiar with the correct indication for all imaging studies.  The American College of Radiology (ACR) has published “appropriateness criteria”.   Recently the appropriateness criteria information can be integrated into a CPOE in the form of ACR Select.

ACR Select offers a national standard, and integration, which offers real-time, decision support for providers when ordering imaging studies.

Assessment

Providers need automated decision support when ordering imaging procedures.  Currently order entry decision support is non-existent in our CPOE.   Implementation of ACR Select decision support for imaging within CPOE improves patient outcome/quality of care, reduces unnecessary utilization, increases provider satisfaction, and creates analysis opportunities that are not possible with the current CPOE.

Plan

Enable ACR Select within the CPOE workflow. Include data capture and analytics to evaluate physician performance and effectiveness of point-of-order clinical decision support. Use this data to provide targeted intervention and counseling. Also, implement soft or hard stops for inappropriate orders to encourage or mandate consultation with radiology.

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